Cognitive impairment in patients with rheumatoid arthritis

Vitturi, Bruno Kusznir; Nascimento, Bruno Azeredo Coutinho; Alves, Beatriz Rizkallah; Campos, Felipe Sobolewski Carneiro de; Torigoe, Dawton Yukito

doi:10.1016/j.jocn.2019.08.027

Cited by 42 publications

(24 citation statements)

References 57 publications

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“…Previously, functional limitations have already been linked with cognitive function in rheumatic diseases. 7 Apart from HAQ, we did not identify any other predictor of cognitive decline, despite evaluating a wide range of variables. This fact may perhaps be better evaluated in longitudinal multicenter studies involving a large number of patients.…”

Section: Discussionmentioning

confidence: 60%

“…However, it is increasingly recognized that autoimmune rheumatological diseases can be accompanied by cognitive dysfunction, with demographic factors, medical comorbidities, and medical treatment acting as potential risk factors. 6,7 One hypothesis for dementia in AS is the neurodegeneration caused by systemic inflammation. 8 Long-term or high-dose treatments with antiinflammatory drugs are commonly used in rheumatic diseases and may decrease the volume of the hippocampus, causing cognitive impairment as well.…”

Section: Introductionmentioning

confidence: 99%

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Cognitive Impairment in Patients with Ankylosing Spondylitis

Vitturi

Suriano

Sousa

et al. 2020

Can. J. Neurol. Sci.

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ABSTRACT:Background:Little is known about the potential systemic effects of ankylosing spondylitis (AS) on the nervous system. We designed a study aiming to assess the frequency and clinical predictors of cognitive impairment in AS patients.Methods:We carried out a cross-sectional case–control study composed of consecutive patients with AS. Trained and blinded interviewers registered clinical-epidemiological data and applied a standardized neurological assessment for each subject of the study. At baseline, functional limitations were characterized using the Health Assessment Questionnaire. Cognitive impairment was evaluated with the Brief Cognitive Screening Battery, the Montreal Cognitive Assessment, and the Clinical Dementia Rating, while neuropsychiatric symptoms were investigated with the Hospital Anxiety and Depression Scale. Healthy controls were matched for age, educational attainment, sex, and comorbidities. We compared the neurological outcomes between case and controls, and we determined the clinical predictors of cognitive decline.Results:We included 40 patients (mean: 49.3 years) with AS and 40 healthy controls (mean: 48.8 years) in our study. In Brief Cognitive Screening Battery, patients with AS presented a statistically significant poor performance in the clock drawing test and in the verbal fluency. The mean Montreal Cognitive Assessment (MoCA) scores were significantly lower in AS subjects compared to the control group. Also, the prevalence of subjects classified as cognitively impaired according to MoCA was significantly higher in the AS group (90.0% vs. 57.5%, p = 0.02). Moreover, neuropsychiatric symptoms were more prevalent in AS patients. Worse functional limitations were associated with poor cognitive performance as well.Conclusions:Patients with AS might be more vulnerable to cognitive decline.

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Section: Discussionmentioning

confidence: 60%

Section: Introductionmentioning

confidence: 99%

Cognitive Impairment in Patients with Ankylosing Spondylitis

Vitturi

Suriano

Sousa

et al. 2020

Can. J. Neurol. Sci.

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“…Interestingly, Vitturi et al reported RA patients demonstrate evidence of cognitive impairment independent of canonical AD mechanisms earlier in life: RA patients scored significantly lower in MMSE and MoCA cognitive performance assessments relative to healthy controls (p < 0.001). General neuropsychiatric impairment was also found to be more prevalent in RA patients (59.5%) than in age-matched controls (17.1%; p < 0.001) (Vitturi et al, 2019). A recent systematic review recapitulated these findings and found that RA patients-predominantly womenexhibit significantly lower scores in attention, concentration, memory, and verbal function than age-matched controls.…”

Section: Relation To Admentioning

confidence: 92%

The Role of Chronic Inflammatory Bone and Joint Disorders in the Pathogenesis and Progression of Alzheimer's Disease

Culibrk

Hahn

2020

Front. Aging Neurosci.

