SAT0641-HPR FACTORS ASSOCIATED WITH COGNITIVE IMPAIRMENT IN KOREAN ADULTS WITH RHEUMATOID ARTHRITIS
Authors: S. Y. Shin, J. H. Lee, B. Y. Youn
Journal: Annals of the Rheumatic Diseases (2020)

Background: For persons with chronic diseases including rheumatoid arthritis (RA), undamaged cognitive capacity is critical for daily functioning, treatment compliance, and self-management. Disease-specific features of RA such as systemic chronic inflammation or increased comorbid cardiovascular disease (CVD) risk may be closely linked to neurocognitive dysfunction in RA patients [1]. However, the evidence of brain involvement in RA is very rare or even controversial and very little is known about the pathogenic mechanisms of cognitive decline in persons with RA. Objectives: This study explored the prevalence of cognitive impairment in Korean adults with RA using a set of computerized neurocognitive tests and the factors that were significantly associated with cognitive impairment. Methods: Individuals with RA were recruited by their rheumatologists during follow-up visits at one university hospital in Korea. After getting signed consents, a trained research nurse assessed participants with a range of physical, psychosocial, and biological metrics. Cognitive function was assessed using a set of 6 computerized neurocognitive tests yielding 18 indices covering a range of cognitive domains. Subjects were classified as ‘impaired’ if they performed 1 SD below age-based population norms on each test [2]. The total cognitive function score was calculated by summing the transformed scores, ranging from 0 (no impairment) to 18 (worst impairment). Multiple linear regression analyses were conducted to identify the significant factors influencing cognitive impairment. Results: Sixty five subjects with a mean (± SD ) age of 61.9 (±10.0) years were included. 85% were female, 89% were married, and 76% had less 12 years of education. Mean disease activity score (DAS-28) was 2.3 (±1.3) and mean disease duration was 9.8 (±8.7) years. Mean functional limitations score (HAQ) was 0.3 (±0.5) and mean CVD risk factors were 2.3 (±1.5). Total cognitive function score was 11.1 ± 4.0 (2-18). The proportion of persons who were classified as cognitively impaired on each test ranged from 25% to 92%. The proportion of persons classified as cognitively impaired on the quarter of total subtests (5 or more out of 18 subtests) was 94%. The multivariate regression model was statistically significant and accounted for 39% of the variance in cognitive impairment (F=5.26, p &lt;.001). Education (β=-0.32, p =0.010), family income (β=-0.26, p =0.040), and cardiovascular disease risk factors (β=0.27, p =0.025) were significantly associated with cognitive impairment controlling for other covariates. Conclusion: A significant number of RA patients were cognitively impaired. Less education, less family income, and increased cardiovascular disease risk factors were the significant factors affecting cognitive impairment in RA. The findings of this study suggest that the burden of cognitive impairment in RA patients is significant, and future studies identifying specific etiological contributors to cognitive impairment are warranted. References: [1]Wallin, K., Solomon, A., Kåreholt, I., Tuomilehto, J., Soininen, H., &amp; Kivipelto, M. (2012). Midlife rheumatoid arthritis increases the risk of cognitive impairment two decades later: a population-based study. Journal of Alzheimer’s Disease, 31 (3), 669-676. [2]Kozora, E., Ellison, M. C., &amp; West, S. (2004). Reliability and validity of the proposed American College of Rheumatology neuropsychological battery for systemic lupus erythematosus. Arthritis Care &amp; Research, 51 (5), 810-818. Acknowledgments: This research was supported by the 2018 Inje University research grant (No.20180148). Disclosure of Interests: None declared