1
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Pankowski D, Wytrychiewicz-Pankowska K, Pisula E, Fal AM. Prevalence of neurocognitive impairment in patients with rheumatoid arthritis - a systematic review and meta-analysis. Clin Neuropsychol 2024:1-21. [PMID: 39086212 DOI: 10.1080/13854046.2024.2378521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Accepted: 07/06/2024] [Indexed: 08/02/2024]
Abstract
ObjectiveThis study aimed to evaluate prevalence rates (PRs) of neurocognitive impairment and its potential moderators among patients with rheumatoid arthritis (RA). MethodA systematic review of the available literature and data extraction was undertaken on 6 August 2021, with the update by 14 September 2023, by two reviewers independently. Literature was screened for reported rates of prevalence of neurocognitive impairment in RA patients. The meta-analysis was performed using RStudio with the "meta" library. ResultsTwenty-two studies that fulfilled all selection criteria were carefully analyzed. The PR of neurocognitive impairment was 0.49 [0.38-0.61] across all studies included in the review; 0.75 [0.54-0.88] for the MoCA; 0.56 [0.40-0.72] for the MMSE; and 0.26 [0.16-0.38] for comprehensive batteries. The meta-regression results indicated that, depending on the measurement method, the percentage of subjects with positive rheumatoid factor, women ratio, mean age of participants, mean duration of RA, and percentage of domains that had to be impaired to diagnose neurocognitive impairment turned out to be statistically significant moderators. ConclusionsNeurocognitive impairment is a clinically relevant condition in many RA patients, and its prevalence is alarming high.
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Affiliation(s)
- Daniel Pankowski
- Meta Research Centre, University of Wroclaw, Wroclaw, Poland
- Institute of Psychology, University of Wroclaw, Wroclaw, Poland
| | | | - Ewa Pisula
- Faculty of Psychology, University of Warsaw, Warsaw, Poland
| | - Andrzej M Fal
- Collegium Medicum, Cardinal Wyszynski University, Warsaw, Poland
- National Medical Institute of the Ministry of the Interior and Administration, Warsaw, Poland
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2
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Castellazzi M, Candeloro R, Pugliatti M, Govoni M, Silvagni E, Bortoluzzi A. Cerebrospinal Fluid Analysis in Rheumatological Diseases with Neuropsychiatric Complications and Manifestations: A Narrative Review. Diagnostics (Basel) 2024; 14:242. [PMID: 38337758 PMCID: PMC10854855 DOI: 10.3390/diagnostics14030242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 01/15/2024] [Accepted: 01/18/2024] [Indexed: 02/12/2024] Open
Abstract
The analysis of cerebrospinal fluid (CSF) remains a valuable diagnostic tool in the evaluation of inflammatory and infectious conditions involving the brain, spinal cord, and meninges. Since many rheumatic inflammatory diseases can involve the central and peripheral nervous system, the aims of this narrative review were to summarize the latest evidence on the use of CSF analysis in the field of neuropsychiatric manifestations of rheumatic diseases. Routine CSF parameters were taken into consideration for this review: appearance; total protein and cellular content (pleocytosis); lactate and/or glucose; CSF/serum albumin quotient; intrathecal synthesis of IgG. Data regarding the role of CSF analysis in the clinical management of neuropsychiatric systemic lupus erythematosus, primary Sjogren's syndrome, rheumatoid arthritis, and Behçet's syndrome are presented. Although no disease-specific picture has been identified, CSF analysis remains a useful diagnostic tool to confirm the presence of a neuro-inflammatory state or, conversely, to exclude the concomitant presence of other inflammatory/infectious diseases affecting the CNS in the context of systemic rheumatologic conditions.
