FRI0089 Assessment of cognitive function in rheumatoid arthritis
Authors: Z. Kardos, C. Oláh, M. Andrejkovics, E. Bodnár, K. Hodosi, K. Fazekas, Á. Flórián, K. Lukács, Á. Miksi, Z. Baráth, L. Tamási, Z. Szekanecz
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> For long, rheumatoid arthritis (RA) was thought not to associate with central nervous system (CNS) involvement. In recent years some studies suggest that cognitive function is impaired in RA patients. Accelerated atherosclerosis and reduced function of intracranial vessels in RA can be associated with vascular dementia. <h3>Objectives</h3> We assessed RA patients and healthy controls by neuropsychological tests, cognitive function such as attention, intelligence, memory tests and also by anxiety and depression tests. We wished to explore the prevalence of neuropsychiatric manifestations and cognitive impairment in patients with RA. Intracerebral vascular lesions were investigated by brain MRI. <h3>Methods</h3> Sixty RA female patients were included. Among them, 20 were MTX-treated, biologic-free, 40 patients received biologics. The controls included 39 non-RA healthy women. The following standardised tests were used: the Montreal Cognitive Assesment (MoCa) Test, the Victoria Stroop Test (VST), the Spielberger State-Trait Anxiety Inventory (STAI), the Benton Visual Retention Test (BVRT), the Beck Depression Inventory (BDI), the Brigg's and Nebe's Test, the Trail Making Test (TMT) A and B, the Word fluency with the letter (WF-L) and with category naming tests (WF-C), the Rey-Osterreich Auditory Verbal Learning Test (RAVLT), the Weschler Adult Intelligence Scale (WAIS). We also performed brain MRI in all patients in order to associate cognitive function with MRI changes. <h3>Results</h3> The MoCa total score was significantly lower in RA patients (23.3±3.8) especially in biologic-treated group (22.6±4.3) compared to controls (25.6±2.4) (p=0,002; 0,001). The attention MoCa test score was significantly lower in biologic- (4.5±1.6) compared to MTX-treated patients (5.7±0.6)(p=0.001). The STAI scores were significantly higher in RA (STAIS: 45.5±8.5; STAIT: 48.0±11.0) compared to controls (STAIS: 36.9±9.1; STAIT: 41.1±9.0)(p&lt;0.001; 0.002). The BDI score was significantly higher in RA (13.2±8.8) and in biologic-treated patients (13.7±8.7) than in controls (8.9±6.5)(p&lt;0.05). The TMT scores were significantly higher in RA (TMT-A: 69.0±26.3; TMT-B:100.2±48.5) compared to controls (TMT-A: 53.1±14.3; TMT-B: 53.1±22.7)(p&lt;0,05). The VST scores were also significantly higher in RA vs controls. The WAIS and Benton scores were significantly lower in RA and in biologic-treated patients than in controls (p=0.005). On brain MRI scans, there were significantly more vascular lesions both in the left and the right side in RA patients (55,1%&gt;53,1%) than in controls (23,5%&gt;20,1%) (p&lt;0,05), the cerebral atrophy is much more common in RA (0,26 vs. 0,03;p=0,005). <h3>Conclusions</h3> These findings suggest that the presence of neuropsychiatric manifestations and cognitive impairment in RA patients is significant. Biologic-treated patients may represent a more severe RA subset thus having cognitive dysfunction more commonly. Brain atrophy, emollition and vascular lesions are more often in RA patients than controls. <h3>Disclosure of Interest</h3> None declared