Relationship between perceived cognitive dysfunction and objective neuropsychological performance in persons with rheumatoid arthritis

Abstract

OBJECTIVE Research shows a gap between perceived cognitive dysfunction and objective neuropsychological performance in persons with chronic diseases. We explored this relationship in persons with rheumatoid arthritis (RA). METHODS Individuals from a longitudinal cohort study of RA participated in a study visit that included physical, psychosocial, and biological metrics. Subjective cognitive dysfunction was assessed using the Perceived Deficits Questionnaire (PDQ; 0–20, higher scores = greater perceived impairment). Objective cognitive impairment was assessed using a battery of 12 standardized neuropsychological measures yielding 16 indices. On each test, subjects were classified as ‘impaired’ if they performed 1 SD below age-based population norms. Total cognitive function scores were calculated by summing the transformed scores (0–16, higher scores = greater impairment). Multiple linear regression analyses determined the relationship of total cognitive function score with PDQ score, controlling for gender, race, marital status, income, education, disease duration, disease severity, depression, and fatigue. RESULTS 120 subjects (mean ± SD age: 58.5 ± 11.0 years) were included. Mean ± SD scores of total cognitive function and PDQ were 2.5 ± 2.2 (0–10) and 5.8 ± 3.8 (0–16), respectively. In multivariate analysis, there was no significant relationship between total cognitive function score and PDQ score. However, depression and fatigue (β = 0.31, p < 0.001; β = 0.31, p = 0.001) were significantly associated with PDQ score. CONCLUSION The findings emphasize the gap between subjective and objective measures of cognitive impairment and the importance of considering psychological factors within the context of cognitive complaints in clinical settings.

The Impact of Exercise, Lifestyle, and Clinical Factors on Perceived Cognitive Function in Patients with Rheumatoid Arthritis: Results from a Prospective Cohort Study

“…Studies in patients with multiple sclerosis and cancer corroborated that depressive symptoms affect a patients’ report of cognitive difficulties . In RA, Shin et al found that higher levels of depression and fatigue were associated with perceived cognitive dysfunction in 120 well‐characterized patients with RA . However, we found that after adjusting for multiple other known risk factors for cognitive function, higher depression scores did not affect the development of reports of frequent concentration, memory, or word‐finding difficulties.…”

“…In healthy cohorts, investigations of preclinical Alzheimer's type dementia have suggested that subjective cognitive complaints may precede abnormalities detected on neuropsychological testing . However, in RA, cognitive impairment can co‐occur with markers of psychological distress , and self‐reported cognitive dysfunction can be influenced by symptoms of depression and fatigue . Appreciating the role that clinical and psychological factors play in the perception of cognition is important because cognitive complaints are clinically meaningful to patients and may portend cognitive decline.…”

Association of Fatigue Intensification with Cognitive Impairment during Radiation Therapy for Prostate Cancer

“…Because perceived cognitive impairment does not always reflect objective cognitive performance [21, 22], it is imperative to supplement cognitive function assessments that rely on self-report with more objective tests. While CAMCI® is a relatively new tool, it allows clinicians to quickly assess specific domains of cognition that patients have trouble with.…”

“…In addition, cognitive deficits in cancer patients are typically assessed using the standard paper-and-pencil tests or in-person interviews, which are time-consuming and labor intensive for patients who are already fatigued [19, 20]. Further, self- reported (or perceived) cognitive deficits do not always reflect a subject’s performance on neuropsychological (or objective) tasks [21-23]. Therefore, there is a need to develop objective cognitive tests that correspond to subjective cognitive impairments that can be useful for cancer patients.…”

Validation of the Brief Cognitive Symptoms Index in Sjögren Syndrome

“…In some studies, deficits in memory and attention are correlated with cognitive complaints 15,16 . In other studies of patients with immune disorders, including systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), and multiple sclerosis, cognitive symptoms have been poorly predictive of objective performance 17,18,19 . Interestingly, despite the inconsistent relationship between cognitive complaints and objectively measured cognitive abilities, future cognitive decline has been linked to subjective cognitive complaints 20 .…”