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Affiliation(s)
- Massimiliano Castellazzi
- Department of Neurosciences and Rehabilitation, University of Ferrara, 44121 Ferrara, Italy; (R.C.); (M.P.)
| | - Raffaella Candeloro
- Department of Neurosciences and Rehabilitation, University of Ferrara, 44121 Ferrara, Italy; (R.C.); (M.P.)
| | - Maura Pugliatti
- Department of Neurosciences and Rehabilitation, University of Ferrara, 44121 Ferrara, Italy; (R.C.); (M.P.)
| | - Marcello Govoni
- Department of Medical Sciences, University of Ferrara, 44121 Ferrara, Italy; (M.G.); (E.S.); (A.B.)
| | - Ettore Silvagni
- Department of Medical Sciences, University of Ferrara, 44121 Ferrara, Italy; (M.G.); (E.S.); (A.B.)
| | - Alessandra Bortoluzzi
- Department of Medical Sciences, University of Ferrara, 44121 Ferrara, Italy; (M.G.); (E.S.); (A.B.)
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3
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Kang W, Whelan E, Malvaso A. Understanding Cognitive Deficits in People with Arthritis. Healthcare (Basel) 2023; 11:healthcare11091337. [PMID: 37174879 PMCID: PMC10178460 DOI: 10.3390/healthcare11091337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 04/28/2023] [Accepted: 05/03/2023] [Indexed: 05/15/2023] Open
Abstract
Cognitive deficits are commonly seen in people with arthritis. However, previous studies focused primarily on small-sized clinical samples. There is a need for cohort-based studies, which are characterized by high generalizability. In addition, these studies mainly focused on attention, memory, and executive function. However, cognition is not a single concept, but includes other cognitive domains, such as verbal fluency and arithmetic abilities. Thus, we aim to explore how arthritis can affect cognitive abilities, including episodic memory, semantic verbal fluency, fluid reasoning, and numerical ability by using a large cohort from the United Kingdom. The main findings were that people with arthritis have significantly lower immediate word recall (t(2257) = -6.40, p < 0.001, Cohen's d = -0.12, 95% C.I. = [-0.16, -0.08]), delayed word recall (t(2257) = -5.60, p < 0.001, Cohen's d = -0.11, 95% C.I. = [-0.14, -0.07]), semantic verbal fluency (t(2257) = -3.03, p < 0.01, Cohen's d = -0.06, 95% C.I. = [-0.10, -0.02]), fluid reasoning (t(2257) = -3.96, p < 0.001, Cohen's d = -0.07, 95% C.I. = [-0.11, -0.04]), and numerical ability (t(2257) = -3.85, p < 0.001, Cohen's d = -0.07, 95% C.I. = [-0.10, -0.03]) compared to what they would expect given their demographics. Interventions are needed to improve cognitive abilities in people with arthritis.
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Affiliation(s)
- Weixi Kang
- Imperial College London, London SW7 2BX, UK
| | - Edward Whelan
- Independent Researcher, 99MX QH Maynooth, County Kildare, Ireland
| | - Antonio Malvaso
- Department of Brain and Behavioral Sciences, University of Pavia, 27100 Pavia, Italy
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4
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Revealing the Role of Social Support on Cognitive Deficits in Fibromyalgia Syndrome. Behav Neurol 2022; 2022:3852746. [PMID: 36091221 PMCID: PMC9458397 DOI: 10.1155/2022/3852746] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 07/04/2022] [Accepted: 08/22/2022] [Indexed: 01/10/2023] Open
Abstract
Despite the relevance of cognitive deficits in fibromyalgia syndrome (FMS) and the attempts to elucidate the influence of the disorder symptoms in the cognitive decline reported by patients, no studies have explored the specific role of social support on cognition in FMS. Social support has been shown to be an essential modulator factor on cognitive performance in other diseases. Sixty-four women with FMS and 32 healthy women participated in the study and completed questionnaires pertaining to anxiety, depression, fatigue, insomnia, clinical pain, and social support, along with a neuropsychological battery assessing verbal memory, organization, strategic and planning abilities, self-regulation, processing speed, attention, and cognitive flexibility. Results showed that FMS patients exhibited lower values in all social support dimensions in comparison with healthy individuals, especially in the socializing dimension. Despite the lower social support observed in FMS, all social support dimensions showed a positive impact on verbal memory, organization and planning abilities, strategic planning, self-regulation, processing speed, attention, and cognitive flexibility in these patients. In fact, social support was associated with greater correct responses and processing speed and minor number of errors in all the neuropsychological battery tests. Socializing was the main predictor of organization and planning abilities, strategic planning, and self-regulation. In sum, results suggest that social support may be a key factor in buffering the cognitive decline observed in FMS. Designing psychoeducation programs and intervention programs directed not only to FMS patients but also relatives, health care workers, and the general population might be essential to improve the social support of FMS patients and positively impact on patient's cognitive status.