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Late-onset Alzheimer's Disease (LOAD) is a devastating neurodegenerative disorder that causes significant cognitive debilitation in tens of millions of patients worldwide. Throughout disease progression, abnormal secretase activity results in the aberrant cleavage and subsequent aggregation of neurotoxic Aβ plaques in the cerebral extracellular space and hyperphosphorylation and destabilization of structural tau proteins surrounding neuronal microtubules. Both pathologies ultimately incite the propagation of a disease-associated subset of microglia—the principle immune cells of the brain—characterized by preferentially pro-inflammatory cytokine secretion and inhibited AD substrate uptake capacity, which further contribute to neuronal degeneration. For decades, chronic neuroinflammation has been identified as one of the cardinal pathophysiological driving features of AD; however, despite a number of works postulating the underlying mechanisms of inflammation-mediated neurodegeneration, its pathogenesis and relation to the inception of cognitive impairment remain obscure. Moreover, the limited clinical success of treatments targeting specific pathological features in the central nervous system (CNS) illustrates the need to investigate alternative, more holistic approaches for ameliorating AD outcomes. Accumulating evidence suggests significant interplay between peripheral immune activity and blood-brain barrier permeability, microglial activation and proliferation, and AD-related cognitive decline. In this work, we review a narrow but significant subset of chronic peripheral inflammatory conditions, describe how these pathologies are associated with the preponderance of neuroinflammation, and posit that we may exploit peripheral immune processes to design interventional, preventative therapies for LOAD. We then provide a comprehensive overview of notable treatment paradigms that have demonstrated considerable merit toward treating these disorders.

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“…10 Most of the cognitive assessment tools administered to RA patients are basic cognitive screening tests such as the Mini-Mental State Examination (MMSE), 11 or the Montreal Cognitive Assessment. 12 Although useful to assess global impairment or to eliminate associated conditions such as dementia, these instruments lack the sensitivity and objectivity needed to identify more subtle, subclinical signs of impairment.…”

Section: Introductionmentioning

confidence: 99%

<p>A Computerized Assessment of Verbal and Visuospatial Memory (Dys)functions in Patients with Rheumatoid Arthritis</p>

Petra

Visu‐Petra

Buta

et al. 2020

PRBM

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Purpose: Rheumatoid arthritis (RA) is a chronic inflammatory systemic disease associated with various degrees of impairment across different cognitive domains. We aimed to provide a detailed computerized investigation of verbal and visuospatial short-term and working memory (dys)functions in RA patients, assessing both accuracy and response speed, while relating them to age, disease-related activity, affective problems, psychomotor speed and other clinical parameters. Patients and Methods: The study included 29 RA patients (mean age 50.6 ± 12.3 years, 79% female) and 30 controls (matched according to age, gender and education), assessed with short-term and working memory tasks from the Cambridge Neuropsychological Test Automated Battery (CANTAB) and the Automated Working Memory Assessment (AWMA). Results: RA patients were significantly slower on the basic processing speed test (Motor Screening Test, p =0.003). Their short-term information storage (verbal and visuospatial) was comparable to controls, yet this similar accuracy came at the expense of a longer response time to retain information correctly (on spatial span, p = 0.04). On tasks with higher executive demands, both visuospatial and verbal working memory were compromised, as RA patients took longer (p = 0.004) and had a higher number of total errors (p = 0.02) when conducting a strategic memoryguided search (Spatial Working Memory), and had a significantly lower verbal working memory span on the backwards digit recall test (p = 0.02). Conclusion: The findings of this study emphasize the usefulness of performing computerized tests to detect subtle signs of cognitive impairment and of intact performance, which can inform memory training protocols for this vulnerable population.

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Cognitive impairment in patients with rheumatoid arthritis

Cited by 42 publications

References 57 publications

Cognitive Impairment in Patients with Ankylosing Spondylitis

Cognitive Impairment in Patients with Ankylosing Spondylitis

The Role of Chronic Inflammatory Bone and Joint Disorders in the Pathogenesis and Progression of Alzheimer's Disease

<p>A Computerized Assessment of Verbal and Visuospatial Memory (Dys)functions in Patients with Rheumatoid Arthritis</p>

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