Aim: To describe the prevalence of cognitive impairment and the most affected cognitive domains, employing the Montreal Cognitive Assessment (MoCA) and the Automated Neuropsychological Assessment Metrics (ANAM) of a Latin American primary Sjögren's syndrome (pSS) cohort, and compare these patients to secondary Sjögren's syndrome (sSS) subjects and controls. Methods: This was a comparative cross-sectional study of patients with a diagnosis of pSS who fulfilled the American-European Consensus Group 2002 criteria and/ or American College of Rheumatology/European League Against Rheumatism 2016 criteria; clinical information was evaluated prior to cognitive evaluation, which consisted of a single session in which the MoCA and ANAM were applied. Results: A total of 122 subjects were included in the analysis (51 pSS, 20 sSS and 51 controls); mean age of pSS was 56 years (SD 10.4), of which 47 (92.15%) were women. Moderate-severe cognitive impairment by MoCA was 17% in pSS, 5% in sSS, and 15% in controls, and by ANAM were 29% in pSS and 10% in sSS (P > .05). Visuospatial/ executive subdomain in the MoCA was different between the pSS and the control group (P = .005). We encountered a statistically significant difference between pSS patients and control scores from the program in 6 of the 7 domains tested by the ANAM. Conclusion: No difference was found in the prevalence of cognitive impairment between pSS subjects and controls by MoCA. Several subdomain scores differed between groups in both scales. Evaluation of cognitive disorders in patients with SS, even in early stages of the disease, seems advisable but the best strategy is yet to be elucidated. How to cite this article: Riega-Torres JCL, Treviño-Castro MA, Hernandez-Galarza IDJ, et al. Cognitive dysfunction in Sjögren's syndrome using the Montreal Cognitive Assessment Questionnaire and the Automated Neuropsychological
Background:Primary Sjögren’s syndrome (pSS) and systemic lupus erythematosus (SLE) share several clinical manifestations including neurological involvement. Cognitive dysfunction is a common neuropsychiatric manifestation in both, but evaluation and diagnosis is often challenging and delayed. The Automated Neuropsychological Assessment Metrics (ANAM) is a computerized cognitive screening tool that does not need specialized personnel to apply and is less time consuming than other tests.Objectives:Assess cognitive function of SLE and pSS patients with a computer-based tool (ANAM) in a single rheumatology clinic, compare its performance, and record their clinical and demographic characteristicsMethods:We recruited patients from the rheumatology clinic of the UANL University Hospital who met the pSS 2002 AECG or ACR-EULAR 2016 classification criteria and SLE patients fulfilling SLICC 2012 criteria. We defined mild cognitive impairment as 1 to 1.9 SD below controls, and moderate-severe cognitive impairment as 2 SD or more below the comparison group (subjects matched by age, sex, ethnicity and educational level by the ANAM program) as previously employed in SLE.Percentages were used for categorical variables and means (±SD) for numerical ones. To observe differences between groups, chi square and Student´s t were used,p<0.05 was considered significant.Results:A significant difference was observed in the total ANAM score between SLE and pSS patients (Table 1). In SLE, the most affected domains were simple reaction time, code substitution and delayed memory; in pSS patients, the most affected domains were inhibition and spatial work memory (Table 2).Table 1.Differences in ANAM performance between pSS and SLE.VariablepSSmean, (SD)SLEmean, (SD)pFemale, %92.293.50.77Age (years)56.25 (10.45)31.99 (13.17)0.001Disease duration (years)6.38 (6.15)5.61 (6.1)0.492ANAM total score-1.43 (0.85)-1.87 (0.96)0.008Simple reaction time25.554.50.001Simple reaction time score148.39 (32.44)144.13 (52.37)0.571Code substitution (Learning)13.79.10.411Code substitution (Learning) score33.39 (8.42)38.61 (14.23)0.001Procedural reaction time-Attention15.727.30.125Procedural reaction time-Attention score70.29 (12.11)73.17 (17.68)0.277Mathematical processing11.8130.838Mathematical processing score17.92 (11.07)15.57 (6.63)0.177Matching to sample-spatial work memory21.67.80.025Matching to sample-spatial work memory score20.08 (7.66)22.26 (8.72)0.139Code substitution-delayed memory15.77.80.161Code substitution-delayed memory score26 (11.57)33.69 (18.99)0.005Simple reaction time21.632.90.165Simple reaction time score148.88 (24.82)166.29 (38.87)0.004Go/No-Go, Inhibition21.65.20.005Go/No-Go, Inhibition score3.41 (1.573.27 (1.68)0.635Conclusion:Cognitive impairment was common in both diseases but the cognitive domains affected were different. Rheumatologists should be aware of these differences when evaluating cognitive dysfunction in SLE and pSS patients.References:[1]Kurtuluş F, Çay H, Parlak E, Yaman A. Montreal cognitive assessment in primary sjogren’s syndrome. A brief screening tool. Neurosciences. 