Primary Sjögren's syndrome is associated with significant cognitive dysfunction

Tezcan, Mehmet Engin; Koçer, Emine Belgin; Haznedaroğlu, Şeminur; Sönmez, Cemile; Mercan, Rıdvan; Yücel, Ayşegül Atak; İrkeç, Ceyla; Bıtık, Berivan; Göker, Berna

doi:10.1111/1756-185x.12912

Cited by 16 publications

(21 citation statements)

References 30 publications

(46 reference statements)

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“…Our cohort included 64 patients, which is a comparatively large number for a rare disease. More importantly, the threshold definition of cognitive impairment was often lower in comparison to our applied definition, which results in a more robust testing on our part, antagonizing overestimation 10 . Finally, in‐between‐study‐comparability is diminished, as the applied methodology shows a wide variety.…”

Section: Discussionmentioning

confidence: 83%

“…Extraglandular neurological manifestations of Sjögren’s syndrome are increasingly recognized, forming the entity of Neuro‐Sjögren 3–7 . While peripheral neuropathy and cranial nerve affection 4,5 are the most prevalent neurological symptoms of Sjögren’s syndrome with rates of up to 60%, there have been several studies suggesting the involvement of the central nervous system through spinal cord involvement, headache, 8 and cognitive dysfunction 9–12 . Neuropsychological testing in patients with Sjögren’s syndrome has hitherto been performed on mostly rheumatological cohorts with the typical female preponderance 13 .…”

Section: Introductionmentioning

confidence: 99%

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Cognitive impairment in patients with Neuro‐Sjögren

Seeliger

Jacobsen

Hendel

et al. 2020

Ann Clin Transl Neurol

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Objective Extraglandular neurological manifestations of Sjögren’s syndrome are increasingly recognized, defining the disease entity of Neuro‐Sjögren. Neuropsychological assessment of patients with Sjögren’s syndrome has hitherto been performed on predominantly rheumatological cohorts. These studies revealed a wide variety of prevalence rates for cognitive impairment (22–80%), while variable cut‐off criteria for detection of cognitive impairment were applied. Attentional functions have not yet been thoroughly investigated in these patients, although they clearly represent relevant aspects of cognitive functioning in daily life. Methods We therefore conducted extensive neuropsychological assessment based on two neuropsychological test batteries [i.e., the extended German version of the Consortium to Establish a Registry for Alzheimer’s Disease Neuropsychological Assessment Battery (CERAD‐PLUS), and the test battery for attentional performance (TAP) as a well‐established assessment of attentional functions in the German‐speaking part of Europe]. Results Sixty‐four patients with Neuro‐Sjögren, who were treated at our university hospital between December 2016 and January 2019, were included. Evidence for the presence of cognitive impairment was found in 55% of patients with Neuro‐Sjögren. The degree of cognitive impairment ranged from mild (38%) to severe (17%). Attentional and mnemonic subtests showed pronounced cognitive impairment in patients with Neuro‐Sjögren. Interpretation Our results suggest that a substantial proportion of patients with Neuro‐Sjögren suffer from cognitive impairment, putatively as a corollary of attentional deficits, which might exert adverse effects on occupational abilities, other cognitive functions, and social role functioning.

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Section: Discussionmentioning

confidence: 83%

Section: Introductionmentioning

confidence: 99%

Cognitive impairment in patients with Neuro‐Sjögren

Seeliger

Jacobsen

Hendel

et al. 2020

Ann Clin Transl Neurol

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“…This cohort had a short disease duration (3.5 years) which may suggest that cognitive dysfunction appears early after disease diagnosis. Similarly, Tezcan et al 18 identified cognitive dysfunction by several standardized cognitive tests in pSS patients reporting a prevalence of 78.8%. This group had low disease activity (SS Disease Activity Index score 2.06 ± 0.11) and duration (12 months).…”

