Cognitive impairment in radiographic axial spondyloarthritis patients and its relation to disease characteristics

Abstract

Aim of the work

Cognitive involvement in patients with radiographic axial spondyloarthritis (r-axSpA) has not been sufficiently studied. This study aimed to assess cognitive functions in these patients and their relation to disease characteristics.

Patients and methods

Sixty r-axSpA patients and 60 age, sex- and education-matched healthy controls were enrolled. Disease activity was assessed by the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and functional impairment by the Bath Ankylosing Spondylitis Functional Index (BASFI). Patients and controls were assessed by the Depression, Anxiety and Stress scale (DASS) and the Montreal Cognitive Assessment (MoCA) Basic test.

Results

The mean age of the patients was 35.8 ± 8.6 years, median disease duration of 10 years, 52 (86.7 %) were males and the educational attainment was 13.4 ± 4.7 years. The median BASDAI was 4.45 (3.75– 5.65) and BASFI was 5.1 (3.5–6.7). The patients experienced different grades of depression (78.4 %), anxiety (71.7 %) and stress (76.7 %) compared to 15 %, 31.7 %, and 30 % of the control, respectively (p < 0.001). Eighteen (30 %) patients showed impaired cognitive functions on the MoCA B test (score < 26) versus none of the controls (p < 0.001). Executive function, immediate recall, fluency, abstraction and visuoperception were more frequently involved in patients (p = 0.001, p = 0.022, p = 0.011, p = 0.001 and p = 0.001, respectively). Impaired MoCA was significantly associated with older age (p = 0.029), lower education levels (p = 0.003), and higher BASFI (p = 0.003), but not with disease duration, BASDAI or DASS scores.

Conclusion

Cognitive impairment is frequent among r-axSpA patients and is associated with older age, lower educational attainment, and more functional limitations.