AB0411 COGNITIVE IMPAIRMENT IN PRIMARY SJÖGREN’S SYNDROME: A CASE-CONTROL STUDY
Authors: M. J. Garza Martínez, M. A. Treviño-Castro, A. Cárdenas, C. V. Solis, R. Pineda, J. C. Riegatorres, C. M. Skinner Taylor, D. Á. Galarza-Delgado
Journal: Annals of the Rheumatic Diseases (2020)

Background: Neurological symptoms are common in primary Sjögren’s syndrome (pSS) with a prevalence of 8.5 to 70%, focusing on cognitive impairment, information in pSS is scarce. Many neuropsychological tests are used to diagnose cognitive impairment. The Montreal Cognitive Assessment (MoCA) is a validated, practical, and reliable instrument for screening mild cognitive impairment. Objectives: To evaluate the prevalence of cognitive impairment with the MoCA test in pSS and compare it with controls. Methods: Patients of a rheumatology clinic in Northeastern Mexico were recruited, who met the pSS AECG 2002 or ACR-EULAR 2016 classification criteria. Controls, matched by demographic characteristics were included for comparison. All subjects took the MoCA. The test has a range of 0-30 points, the highest score reflects better cognitive function, and explores 6 cognitive domains (Table 2). Table 1. Demographic and clinical characteristics ≤ 9 years of education ≥10 years of education Group N mean, SD 1 Min-max p -value n mean, SD 1 Min-max p -value MoCA total pSS 17 25.65 (2.17) 20 - 29 0.248 46 26.67 (2.27) 20 - 30 0.3 Control 14 24.36 (3.85) 17 - 30 36 27.22 (2.24) 21 - 30 Visuospatial pSS 17 3.76 (0.9) 1 - 5 0.505 46 4.17 (1.03) 2 - 5 0.056 Control 14 4.07 (1.59) 0 - 5 36 4.58 (0.87) 2 - 5 Naming pSS 17 2.82 (0.39) 2 - 3 0.831 46 2.96 (0.2) 2 - 3 0.711 Control 14 2.79 (0.57) 1 - 3 36 2.97 (0.16) 2 - 3 Deyaled recall pSS 17 3.06 (1.34) 1 - 5 0.251 46 3.48 (1.31) 0 - 5 0.921 Control 14 2.43 (1.65) 0 - 5 36 3.44 (1.68) 0 - 5 Attention pSS 17 5 (0.79) 3 - 6 0.041 46 5.37 (0.77) 4 - 6 0.285 Control 14 4.29 (1.06) 3 - 6 36 5.53 (0.56) 4 - 6 Abstraction pSS 17 1.71(0.68) 0 - 2 0.464 46 1.89 (0.31) 1 - 2 0.79 Control 14 1.86 (0.36) 1 - 2 36 2 (0.23) 1 - 3 Orientation pSS 17 6 (0) 6 - 6 0.999 46 5.93 (0.25) 5 - 6 0.083 Control 14 6 (0) 6 - 6 36 6 (0) 6 - 6 Language pSS 17 2.41(0.71) 1 - 3 0.741 46 2.61 (0.57) 1 - 3 0.878 Control 14 2.5 (0.76) 1 - 3 36 2.58 (0.84) 0 - 3 1 SD: Standard deviation We defined mild cognitive impairment as a score &lt;26 and moderate-severe cognitive impairment as a score &lt;24 as previously determined in Mexican population. Results: Demographic and clinical characteristics are described in Table 1. Mild cognitive impairment was present in 13 (25.4%) in pSS group versus 14 (27%) in control group. Moderate-severe cognitive impairment was present in 9 (17%) of pSS group versus 8 (15%) in control (p&gt; 0.05). Table 2. MoCA subtest analysis by years of education in pSS and control group. Characteristics pSS n=51 Control n=51 Age, Mean (SD) 56 (10.4) 54 (14) Sex Female n (%) 47 (92.15) 48 (94) Male n (%) 4 (7.85) 3 (7.3) Disease duration (years), mean (SD) 6.38 (6.15) ESSPRI mean (SD) 4.94 (2.28) Years of education, median (q25-q75) 13 (10-17) 12 (10-15) Employment, mean (%) 19 (37) 29 (56) Results of the individual domains and comparison between groups are shown in Table 2. Attention was lower in the pSS group with ≤9 years of education compared to the control group (p &lt;0.05). Conclusion: We did not found a difference in the prevalence of cognitive impairment, either mild or moderate-severe, in pSS subjects with low disease duration versus controls by MoCA. We found a lower attention score in the pSS group with less than 10 of years of education. The combination of neuropsychological examining and imaging techniques, such as SPECT or brain MRI, seem a more sensitive way to detect cognitive impairment in earlier stages. References: [1]Manzo, C., Martinez-Suarez, E., Kechida, M., Isetta, M. and Serra-Mestres, J. (2019). Cognitive Function in Primary Sjögren’s Syndrome: A Systematic Review. Brain Sciences, 9(4), p.85. [2]Aguilar-Navarro S, Mimenza-Alvarado A, Palacios-García A, Samudio-Cruz A, Gutiérrez-Gutiérrez L, Ávila-Funes J. Validez y confiabilidad del MoCA (Montreal Cognitive Assessment) para el tamizaje del deterioro cognoscitivo en méxico. Revista Colombiana de Psiquiatría. 2018;47(4):237-243. Disclosure of Interests: None declared