Section: Discussionmentioning

confidence: 86%

Cognitive dysfunction in Sjögren’s syndrome using the Montreal Cognitive Assessment Questionnaire and the Automated Neuropsychological Assessment Metrics: A cross‐sectional study

et al. 2020

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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

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“…Both mechanisms would make the correlation stronger but for different reasons. Although the specific cellular/biochemical mechanisms for such changes in correlation are unknown, they are likely to share similar mechanisms that underlie brain dysfunction in other autoimmune or inflammatory brain disorders (Selmi et al, 2016), including neuropsychiatric lupus (Belmont et al, 1996, Menon et al, 1999, Omdal et al, 2005), rheumatoid arthritis (Shin et al, 2012), Sjögren's syndrome (Tezcan et al, 2016), and psoriasis (Gisondi et al, 2014). A special case is autoimmune encephalitis where the investigation of cellular autoimmune mechanisms has progressed appreciably (Armangue et al, 2015, Boronat et al, 2013, Clemente-Casares et al, 2016, Dalmau and Rosenfeld, 2008, Dalmau and Rosenfeld, 2014, Linnoila et al, 2014).…”

Section: Discussionmentioning

confidence: 99%

Brain Correlates of Human Leukocyte Antigen (HLA) Protection in Gulf War Illness (GWI)

et al. 2016

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BackgroundWe recently reported that six alleles from class II genes of the Human Leukocyte Antigen (HLA) confer protection from Gulf War Illness (GWI) (Georgopoulos et al., 2015). The most significant effect is exerted on Neurological-Cognitive-Mood (NCM), Pain, and Fatigue symptoms, such that higher number of copies of the protective alleles are associated with lower symptom severity. Here we tested the hypothesis that this effect is exerted by modulating the strength of neural synchronicity.MethodsEighty-one Gulf War veterans (65 with GWI and 16 healthy controls) underwent a magnetoencephalography (MEG) scan to assess the strength of brain synchronicity by computing zero-lag crosscorrelations (and their Fisher z transforms) between prewhitened MEG time series. A high-resolution HLA genotyping determined the number of copies, k, of the 6 protective alleles above in each participant. We tested the hypothesis above by regressing NCM, Pain and Fatigue symptom severity against the interaction term, k × z (HLA-related effect), while including z (non-HLA-related effect), gender and age as covariates. The k × z and z terms assessed HLA- and non-HLA-related effects, respectively, of neural synchronicity on symptom severity. The distributions of these effects in sensor space were visualized using statistical heatmaps.FindingsWe found significant, graded HLA- and non-HLA-related effects: (a) NCM > Pain > Fatigue for HLA-related effects, (b) NCM > Fatigue > Pain for non-HLA-related effects, and (c) HLA-related > non-HLA-related effects for all symptoms. These effects had widespread but distinct distributions in sensor space that allowed the orderly separation of the 6 terms (3 symptom domains × 2 HLA factors) in a multidimensional plot, where one dimension separated the symptoms and the other the HLA relation.InterpretationThese findings demonstrate the presence of substantial, widespread, distinct and orderly HLA- and non-HLA-related neural influences on NCM, Pain and Fatigue symptom severity in GWI.FundingU.S. Department of Veterans Affairs and University of Minnesota.

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Primary Sjögren's syndrome is associated with significant cognitive dysfunction

Abstract: Results of this study suggest that cognitive dysfunction is quite prevalent in PSS patients without being associated with studied antibodies.

Cited by 16 publications

References 30 publications

Cognitive impairment in patients with Neuro‐Sjögren

Cognitive impairment in patients with Neuro‐Sjögren

Cognitive dysfunction in Sjögren’s syndrome using the Montreal Cognitive Assessment Questionnaire and the Automated Neuropsychological Assessment Metrics: A cross‐sectional study

Brain Correlates of Human Leukocyte Antigen (HLA) Protection in Gulf War Illness (GWI)

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