2019;24(3):199-206.[2]Tayer-Shifman O, Green R, Beaton D, Ruttan L, Wither J, Tartaglia M et al. Validity evidence supports the use of automated neuropsychological assessment metrics as a screening tool for cognitive impairment in lupus. Arthritis Care & Research. 2019;.Disclosure of Interests:None declared
Background:Neurological symptoms are common in primary Sjögren’s syndrome (pSS) with a prevalence of 8.5 to 70%, focusing on cognitive impairment, information in pSS is scarce.Many neuropsychological tests are used to diagnose cognitive impairment. The Montreal Cognitive Assessment (MoCA) is a validated, practical, and reliable instrument for screening mild cognitive impairment.Objectives:To evaluate the prevalence of cognitive impairment with the MoCA test in pSS and compare it with controls.Methods:Patients of a rheumatology clinic in Northeastern Mexico were recruited, who met the pSS AECG 2002 or ACR-EULAR 2016 classification criteria. Controls, matched by demographic characteristics were included for comparison. All subjects took the MoCA. The test has a range of 0-30 points, the highest score reflects better cognitive function, and explores 6 cognitive domains (Table 2).Table 1.Demographic and clinical characteristics≤ 9 years of education≥10 years of educationGroupNmean, SD1Min-maxp-valuenmean, SD1Min-maxp-valueMoCA totalpSS1725.65 (2.17)20 - 290.2484626.67 (2.27)20 - 300.3Control1424.36 (3.85)17 - 303627.22 (2.24)21 - 30VisuospatialpSS173.76 (0.9)1 - 50.505464.17 (1.03)2 - 50.056Control144.07 (1.59)0 - 5364.58 (0.87)2 - 5NamingpSS172.82 (0.39)2 - 30.831462.96 (0.2)2 - 30.711Control142.79 (0.57)1 - 3362.97 (0.16)2 - 3Deyaled recallpSS173.06 (1.34)1 - 50.251463.48 (1.31)0 - 50.921Control142.43 (1.65)0 - 5363.44 (1.68)0 - 5AttentionpSS175 (0.79)3 - 60.041465.37 (0.77)4 - 60.285Control144.29 (1.06)3 - 6365.53 (0.56)4 - 6AbstractionpSS171.71(0.68)0 - 20.464461.89 (0.31)1 - 20.79Control141.86 (0.36)1 - 2362 (0.23)1 - 3OrientationpSS176 (0)6 - 60.999465.93 (0.25)5 - 60.083Control146 (0)6 - 6366 (0)6 - 6LanguagepSS172.41(0.71)1 - 30.741462.61 (0.57)1 - 30.878Control142.5 (0.76)1 - 3362.58 (0.84)0 - 31SD: Standard deviationWe defined mild cognitive impairment as a score <26 and moderate-severe cognitive impairment as a score <24 as previously determined in Mexican population.Results:Demographic and clinical characteristics are described in Table 1. Mild cognitive impairment was present in 13 (25.4%) in pSS group versus 14 (27%) in control group. Moderate-severe cognitive impairment was present in 9 (17%) of pSS group versus 8 (15%) in control (p> 0.05).Table 2.MoCA subtest analysis by years of education in pSS and control group.CharacteristicspSSn=51Controln=51Age, Mean (SD)56 (10.4)54 (14)SexFemale n (%)47 (92.15)48 (94)Male n (%)4 (7.85)3 (7.3)Disease duration (years), mean (SD)6.38 (6.15)ESSPRI mean (SD)4.94 (2.28)Years of education, median (q25-q75)13 (10-17)12 (10-15)Employment, mean (%)19 (37)29 (56)Results of the individual domains and comparison between groups are shown in Table 2. Attention was lower in the pSS group with ≤9 years of education compared to the control group (p <0.05).Conclusion:We did not found a difference in the prevalence of cognitive impairment, either mild or moderate-severe, in pSS subjects with low disease duration versus controls by MoCA. We found a lower attention score in the pSS group with less than 10 of years of education.The combination of neuropsychological examining and imaging techniques, such as SPECT or brain MRI, seem a more sensitive way to detect cognitive impairment in earlier stages.References:[1]Manzo, C., Martinez-Suarez, E., Kechida, M., Isetta, M. and Serra-Mestres, J. (2019). Cognitive Function in Primary Sjögren’s Syndrome: A Systematic Review. Brain Sciences, 9(4), p.85.[2]Aguilar-Navarro S, Mimenza-Alvarado A, Palacios-García A, Samudio-Cruz A, Gutiérrez-Gutiérrez L, Ávila-Funes J. Validez y confiabilidad del MoCA (Montreal Cognitive Assessment) para el tamizaje del deterioro cognoscitivo en méxico. Revista Colombiana de Psiquiatría. 2018;47(4):237-243.Disclosure of Interests:None declared
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