THU0134 COGNITIVE IMPAIRMENT IN RHEUMATOID ARTHRITIS
Authors: C. Edwards, B. Mcdowell, C. Holroyd, C. Cardwell, M. Mchenry, G. Meenagh, C. Holmes, B. Mcguiness
Journal: Annals of the Rheumatic Diseases (2020)

Background: Increasing evidence suggests that systemic inflammation may be associated with an increased risk of developing cognitive dysfunction and Alzheimer’s disease (AD). Some studies have found an association between rheumatoid arthritis (RA) and neurodegeneration with several finding increased incidence of mild cognitive impairment (MCI) in those with RA compared to healthy controls. Objectives: This study aims to use preliminary data from the R h e umatoid arthriti s , med i cation and memory st udy (RESIST) to investigate the prevalence of MCI in a population of patients with RA and explore the relationship between MCI and specific demographic and clinical characteristics. Methods: The Montreal Cognitive Assessment (MoCA) was used as a cognitive screening tool and was administered to subjects ≥55 years of age who had been diagnosed with RA according to the ACR/EULAR criteria. Demographic and clinical data was recorded at screening in face-to-face interviews and included age, gender, date of RA diagnosis and RA medication. RA disease activity score from 28 joints (DAS28), rheumatoid factor (RF) level, anti-cyclic citrullinated peptide (anti-CCP) level, erythrocyte sedimentation rate (ESR) were recorded. 260 participants completed both screening and baseline visits as part of the RESIST longitudinal study, MoCA scores from baseline were analysed for these participants. Statistical analysis was used to provide descriptive statistics and explore possible predictors of cognitive impairment. Results: A total of 636 participants (mean age 68.1 yrs, female 67.5%) were screened between May 2018 and December 2019. The mean MoCA for screened participants was 25.4; 45.3% scored &lt;26 in the MoCA and were considered to have mild cognitive impairment. Age was negatively correlated with MoCA score and was the only significant predictor of cognitive impairment. For each year of increase in age the MoCA score reduced by a mean of 0.08 points (p&lt;0.05). There was little evidence of a difference in mean MoCA score by gender, RA medication, duration of disease, DAS28 score, ESR, anti-CCP or RF levels. The mean MoCA scores increased by 0.4 points between screening and baseline (P&lt;0.001). Conclusion: A large proportion of participants scored below the proposed cut-off for normal cognition in the MoCA suggesting a high prevalence of MCI in adults &gt;55 years with moderately active RA. This provides further support for the role of chronic inflammation in cognitive dysfunction and AD. Screening for MCI in rheumatology clinics might be clinically useful. Demographics Outcome Age mean years (+/-SD) (n=633) 68.1 (8.01) Gender (n=636) Female n (%) 429 (67.5) RA Medication (n=636) csDMARD n (%) TNFi n (%) 368 (57.9) 268 (42.1) Duration of RA mean years (+/-SD) (n=484) 14.4 (13.9) DAS28 mean (+/-SD) (n=306) 3.5 (2.04) ESR mean (+/-SD) (n=501) 23.4 (22.0) Anti-CCP (n=387) Positive n (%) 236 (61) Rheumatoid Factor (n=377) Positive n (%) 277 (73.5) MoCA Score points (n=636) ≥26, n (%) &lt;26 n (%) 348 (54.7) 288 (45.3) Subjective memory concerns (n=430) Yes n (%) No n (%) 95 (22.1) 335 (77.9) Disclosure of Interests: Christopher Edwards Grant/research support from: Abbvie, Biogen, Roche, Consultant of: Abbvie, Samsung, Speakers bureau: Abbvie, BMS, Biogen, Celgene, Fresenius, Gilead, Janssen, Lilly, Mundipharma, Pfizer, MSD, Novartis, Roche, Samsung, Sanofi, UCB , Bethany McDowell: None declared, Chris Holroyd: None declared, Chris Cardwell: None declared, Michelle McHenry Speakers bureau: Novartis, Pfizer, AbbVie, Celgene, Lilly, Gary Meenagh: None declared, Clive Holmes: None declared, Bernadette McGuiness: None declared