Cognitive screening proposed for certain patients with autoimmune rheumatic diseases
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Older patients with chronic autoimmune rheumatic diseases — rheumatoid arthritis, systemic lupus erythematosus and systemic sclerosis — who have sustained disease activity or organ damage should be evaluated for cognitive deficits, according to a review published in Arthritis Research & Therapy.
“It is well-known that some rheumatic diseases, such as SLE, exert neuropsychiatric manifestations,” Zoltán Szekanecz, MD, PhD, of the University of Debrecen, in Hungary, told Healio Rheumatology. “Recently, similar observations have been made in rheumatoid arthritis and systemic sclerosis. Many aspects of central nervous system have been characterized, however, there have been only a few communications with respect to cognitive dysfunction in these diseases.”
In their review, Szekanecz and colleagues from London, New York and Hungary discussed cognitive dysfunction in RA, SLE and SSc. According to the authors, several standardized measures of cognitive function have been developed, including the Montreal Cognitive Assessment (MoCA), Trail Making Test (TMT), Victoria Stroop Test (VST), Wechsler Adult Intelligence Scale (WAIS) and Benton Visual Retention Test (BVRT). Beck Depression Inventory (BDI) and State-Trait Anxiety Inventory (STAIT/S) may be used to assess depression and anxiety, respectively.
In RA, various domains of cognitive dysfunction may be associated with age, lower education, disease duration and activity, as well as inflammatory markers and some measures of vascular pathology, Szekanecz and colleagues wrote. In particular, researchers have made key strides in neuropsychiatric SLE and SLE-specific cognitive dysfunction, in both the explanation of the pathogenic pathways and possible treatment strategies, as well as in imaging studies and the design and validation of screening and monitoring tools.
Further, although SSc rarely directly affects brain function, the associated psychological burden can be significant. This burden can include depression, anxiety and social impacts. According to the authors, this is a major unmet need despite promising data from recent, ongoing clinical trials of potential therapies for skin or lung manifestations of the disease.
“Cognitive dysfunction may be subclinical but may highly affect the patients’ quality of life, attitude and several aspects of daily life,” Szekanecz said. “In the three diseases covered by this review paper we tried to put these alterations in context with disease pathogenesis and therapy. We think that a combination of treatment of the underlying inflammatory disease together with tailored cognitive behavioral therapy may benefit these patients.” – by Jason Laday
Disclosures: The researchers report no relevant financial disclosures.
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