Prevalence of cognitive impairment in patients with rheumatoid arthritis: a cross sectional study

Abstract

Objective To explore the role of chronic inflammation in rheumatoid arthritis (RA) on cognition. Methods and analysis Six hundred sixty-one men and women aged ≥55 years who fulfilled the American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) criteria for RA were recruited from three healthcare trusts in the United Kingdom (UK) between May 2018 and March 2020. Study participants took part in interviews which captured sociodemographic information, followed by an assessment of cognition. RA specific clinical characteristics were obtained from hospital medical records. Participants were cognitively assessed using the Montreal Cognitive Assessment (MoCA) and were classified as cognitively impaired if they scored ≤27/30 points. Linear regression analyses were conducted to identify which demographic and clinical variables were potential predictors of cognitive impairment. Results The average age of participants was 67.6 years and 67% (444/661) were women. 72% (458/634; 95% CI 0.69 to 0.76) of participants were classified as cognitively impaired (MoCA≤27). Greater cognitive impairment was associated with older age (p = .006), being male (p = .041) and higher disease activity score (DAS28) (with moderate (DAS28 > 3.1) (p = 0.008) and high (DAS28 > 5.1) (p = 0.008)) compared to those in remission (DAS28 ≤ 2.6). There was no association between MoCA score and education, disease duration, RF status, anti-cyclic citrullinated peptide (anti-CCP) status, RA medication type or use of glucocorticoids or non-steroidal anti-inflammatory drugs (p > 0.05). Conclusion This study suggests that cognitive impairment is highly prevalent in older adults with RA. This impairment appears to be associated with higher RA disease activity and supports the concept that chronic systemic inflammation might accelerate cognitive decline. This underlines the importance of controlling the inflammatory response.

The Work Experience Survey – Rheumatic conditions (United Kingdom): Psychometric properties and identifying the workplace barriers of employed people with inflammatory arthritis receiving vocational rehabilitation

“…This was the third most common in this study, with a higher percentage reporting such barriers, highlighting the importance of considering barriers outside the workplace in VR. In this study, Section 4B, completing mental, time, energy and emotional demands, was the second most common section with problems, compared to less than 25% in WORK‐IT, reflecting that 31%–72% of people with RA experience cognitive impairment (McDowell et al., 2022 ; Shin et al., 2012 ).…”

Cognitive implications of rheumatoid arthritis: A call for comprehensive care and research focus

“…1 Thus, yoga is a valuable adjunct therapy for individuals with RA and is recommended by doctors to RA patients to reduce the risk of cognitive impairment. 1 Additional lifestyle changes including dietary modifications can also be integrated in this context as doctors recommend a healthy diet rich in fruits, vegetables, whole grains, and lean protein due to their benefits in helping the reduction of inflammation and, therefore, ameliorating cognitive function in patients with RA 10,17 Likewise, Omega-3 fatty acids that are found in fatty fish and fish oil supplements, have further exhibited antiinflammatory attributes and might positively impact cognitive function. 12 Furthermore, according to the WHO, by reducing or completely halting the consumption of alcohol and the cessation of tobacco, the risk of cognitive impairment can be mitigated even more so.…”

“…Methotrexate, although highly efficacious, carries a significant risk of cognitive impairment, confusion, and mood changes 9 . Additionally, age plays a role, with cognitive impairment being more evident in older patients 10 . Elderly individuals with long‐standing RA have a higher risk of accelerated inflammatory atherosclerosis and stroke hence increasing their susceptibility to cognitive impairment 4 .…”

Impact of frailty severity and severe pain on cognitive function for community-dwelling older adults with arthritis: a cross-sectional study in Korea

“…Cognitive decline is a notable symptom of aging, with previous studies reporting its relevance in patients with arthritis 5 , particularly affecting attention, memory, and verbal function. Cognitive decline was reported in 67% of patients with RA in the UK 6 , and the incidence of dementia in patients with OA was twice that of non-OA in Taiwan 7 . While depression, chronic pain, drug-related effects, functional disabilities, and inflammation have been proposed as potential explanations for the cognitive decline observed in patients with arthritis, the precise mechanism underlying this decline remains unclear 8 .…”