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5
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Hugon J. Rheumatoid arthritis and Cognitive decline. Joint Bone Spine 2022; 89:105346. [DOI: 10.1016/j.jbspin.2022.105346] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 12/23/2021] [Accepted: 01/06/2022] [Indexed: 11/30/2022]
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6
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Papastefanakis E, Dimitraki G, Ktistaki G, Fanouriakis A, Karamaouna P, Bardos A, Kallitsakis I, Adamichou C, Gergianaki I, Repa A, Bertsias G, Sidiropoulos P, Karademas E, Simos P. Screening for cognitive impairment in systemic lupus erythematosus: Application of the Montreal Cognitive Assessment (MoCA) in a Greek patient sample. Lupus 2021; 30:2237-2247. [PMID: 34861804 DOI: 10.1177/09612033211061062] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Cognitive impairment (CI) is one of the most frequent neuropsychiatric manifestations of systemic lupus erythematosus (SLE). Given that extensive neuropsychological testing is not always feasible in routine clinical practice, brief cognitive screening tools are desirable. The aim of this study was to evaluate the Montreal Cognitive Assessment (MoCA) as a screening tool for CI in SLE. METHODS Consecutive SLE patients followed at a single centre were evaluated using MoCA and an extensive neuropsychological test battery (NPT), including the Digits Forward and Digits Backwards, Rey Auditory Verbal Learning Memory Test, Trail Making Test, Stroop Colour-Word Test, Semantic and Phonetic Verbal Fluency tests and a 25-problem version of the General Adult Mental Ability test. The criterion validity of MoCA was assessed through receiver operating characteristic (ROC) analyses using three different case definitions: i) against normative population data, ii) and iii) against average performance of a comparison group of rheumatoid arthritis (RA) patients, to adjust for possible confounding effects of chronic illness and inflammatory processes on cognitive performance. The effect of patient-related (age, years of education, anxiety, depression, fatigue and pain) and disease-related (activity, damage, age at diagnosis, disease duration, use of glucocorticoid, psychotropic and pain medication) parameters on the MoCA was examined. RESULTS A total of 71 SLE patients were evaluated. MoCA significantly correlated with all NPT scores and was affected by education level (p < 0.001), but not by other demographic or clinical variables. The optimal cutoff for detecting CI, as defined on the basis of normative population data, was 23/30 points, demonstrating 73% sensitivity and 75% specificity. A cutoff of 22/30 points, using neuropsychological profiles of the RA group as inflammatory disease controls, exhibited higher sensitivity (100%, based on both definitions) and specificity (87% and 90%, depending on the definition). The standard cutoff of 26/30 points displayed excellent sensitivity (91-100%) with significant expenses in specificity (43-45%). CONCLUSION The MoCA is an easily applied tool, which appears to be reliable for identifying CI in SLE patients. The standard cutoff score (26/30) ensures excellent sensitivity while lower cutoff scores (22-23/30) may, also, provide higher specificity.
