Cognitive dysfunction more common ‘than we want to admit’ in rheumatic disease
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SAN DIEGO — Limited assessment tools make it difficult to determine the prevalence and severity of cognitive disorders in patients with rheumatic and autoimmune diseases, according to a speaker at the Congress of Clinical Rheumatology West.
“These are the complaints we hear from patients all the time , regardless of their age, their disease,” Noa Schwartz, MD, MS, co-director of the Lupus Clinic at the Montefiore Medical Center, in New York, told attendees. “Things like, ‘I can’t concentrate, I don’t remember why I walked into a room, I feel like I’m slow.’”
These complaints raise a questions for rheumatologists, including whether, and how, to address these issues.
“In reality, cognitive dysfunction occurs probably a lot more often than we want to admit,” Schwartz said.
Primary cognitive dysfunction manifests in different autoimmune inflammatory rheumatic diseases (AIRDs), according to Schwartz. She added that they come in different forms and are often due to different pathogenic processes, with some being acute or inflammatory and others chronic and progressive.
“Most autoimmune and rheumatic diseases have been associated with various degrees of cognitive dysfunction,” Schwartz said. “It is important to note that even mild cognitive impairment can disrupt daily functioning for individuals with rheumatoid arthritis.”
She added that patients with lupus identify cognitive dysfunction among the top distressing symptoms of their disease that directly detract from their quality of life. As such, most of the research is in this disease, but the findings can be extrapolated to other conditions, if need be.
Looking at causes, depression and distressed emotional states can contribute to cognitive dysfunction in patients with AIRDs, according to Schwartz. Medications can also be associated with these outcomes.
“Cerebrovascular and cardiovascular diseases can lead to structural damage in the brain,” she added.
According to Schwartz, it is important to understand that there are several domains under the umbrella of cognitive dysfunction, including simple or complex attention, reasoning, executive skills — like planning, organizing and sequencing, memory — visual spatial processing, language and psychomotor speed.
“Cognitive dysfunction is significant deficit in any or all of the cognitive domains,” she said.
In assessing a patient for these outcomes, rheumatologists should attempt to determine whether the condition is acute or chronic, a primary or secondary condition, or focal or diffuse.
Schwartz acknowledged that there are currently limited tools to truly assess cognitive dysfunction in autoimmune and rheumatic diseases.
The Comprehensive Neurocognitive Battery is the “gold standard” test for evaluating these outcomes, according to Schwartz, noting that patient-reported assessment frequently fails to correlate with more objective measures.
The Montreal Cognitive Assessment and Attention, Memory and Frontal Abilities Screening Test also may be used.
Conversely, imaging techniques like MRI have not yet been shown to correlate with clinical assessment.
According to Schwartz, the number of patients who are experiencing these disorders may be much greater than previously thought.
“There is something happening below the surface even in those who are not actively complaining about cognitive dysfunction,” she said.
It is for this reason that Schwartz called on the research community to dig deeper.
“We need more investigations to improve our diagnostic and therapeutic capabilities,” she said.
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Schwartz N. ANCA-Associated Cognitive Dysfunction in Rheumatic Diseases. Presented at The Congress of Clinical Rheumatology West; Oct. 20-23, 2022 (hybrid meeting).
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