Characterization of cognitive dysfunction in Sjögren’s syndrome patients

Abstract

Sjögren's syndrome is an autoimmune disorder primarily affecting women, with decreased saliva and tear production as the principal characteristic. Cognitive, neurological, and psychiatric disorders also are associated with Sjögren's. The present study addressed the hypothesis that patients with Sjögren's syndrome differ significantly from matched controls in the prevalence and impact of a number of neuropsychiatric abnormalities. Sjögren's patients and controls (n = 37 per group) underwent medical and psychiatric evaluation, demographic assessments, quality of life and symptom evaluation, and extensive testing of cognitive function and memory. Patients and controls were closely matched for age, gender distribution, verbal IQ, marital status, educational level, employment status, and current/past medical or psychiatric history. On most subjective self-ratings, Sjögren's patients reported greater fatigue, impaired physical functioning, feeling depressed, and autonomic symptomatology compared to controls. Impaired memory was described mainly as loss of thought continuity in the midst of a task or activity. However, the majority of objective measures of cognition, psychomotor function, and memory showed minimal differences between groups. Sjögren's patients rate themselves as impaired on multiple ratings of emotional, cognitive, and physical function, but objective measures of cognition reveal fewer substantive differences between patients and matched controls. Sjögren's patients perceive deteriorated physical function over time, but they achieve a level of functioning comparable to controls despite the burden of their illness.

Impact of pain on cognitive functions in primary Sjögren syndrome with small fiber neuropathy

“…The main goals of these studies were (1) to explore general neurological complications, [5–7,11]  (2) to study the relation between brain imaging and cognitive impairment, [8,12,15–17,43]  (3) to assess the impact of clinical features on cognition, [9,18,44]  (4) to follow the evolution of cognitive disorders, [45]  (5) to describe a study case, [14]  (6) to analyze the difference between lupus and pSS, [10] and (7) to adapt a test of cognitive complaint for pSS. [13] Overall, 473 pSS patients were explored and a fronto-sub-cortical alteration with attentional, executive, memory and visuo-spatial disorders was described.…”

“…However, the prevalence of the cognitive impairment was highly variable in the studies probably due to heterogeneity of patient populations and to analytical factors. On the one hand, patient selection was based on pSS criteria including patients with variable extraglandular manifestations associated or not with cognitive disorders and on the other hand, analytical strategies were variable: 11 studies carried out group analyses compared to control groups, [8–10,12,13,15,16,18,43–45] 12 studies compared patient's performances to normative data, [5–12,15–17,43] whereas 6 reports gave a specific cut-off to define a cognitive impairment. [6,9,10,12,15,43] …”

“…Pain is a major clinical symptom of pSS; however, with only 3 studies, the impact of pain on cognition seems underexplored [9,12,13] comparatively to depression (12 studies) [6–10,12,13,16,18,43–45] and fatigue (8 studies). [8–10,12,13,18,44,45] In these 3 studies on pain, Segal et al found discordant results.…”

“…Usually, pSS patients report abnormal concentration abilities relating difficulties to follow a conversation, to find the proper words, to finish what they are doing or to forget what they are looking for. [18] The observed cognitive profile is characteristic of a fronto-subcortical alteration with memory, attention, and executive disorders. [7,9,16,17,19] Similar cognitive deficits can be observed in chronic pain [20,21] ; however, little is known about the potential synergic impact of pain associated with pSS.…”

Validation of the Brief Cognitive Symptoms Index in Sjögren Syndrome

“…Prospective data regarding cognitive disorders in SS is limited 9,10,11,12,13,14 . A validated screening questionnaire could be a useful adjunct to formal neuropsychometric testing; however, the relationship between subjective memory complaints and cognitive impairment is inconsistent.…”