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Affiliation(s)
- Emmanouil Papastefanakis
- Department of Psychology, of Social Sciences, 381189University of Crete School of Social Science, Rethimno, Greece.,Nursing Department, School of Health Sciences, 554325Hellenic Mediterranean University, Heraklion, Greece
| | - Georgia Dimitraki
- Department of Psychology, of Social Sciences, 381189University of Crete School of Social Science, Rethimno, Greece
| | - Georgia Ktistaki
- Department of Psychiatry, 37778University of Crete School of Medicine, Heraklion, Greece
| | - Antonis Fanouriakis
- Department of Rheumatology, 68993National and Kapodistrian University of Athens, Athens, Greece.,Department of Rheumatology, Attikon University Hospital, Athens, Greece
| | - Penny Karamaouna
- Department of Psychology, of Social Sciences, 381189University of Crete School of Social Science, Rethimno, Greece
| | - Achilles Bardos
- School of Psychology, 214634University of Northern Colorado, Greeley, CO, USA
| | - Ioannis Kallitsakis
- Department of Rheumatology, Clinical Immunology and Allergy, 571850University of Crete, Heraklion, Greece
| | - Christina Adamichou
- Department of Rheumatology, Clinical Immunology and Allergy, 571850University of Crete, Heraklion, Greece
| | - Irini Gergianaki
- Department of Rheumatology, Clinical Immunology and Allergy, 571850University of Crete, Heraklion, Greece
| | - Argyro Repa
- Department of Rheumatology, Clinical Immunology and Allergy, 571850University of Crete, Heraklion, Greece
| | - George Bertsias
- Department of Rheumatology, Clinical Immunology and Allergy, 571850University of Crete, Heraklion, Greece.,Institute of Molecular Biology and Biotechnology, 54570Foundation of Research and Technology Hellas, Heraklion, Greece
| | - Prodromos Sidiropoulos
- Department of Rheumatology, Clinical Immunology and Allergy, 571850University of Crete, Heraklion, Greece.,Institute of Molecular Biology and Biotechnology, 54570Foundation of Research and Technology Hellas, Heraklion, Greece
| | - Evangelos Karademas
- Department of Psychology, of Social Sciences, 381189University of Crete School of Social Science, Rethimno, Greece
| | - Panagiotis Simos
- Department of Psychiatry, 37778University of Crete School of Medicine, Heraklion, Greece.,Institute of Computer Science, 54570Foundation of Research and Technology Hellas, Heraklion, Greece
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7
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Pankowski D, Wytrychiewicz-Pankowska K, Janowski K, Pisula E. Cognitive impairment in patients with rheumatoid arthritis: A systematic review and meta-analysis. Joint Bone Spine 2021; 89:105298. [PMID: 34656753 DOI: 10.1016/j.jbspin.2021.105298] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 09/16/2021] [Accepted: 10/06/2021] [Indexed: 12/31/2022]
Abstract
OBJECTIVE An increasing number of studies have demonstrated cognitive impairment in patients with rheumatoid arthritis (RA). The literature indicates many factors play an important role in this clinical problem, such as the severity of depressive symptoms and the treatment used. The aim of this study was to systematically review studies comparing cognitive functioning between healthy participants and RA patients and to determine both the severity and potential moderators of cognitive impairment. METHODS For this purpose, 16 studies that fulfilled all selection criteria were carefully selected. Altogether, 921 patients with RA (812 women and 109 men) and 700 controls participated in these studies. Due to the inability to perform a network meta-analysis, it was decided to determine the effect sizes for studies which used the same measurement methods. RESULTS The analysis demonstrated greater impairment of cognitive functioning in patients with RA than in healthy controls, with effect sizes ranging from small to large, depending on the assessment method used in the study. CONCLUSIONS The study pinpoints potential biases, lack of replication, and inconsistencies in reporting data as possible confounding factors and suggests further recommendations for assessment methods, research directions and clinical implications. CLINICAL TRIAL REGISTRATION Not applicable.
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Affiliation(s)
- Daniel Pankowski
- Institute of Psychology, University of Economics and Human Sciences in Warsaw, Okopowa 59, 01-030 Warsaw, Poland; Faculty of Psychology, University of Warsaw, Stawki 5/7, 00-183 Warsaw, Poland.
