Background/Purpose:  For persons with chronic diseases such as rheumatoid arthritis (RA), intact cognitive function is crucial for performing main daily activities and adhering to self-management regimens. Persons with impaired cognitive function have decreased functional independence, reduced quality of life, and increased risk of mortality. Although several mechanisms may influence cognitive function in RA, it has not been well-studied in this population. This study explored the prevalence of cognitive impairment in persons with RA using a set of computerized neurocognitive tests and the factors that were significantly correlated with cognitive impairment.

Methods:  Individuals with RA were recruited by their rheumatologists during follow-up visits at one university hospital in Korea. After getting signed consents, a trained research nurse assessed participants with a range of physical, psychosocial, and biological metrics. Cognitive function was assessed using a set of 6 computerized neurocognitive tests yielding 18 indices covering a range of cognitive domains. Subjects were classified as ‘impaired’ if they performed 1 SDbelow age-based population norms on each test. A total cognitive impairment score was calculated by summing the transformed scores, ranging from 0 (no impairment) to 18 (worst impairment). Pearson correlation coefficient analyses were conducted to identify the variables that might be significantly associated with cognitive impairment.

Results:  Thirty three subjects with a mean (±SD) age of 64 (±11.8) years were included in the final analyses. 85% were female, 85% were married, and mean educational level was 9.6 (±4.9) years. Mean DAS-28 level was 2.6 (±1.5) and mean disease duration was 114 (±86.8) months. Mean HAQ score was 0.6 (±0.8), mean SPPB score was 7.4 (±2.5), and mean cardiovascular disease (CVD) risk factors were 2.9 (±1.5). 32.4% had depression and 70.6% had sleep problems. The proportion of persons who were classified as cognitively impaired on each test were 29% in Card Sorting Test (executive function), 56% in Trail Making Test (visuo-motor coordination), 74% in Visual Span Test (language memory), 79% in Verbal Learning Test (visuo-spatial memory), 24% in Visual Continuous Performance Test (continuous attention), and 65% in Word-Color Test (selective attention). Mean total cognitive impairment score was 10.7 (±4.1), and ranged from 2-17. 79% were classified as cognitively impaired on five or more test indices. Education (r=-493, p<.05), marital status (r=-.424, p<.05), income (r=-.661, p<.05), and CVD risk factors (r=.447, p<.05), SPPB score (r=-.485, p<.05) were significantly correlated with total cognitive impairment score.

Conclusion:  A significant number of RA patients were cognitively impaired. Low educational levels, non-married status, low income, and increased CVD risk factors, and increased functional limitations may be potential risks of cognitive impairment in this population. These findings suggest that the burden of cognitive impairment in RA is significant, and future studies identifying specific etiological contributors to cognitive impairment are warranted.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/factors-associated-with-cognitive-impairment-in-korean-adults-with-rheumatoid-arthritis/