Session Information
Session Type: ACR Poster Session B
Session Time: 9:00AM-11:00AM
Background/Purpose: Cognitive impairment (CI) casts a significant burden on individuals, caretakers and the US health care system with an estimated prevalence between 10-20%. While CI is seen in a portion of the general population, it has also been identified in systemic lupus erythematosus, primary Sjogren’s syndrome, antiphospholipid syndrome and rheumatoid arthritis (RA). However, no study has specifically evaluated the prevalence of CI in adults with RA over the age of 65. Our goal was to assess the prevalence of CI in a cohort of elderly patients with RA, and to pilot an educational intervention in those affected.
Methods: A cross sectional, survey based study was conducted at a single tertiary center, outpatient rheumatology clinic. Inclusion criteria were >65 years of age and a history of RA by 1987 criteria. Exclusion criteria included overlap syndromes. Thirty patients were consecutively enrolled and underwent our novel rheumatology-specific screening tool, the Rheumatology Mini-Cog (RMC). Those who failed were administered the Mini-cog. Those passing the Mini-cog were presumed not to have CI and administered an educational intervention using the Teach Back method. Those failing the Mini-cog were presumed to have CI and participated in an educational intervention with a family member or friend.
Results: Thirty patients were recruited during routine office visits. The average age was 72.2 years, 83% were Caucasian and 70% were female. Eight of 30 patients (26.7%) were found to have CI. Of those with CI, there was a higher prevalence of erosive disease (57.1% vs 83.3%, p=0.36), longer disease duration (10.2 vs 19.5 years, p=0.01), higher RAPID-3 scores (9.16 vs 12.98, p=0.18), use of multiple DMARDs (22.7% vs 75%, p=0.04) and anti-TNF usage (13.6% vs 50%, p=0.06). There was no difference in frequency of diabetes, hypertension, depression or anti-depressant usage between groups.
Conclusion: Our study suggests the prevalence of CI in RA patients is significantly higher than the general population and may benefit from a one-time screening. The prevalence of CI was also correlated with disease duration and more aggressive disease, suggesting RA is an independent risk factor. While this is the first study to identify CI in older adults with RA, further studies would be warranted to assess the use of validated instruments and potential interventions, if CI is found.
|
TABLE 1. Main study results |
|||
|
|
No CI |
CI |
P-values |
|
|
22 |
8 |
|
|
Age, yrs (mean) |
65-80 (71.7) |
69-81 (74.3) |
0.15 |
|
Ethnicity (%) Caucasian African American |
_ 18 (81.8) 4 (18.2) |
_ 7 (87.5) 1 (12.5) |
1.00 |
|
Gender: n (%) Male Female |
_ 7 (31.9) 15 (68.1) |
_ 2 (25.0) 6 (75.0) |
0.39 |
|
Diagnosis (years) |
10.2 (2-20) |
19.5 (1-43) |
0.01 |
|
Seropositive (%) |
15/16 (93.7) |
4/5 (80) |
0.42 |
|
Erosive disease (%) |
13/22 (57.1) |
6/7 (83.3) |
0.36 |
|
RA Medications (%) |
Statistically significant Multiple agents – 5 (22.7) Not significant Anti-TNF – 3 (13.6) Biologics – 6 Prednisone – 1 Methotrexate – 14 Sulfasalazine – 2 leflunomide – 3 Hydroxychloroquine – 3 NSAID (no DMARD) – 1 tofacitinib – 1 None – 2 |
Statistically significant Multiple agents – 6 (75) Not significant Anti-TNF – 4 (50) Biologics – 5 Prednisone – 1 Methotrexate – 7 Sulfasalazine – 1 leflunomide – 1 Hydroxychloroquine – 2 NSAID (no DMARD) – 0 tofacitinib – 0 None -0 |
_ 0.04 _ 0.06 0.10 _ 0.37
|
|
MD-HAQ |
1.51 (0-5.7) |
2.92 (0.3-7.7) |
0.10 |
|
RAPID-3 |
9.16 (0-23.5) |
12.98 (0.3-23.5) |
0.18 |
|
PHQ8 median |
6 (0-16) |
4 (0-20) |
0.92 |
|
CNS insult history |
No history – 22/22 |
No history 8/8 |
|
|
Lives with partner or spouse |
11/22 |
4/7 |
1.00 |
|
Diabetes Mellitus (%) |
5 (22.7) |
0 (0) |
0.29 |
|
Hypertension (%) |
17 (77.2) |
3 (37.5) |
0.07 |
|
SSRI/SNRI use (%) |
4 (18.1) |
1 (12.5) |
1.00 |
CI: Cognitive Impairment; MD-HAQ: Multidimensional Health Assessment Questionnaire, 0-10; RAPID-3: 0-30 (remission <3, low disease activity (DA) 3.1-6, moderate DA 6.1-12, high DA >12); PHQ8: Patient Health Questionnaire, 0-24 (>10 consistent with major depression)
|
TABLE 2. RMC and Mini-Cog results |
|||
|
|
No CI |
CI |
P-value |
|
RMC |
Medications pass – 15/22 Laboratory pass – 4/22 |
Medications pass – 2/8 Laboratory pass – 0/8 |
0.04 0.26 |
|
Mini-Cog |
Word recall (1/3) – 3 (2/3) – 5 (3/3) – 10 Passed CDT – 18/18 |
Word recall (0/3) – 2 (1/3) – 3 (2/3) – 3 Passed CDT – 0/8 |
|
CDT: Clock Draw Test
To cite this abstract in AMA style:
Smith B, O'Rourke KS. Quality Improvement in Elderly Patients with Rheumatoid Arthritis: Pharmacotherapy and Identification of Cognitive Dysfunction [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/quality-improvement-in-elderly-patients-with-rheumatoid-arthritis-pharmacotherapy-and-identification-of-cognitive-dysfunction/. Accessed .« Back to 2015 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/quality-improvement-in-elderly-patients-with-rheumatoid-arthritis-pharmacotherapy-and-identification-of-cognitive-dysfunction/