| | - Kinga Wytrychiewicz-Pankowska
- Institute of Psychology, University of Economics and Human Sciences in Warsaw, Okopowa 59, 01-030 Warsaw, Poland; Faculty of Psychology, University of Warsaw, Stawki 5/7, 00-183 Warsaw, Poland
| | - Konrad Janowski
- Institute of Psychology, University of Economics and Human Sciences in Warsaw, Okopowa 59, 01-030 Warsaw, Poland
| | - Ewa Pisula
- Faculty of Psychology, University of Warsaw, Stawki 5/7, 00-183 Warsaw, Poland
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8
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Richard-Devantoy S, Bertrand JA, Béziat S, Jaussent I, Cazals A, Ducasse D, Greenway KT, Guillaume S, Courtet P, Olié E. Psychological pain and depression: it's hard to speak when it hurts. Int J Psychiatry Clin Pract 2021; 25:180-186. [PMID: 33275047 DOI: 10.1080/13651501.2020.1836225] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To investigate the neuropsychological features of depressed patients reporting high level of psychological pain. METHODS Sixty-two inpatients were included and divided into two groups according to the level of psychological pain assessed by a Likert scale. Cognitive abilities were assessed using the Trail Making Test, the Stroop test, and Verbal Fluency Test (semantic and phonemic verbal fluency). Univariate and multivariate analyses were performed to determine neuropsychological factors associated with a high level of psychological pain. RESULTS The median level of psychological pain was 8/10. High level of psychological pain was associated with poor phonemic verbal fluency performance in men (p = 0.009), but not in women, even after controlling for confounding factors (age, level of depression, anxiety). Groups did not differ on the Trail Making Test, the Stroop test, or the semantic verbal fluency measure. CONCLUSION Psychological pain is a specific clinical entity that should be considered to be more significant than just a symptom of depression. High level of psychological pain appears to be associated with a deficit of phonemic verbal fluency in depressed men. This finding could help to target psychotherapeutic treatments and improve screening.Key pointsPatients with high psychological pain do not differ on the Trail Making Test, the Stroop Test or the Sematic Verbal Fluency Measure to patients with low psychological painHigh psychological pain is associated with a deficit in phonemic verbal fluency in depressed menFuture research should aim to clarify gender differences in psychological pain in participants with and without major depressive disorder, as well as explore the complex relationship between cognition and the different forms of pain (psychological, physical and psychosomatic).
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Affiliation(s)
- Stéphane Richard-Devantoy
- McGill Group for Suicide Studies, McGill University & Douglas Mental Health University Institute, Montréal, Canada.,CISSS des Laurentides, Saint-Jérôme, Canada
| | - Josie-Anne Bertrand
- CISSS des Laurentides, Saint-Jérôme, Canada.,Douglas Mental Health University Institute, Montréal, Canada
| | - Séverine Béziat
- Psychiatric Emergency and Post Emergency Department, Hospital Lapeyronie, CHU Montpellier, Montpellier, France
| | - Isabelle Jaussent
- Université Montpellier, Montpellier, France.,Inserm U1061, Montpellier, France
| | - Aurélie Cazals
- Psychiatric Emergency and Post Emergency Department, Hospital Lapeyronie, CHU Montpellier, Montpellier, France.,Université Montpellier, Montpellier, France
| | - Déborah Ducasse
- Psychiatric Emergency and Post Emergency Department, Hospital Lapeyronie, CHU Montpellier, Montpellier, France.,Université Montpellier, Montpellier, France
| | - Kyle T Greenway
- McGill Group for Suicide Studies, McGill University & Douglas Mental Health University Institute, Montréal, Canada
| | - Sébastien Guillaume
- Psychiatric Emergency and Post Emergency Department, Hospital Lapeyronie, CHU Montpellier, Montpellier, France.,Université Montpellier, Montpellier, France.,Inserm U1061, Montpellier, France
| | - Philippe Courtet
- Psychiatric Emergency and Post Emergency Department, Hospital Lapeyronie, CHU Montpellier, Montpellier, France.,Université Montpellier, Montpellier, France.,Inserm U1061, Montpellier, France
| | - Emilie Olié
- Psychiatric Emergency and Post Emergency Department, Hospital Lapeyronie, CHU Montpellier, Montpellier, France.,Université Montpellier, Montpellier, France.,Inserm U1061, Montpellier, France
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9
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Basile MS, Ciurleo R, Bramanti A, Petralia MC, Fagone P, Nicoletti F, Cavalli E. Cognitive Decline in Rheumatoid Arthritis: Insight into the Molecular Pathogenetic Mechanisms. Int J Mol Sci 2021; 22:ijms22031185. [PMID: 33530359 PMCID: PMC7865873 DOI: 10.3390/ijms22031185] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 01/19/2021] [Accepted: 01/22/2021] [Indexed: 12/21/2022] Open
Abstract
Cognitive decline refers to a deterioration of intellectual and learning abilities and related memory problems, and is often associated with behavioral alterations, which prevents sufferers from carrying out the most common daily activities, such as maintaining normal productive interpersonal relationships, communicating, and leading an autonomous life. Numerous studies have highlighted the association between cognitive decline and autoimmune disorders, including rheumatoid arthritis (RA). RA is a chronic, inflammatory, autoimmune disease that involves systems and organs other than the bones and joints, with varying severity among patients. Here, we review the studies investigating the link between cognitive decline and RA, focusing on the main molecular pathogenetic mechanisms involved. The emerging body of data suggests that clinical, psychological, and biological factors may contribute to the pathogenesis of cognitive decline in RA, including cardiovascular complications, chronic pain, depression, inflammatory factors, changes in hormone levels, drug side effects, and genetics. Further studies are warranted in order to fully clarify the basis underlying the association between cognitive decline and RA and to find new possible diagnostic strategies and therapeutic targets for RA patients.
