Background/Purpose Deficits in higher-order cognitive abilities (episodic memory, executive functions) have been reported in patients with chronic inflammatory disorders, albeit inconsistently. We investigated whether such deficits are associated with impairments in basic cognitive processes (short-term memory, visuomotor speed) and premorbid verbal intelligence, and their potential impact on psychological well-being in newly diagnosed rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE). 

Methods Patients with RA (N=84, age: 54.1±9.1 years, education: 9.1±4.1 years, DAS28: 3.9±1.4) or non-neuropsychiatric SLE (N=60, age: 43.8±9.7 years, education: 12.1±3.7 years, SLEDAI: 3.6±2.7), diagnosed within the last 3 years, were administered a battery of standardized tests of short-term memory (Digits Forward and Digits Reverse tasks), episodic memory (Auditory Verbal Learning Test [AVLT]), executive functions (Stroop Color-Word Naming, General Ability Measure for Adults [GAMA], Controlled Oral Word Association Test [COWAT], Trail Making Test [TMT] B), visuomotor processing speed (TMT A). Premorbid verbal capacity was estimated using the Peabody Picture Vocabulary Test (PPVT-R). Scores were evaluated against age- and education-adjusted Greek population norms. The Hospital Anxiety and Depression Scale (HADS) was used to assess symptoms of impaired mood. 

Results Compared to population norms, RA patients had significantly lower average scores on short term memory, immediate and delayed episodic recall, phonemic fluency, problem solving ability, visuomotor speed and set-shifting ability (p<0.002). SLE patients had significantly reduced performance on short-term memory, immediate and delayed episodic recall, visuomotor speed and set-shifting ability (p<0.003). Cognitive impairment (defined as performance ≥1.5 SD below the population mean on ≥3 indices) was found in 15.5% and 21.3% of RA and SLE patients respectively, and was not significantly affected by medical comorbidities or disease activity. Notably, impairments on higher-order cognitive abilities in patients were explained by deficits in verbal IQ, short-term memory and visuomotor speed. Both clinical variables (number of physical symptoms experienced, β-coefficient = 3.63, p=0.002) and processing speed (β=2.59, p=0.035) significantly contributed independently to the intensity of depression symptoms experienced by patients. 

Conclusion A wide range of cognitive domains was affected in a significant proportion of patients with newly diagnosed RA and SLE. Deficits in higher-order complex memory and executive tasks were largely due to impaired basic cognitive abilities and had an adverse impact on patients’ psychological well-being. Emergence of cognitive defects early in the course of RA and SLE suggests common etiopathogenesis possibly linked to underlying disease processes (including inflammation) and/or administered treatments.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/higher-order-neuropsychological-deficits-are-frequent-and-occur-early-in-ra-and-sle-the-impact-of-basic-processing-abilities-on-psychological-well-being/