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Abstract Number: 1401

Higher-Order Neuropsychological Deficits Are Frequent and Occur Early in RA and SLE: The Impact of Basic Processing Abilities on Psychological Well-Being

Giorgia Dimitraki1, Georgia Ktistaki1, Emmanouil Papastefanakis1, Antonis Fanouriakis2, Irini Gergiannaki2, George Bertsias3, Nikolaos Kougkas2, Argyro Repa3, Evangelos Karademas1, Prodromos Sidiropoulos3 and Panagiotis Simos1, 1Department of Psychology, University of Crete, Rethymnon, Greece, 2Rheumatology, Clinical Immunology and Allergy, University of Crete, Heraklion, Greece, 3Rheumatology, Clinical Immunology, and Allergy, University of Crete, Heraklion, Greece

Meeting: 2014 ACR/ARHP Annual Meeting

Keywords: Cognitive dysfunction, psychological well-being, rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE)

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Session Information

Session Title: Rheumatoid Arthritis - Clinical Aspects (ACR): Comorbidities, Treatment Outcomes and Mortality

Session Type: Abstract Submissions (ACR)

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.


Disclosure:

G. Dimitraki,
None;

G. Ktistaki,
None;

E. Papastefanakis,
None;

A. Fanouriakis,
None;

I. Gergiannaki,
None;

G. Bertsias,
None;

N. Kougkas,
None;

A. Repa,
None;

E. Karademas,
None;

P. Sidiropoulos,
None;

P. Simos,
None.

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