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Affiliation(s)
- Maria Sofia Basile
- IRCCS Centro Neurolesi “Bonino-Pulejo”, Via Provinciale Palermo, Contrada Casazza, 98124 Messina, Italy; (M.S.B.); (R.C.); (A.B.); (M.C.P.)
| | - Rosella Ciurleo
- IRCCS Centro Neurolesi “Bonino-Pulejo”, Via Provinciale Palermo, Contrada Casazza, 98124 Messina, Italy; (M.S.B.); (R.C.); (A.B.); (M.C.P.)
| | - Alessia Bramanti
- IRCCS Centro Neurolesi “Bonino-Pulejo”, Via Provinciale Palermo, Contrada Casazza, 98124 Messina, Italy; (M.S.B.); (R.C.); (A.B.); (M.C.P.)
| | - Maria Cristina Petralia
- IRCCS Centro Neurolesi “Bonino-Pulejo”, Via Provinciale Palermo, Contrada Casazza, 98124 Messina, Italy; (M.S.B.); (R.C.); (A.B.); (M.C.P.)
| | - Paolo Fagone
- Department of Biomedical and Biotechnological Sciences, University of Catania, Via S. Sofia 89, 95123 Catania, Italy; (P.F.); (E.C.)
| | - Ferdinando Nicoletti
- Department of Biomedical and Biotechnological Sciences, University of Catania, Via S. Sofia 89, 95123 Catania, Italy; (P.F.); (E.C.)
- Correspondence:
| | - Eugenio Cavalli
- Department of Biomedical and Biotechnological Sciences, University of Catania, Via S. Sofia 89, 95123 Catania, Italy; (P.F.); (E.C.)
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10
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Chaurasia N, Singh A, Singh IL, Singh T, Tiwari T. Cognitive dysfunction in patients of rheumatoid arthritis. J Family Med Prim Care 2020; 9:2219-2225. [PMID: 32754477 PMCID: PMC7380780 DOI: 10.4103/jfmpc.jfmpc_307_20] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 03/19/2020] [Accepted: 04/15/2020] [Indexed: 12/12/2022] Open
Abstract
Rheumatoid Arthritis (RA) is a form of arthritis characterized by joint pain, stiffness, swelling and deformity. There has been plethora of researches in the area of rheumatoid arthritis which focused on immune system, genetic predisposition and newer treatment modalities. Researchers have also examined the cognitive decline, physical deficits and their interrelationship in patients with RA. Among several psychological aspects depression, anxiety and stress emerge as significant psychological co morbidity. RA is a multifactorial, chronic, inflammatory disease primarily affects physical functioning as well as psychological aspects. Pain, fatigue, duration of disease, disease activity and functional disability are very common in rheumatoid arthritis which is leading cause of psychological distress and functional disability. Various types of neuropsychological battery were used to assess the decline in specific areas like attention, executive functioning, visuo-spatial learning, verbal learning/memory etc. These functions were compared with other type of arthritis disease. Also, various other factors like depression, cardiovascular diseases, other systemic and chronic disease and concomitant drugs intake etc. also affected cognitive functioning in Rheumatoid Arthritis patients. The objective of this review was to identify and explore the rates and types of cognitive impairment in RA. This present review paper systematically examines and summarizes the cognition related decrement in arthritis patients. Multiple research articles between 1990 to 2018 were searched. These reviews were evaluated and synthesized using a narrative and descriptive approach.
