Cognitive Functions Associated with Brain Imaging Markers in Patients with Psoriasis

Abstract

Psoriasis is a severe inflammatory disease associated with a higher comorbidity of depression, cognitive dysfunction and brain atrophy. The association between psoriasis, magnetic resonance imaging (MRI) markers and cognitive impairment has rarely been investigated, and the existing results are conflicting. Methods. This study included 89 subjects (53 patients with psoriasis and 36 healthy controls). The severity of psoriasis was evaluated using the Psoriasis Area and Severity Index (PASI) score; for depression, the Hospital Anxiety and Depression Scale (HADS) scale was used. Neuropsychological tests were also applied, including a Trail Making Test (TMT) as well as Digit Span, Stroop, Verbal Fluency and Rey Auditory Verbal Learning tests. MRI scans were performed using a 1.5 T scanner. Brain volumetry, white matter lesions, grey matter and white matter were evaluated. The extent of these changes was assessed on the Fazekas scale. The differences between groups were evaluated using a Student’s t-test and a Mann-Whitney U test, and a Pearson correlation analysis was also performed. Results. Patients with psoriasis presented worse achievements on all the neuropsychological tests and showed more intense changes on MRI compared to healthy controls. The severity of psoriasis as determined by PASI scores was associated with depression, and a greater psychomotor slowness severity of changes in the brain was associated with poorer results on the neurological tests. Conclusions. Our results indicate the possibility of progressive brain atrophy related to cognitive decline in psoriasis.

Altered brain activity and cognitive impairment in patients with psoriasis

“…Our results showed diminished cognitive functions in various domains for processing speed, attention, memory and executive function in patients with psoriasis, which is supported by prior studies. 7,9,10,12,[34][35][36] A prior study also identified an association between cognitive impairment and depression. 37 However, our study showed no association between cognitive decline and depression (GAD7), anxiety (PHQ9) or sleep quality (PSQI) scores.…”

“…We found the clinical severity indicators of psoriasis especially the PASI score being significantly correlated with cognitive testing scores, which was generally in line with a prior study. 34 Psoriasis and cognitive impairment have been linked through the chronic inflammation process 38,39 and aberrant immune response. 11 In addition, a more severe status of psoriasis may be associated with a greater risk of comorbidities such as cardiovascular disease, diabetes, obesity, etc., 40 which were high-risk factors for cognitive impairment.…”

Association between skin disease and anxiety: a logistic analysis and prediction

“…A few studies have analyzed the psychological status of middle-aged and young patients with dermatosis; generally, young patients pay more attention to appearance, and their emotional state is more linked to changes in appearance ( 20 ). It was reported that old patients with skin pruritus mostly showed type A behavior, who were prone to being nervous and anxious, and were not able to cope with this situation ( 21 , 22 ). Pruritus is an unpleasant feeling of the skin or mucous membrane that causes a desire to scratch.…”

Psoriatic arthritis of the temporomandibular joint: A systematic review

“…PsA is found in one out of every five psoriasis patients, and the joints such as elbows, knees, scalp, lumbosacral areas, intergluteal clefts and glans penis are affected in up to 30% of patients 6 . Psoriasis is also linked to an increased risk of depression, cognitive impairment and brain atrophy 7 …”

“…6 Psoriasis is also linked to an increased risk of depression, cognitive impairment and brain atrophy. 7 Psoriatic arthritis (PsA) belongs to a group of rheumatological disorders characterised by a variety of clinical symptoms and pathologies that can impair a patient's quality of life. 8 This inflammatory arthritis is a heterogeneous, chronic, inflammatory musculoskeletal condition that destroys function towards the peripheral and axial joints, with no universally accepted classification or diagnostic criteria for axial involvement in PsA, and no agreement on treatment paradigms, increasing the difficulty of PsA management.…”