Neurosonological and cognitive screening for evaluation of systemic sclerosis patients

Changes of cerebral structure and perfusion in subtypes of systemic sclerosis: a brain magnetic resonance imaging study

OBJECTIVES

The characteristics of brain impairment in different subtypes of systemic sclerosis (SSc) (dcSSc, diffuse cutaneous SSc; lcSSc, limited cutaneous SSc) remain unclear. This study aimed to characterize cerebral structure and perfusion changes in different subtypes of SSc patients using magnetic resonance (MR) imaging.

METHODS

Seventy SSc patients (46.0 ± 11.7 years, 62 females) and 30 healthy volunteers (44.8 ± 13.7 years, 24 females) were recruited and underwent brain MR imaging and Montreal Cognitive Assessment (MoCA) test. Gray matter (GM) volumes were measured using voxel-based morphometry analysis on T1-weighted images. Voxel-based and regional cerebral blood flow (CBF) was calculated on arterial spin labelling images. The cerebral structural and perfusion measurements by MR imaging were compared among dcSSc, lcSSc and healthy subjects using one-way ANOVA. The correlations between clinical characteristics and MR imaging measurements were also analysed.

RESULTS

The dcSSc patients exhibited a significant reduction in GM volume in the para-hippocampal region (cluster P < 0.01, FWE corrected) compared with healthy volunteers. Whereas SSc patients, particularly lcSSc patients, showed elevated CBF in cerebellum, insula, cerebral cortex and subcortical structures (regional analyses: all P < 0.05; voxel-based analyses: cluster P < 0.01, FWE corrected). Furthermore, clinical characteristics of modified Rodnan skin score (mRSS) (r value ranged from -0.29 to -0.45), MoCA scores (r = 0.40) and anti-nuclear antibody (ANA) positivity (r = -0.33) were significantly associated with CBF in some regions (all P < 0.05).

CONCLUSION

The manifestations of brain involvement vary among different subtypes of SSc. In addition, severe skin sclerosis may indicate higher risk of brain involvement in SSc patients.

Brain functional alternation in patients with systemic sclerosis: a resting-state functional magnetic resonance imaging study

BACKGROUND

Neuropsychiatric manifestations, such as cognitive impairment, are relatively prevalent in systemic sclerosis (SSc) patients. This study aimed to investigate the resting state (RS) functional alternations of SSc patients and the potential influenced factors.

METHODS

Forty-four SSc patients (mean age, 46.3 ± 11.4 years; 40 females) and 19 age and sex comparable healthy volunteers (mean age, 42.6 ± 11.3 years; 16 females) were recruited and underwent RS functional MR imaging (fMRI) and neuropsychological assessments. Functional segregation analysis was performed to calculate the amplitude of low frequency fluctuation (ALFF) and regional homogeneity (ReHo). Functional integration analysis was conducted using group independent component analysis to calculate intra-network and inter-network functional connectivity (FC). The fMRI measurements were compared between SSc patients and healthy volunteers using voxel-based pairwise two-sample t-tests. The correlations between clinical characteristics and fMRI measurements were also analyzed.

RESULTS

Compared to healthy volunteers, SSc patients exhibited significantly decreased ALFF and increased ReHo (all P < 0.01, FWE corrected). SSc patients predominantly showed decreased intra-network and inter-network FC in the auditory network, visual network, default mode network, frontoparietal network and attention network (intra-network FC: P < 0.01, uncorrected, cluster size > 30; inter-network FC: P < 0.05, FDR correction). Furthermore, clinical characteristics including disease duration (r value ranged from - 0.31 to 0.36), elevated erythrocyte sedimentation rate (r = 0.35), Montreal Cognitive Assessment score (r = 0.43), and Hamilton Depression Scale score (r = -0.40) were significantly associated with fMRI measurements (all P < 0.05).

CONCLUSIONS

Spontaneous activity and functional connectivity alternations can be seen in SSc patients, which are partially associated with neuropsychiatric manifestations and tend to aggravate with disease duration.

Mild cognitive impairment in patients with systemic sclerosis and features analysis

OBJECTIVE

Nervous system damage in patients with SSc has recently attracted attention. In this study, we aimed to explore mild cognitive impairment (MCI) in SSc patients and the characteristics of these patients.

METHODS

A total of 103 SSc patients were consecutively enrolled from July 2018 to May 2019, and 97 matched healthy individuals were also included as controls. Brief cognitive tests, such as the Beijing version of the Montreal Cognitive Assessment (MoCA-BJ), were used to assess the cognitive function of all subjects. We compared the differences in MCI between SSc patients and healthy controls, as well as the differences in demographic and clinical features between SSc patients with and without MCI. Associations of quantitative demographic and clinical features with MoCA-BJ scores in the SSc patients were also evaluated.

RESULTS

The score of MoCA-BJ was lower in the SSc group compared with those in the healthy group [24 (9-30) vs 26 (15-30), P < 0.001]. MCI (MoCA-BJ score ≤ 25) was found in 61.2% (63/103) of the enrolled SSc patients but only in 27.8% (27/97) of the healthy individuals. Other tests evaluating some of the specific domains of cognitive functions showed that the SSc patients had impaired memory, attention and executive ability. Compared with SSc patients without MCI, SSc patients with MCI had lower education level, total serum protein and serum albumin but higher ANA positivity.

CONCLUSION

MCI is common in patients with SSc and should be drawn to the attention of rheumatologists. Lower education level, malnutrition and higher ANA positivity were closely related to the cognitive dysfunctions in SSc patients, providing directions for further interventions.

Evaluation of cognitive function in systemic sclerosis patients: a pilot study

OBJECTIVE

To investigate cognitive dysfunction in adult patients with systemic sclerosis (SSc) who had no known clinical neurological manifestations and to relate it with other disease severity parameters.

METHODS

In the present study, 20 SSc consecutive female patients, who met the 2013 American College of Rheumatology SSc criteria, were compared with 20 healthy age-, gender-, and educational status-matched volunteer hospital workers. Mean age and duration of illness were 41.8 ± 12.52 and 6.9 ± 5.4 years respectively. Mini-Mental State Examination (MMSE), Wechsler Adult Intelligence scale (WAIS-III), and P300 component of event-related potentials (ERPs) were used to evaluate cognitive function in SS subjectively and objectively respectively.

RESULTS

Sixty-five percent (13 out of 20) of SSc patients had MMSE score < 25, and cognitive impairment. Despite the lack of clinically apparent neurological manifestations, SSc patients had significantly low MMSE score, high Deterioration Index (DI), and prolonged P300 latency compared with that of the control group (P = 0.0001; 0.010 and 0.008 respectively). A significant positive association was found between (DI) and the Medsger severity vascular score (r = 0.518; P = 0.012).There were few differences between limited and diffuse SSc.

CONCLUSIONS

To our knowledge, few studies highlighted that subclinical cognitive impairment can occur in the course of SSc disease. Early diagnosis of cognitive impairment should be investigated either subjectively (using psychometrics tests as MMSE or WAIS-III) or objectively using P300 evoked related potentials. Medsger severity vascular score seems to be closely related to cognitive impairment.Key points• Cognitive impairment can be associated with Medsger Vascular severity score and the duration of illness.• Further larger studies will be needed to estimate the effect of disease activity on cognitive function, to further delineate the differences between limited and diffuse SSc in this area, and to understand the underlying pathophysiological mechanisms causing cognitive impairment in patients with SSc.• To investigate impaired cognitive function in patients with SSc, even in the absence of clinically apparent neurological and vascular disease.