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Affiliation(s)
- Neha Chaurasia
- Cognitive Science Laboratory, Department of Psychology, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Anup Singh
- Department of Geriatric Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Indramani L Singh
- Cognitive Science Laboratory, Department of Psychology, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Tara Singh
- Cognitive Science Laboratory, Department of Psychology, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Trayambak Tiwari
- Cognitive Science Laboratory, Department of Psychology, Banaras Hindu University, Varanasi, Uttar Pradesh, India
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11
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Oláh C, Schwartz N, Denton C, Kardos Z, Putterman C, Szekanecz Z. Cognitive dysfunction in autoimmune rheumatic diseases. Arthritis Res Ther 2020; 22:78. [PMID: 32293528 PMCID: PMC7158026 DOI: 10.1186/s13075-020-02180-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 04/01/2020] [Indexed: 02/08/2023] Open
Abstract
For people with chronic autoimmune rheumatic diseases (AIRD), such as rheumatoid arthritis (RA), systemic lupus erythematosus (SLE) or systemic sclerosis (SSc), normal cognitive functions are essential for performing daily activities. These diseases may be associated with cognitive dysfunction (CD). In RA, CD has been associated with age, lower education and disease duration and activity. Great advances have been achieved in neuropsychiatric SLE in the identification of pathogenic pathways, assessment and possible treatment strategies. SSc rarely exerts direct effects on the brain and cognitive function. However, the psychological burden that includes depression, anxiety and social impact may be high. AIRD patients with sustained disease activity, organ damage or lower education should be evaluated for CD. The control of systemic inflammation together with tailored behavioural cognitive therapies may benefit these patients.
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Affiliation(s)
- Csaba Oláh
- Departments of Neurosurgery, Borsod County Teaching Hospital, Miskolc, Hungary
| | - Noa Schwartz
- Division of Rheumatology, Albert Einstein College of Medicine, Bronx, NY, 10461, USA
| | - Christopher Denton
- Centre for Rheumatology, Royal Free Campus, University College London, London, UK
| | - Zsófia Kardos
- Departments of Rheumatology, Borsod County Teaching Hospital, Miskolc, Hungary
| | - Chaim Putterman
- Division of Rheumatology, Albert Einstein College of Medicine, Bronx, NY, 10461, USA.,Department of Microbiology & Immunology, Albert Einstein College of Medicine, Bronx, NY, 10461, USA.,Azrieli Faculty of Medicine of Bar Ilan University, Zefat, Israel.,Research Institute, Galilee Medical Center, Nahariya, Israel
| | - Zoltán Szekanecz
- Division of Rheumatology, Faculty of Medicine, University of Debrecen, Nagyerdei str 98, Debrecen, 4032, Hungary.
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12
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Jones HJ, Hubbard L, Mitchell RE, Jones SA, Williams NM, Zammit S, Hall J. Association of Genetic Risk for Rheumatoid Arthritis With Cognitive and Psychiatric Phenotypes Across Childhood and Adolescence. JAMA Netw Open 2019; 2:e196118. [PMID: 31225891 PMCID: PMC6593640 DOI: 10.1001/jamanetworkopen.2019.6118] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 05/06/2019] [Indexed: 12/17/2022] Open
Abstract
Importance The association of rheumatoid arthritis (RA) with cognitive and psychiatric phenotypes has been recognized. However, it is not known whether these phenotypes are a consequence of disease-related factors, such as pain, or reflect shared etiological factors. Objective To investigate whether genomic risk for RA is associated with cognitive and psychiatric symptoms in children and adolescents. Design, Setting, and Participants This cohort study analyzed data from 3296 to 5936 adolescents (depending on outcome) from the Avon Longitudinal Study of Parents and Children. Clinical and questionnaire data were collected periodically from September 6, 1990, with collection ongoing, and analyzed from August 21, 2017, to May 21, 2018. Exposures Polygenic risk scores (PRSs) for RA. Main Outcomes and Measures Measures of cognition (including IQ, working memory, verbal learning, processing speed, problem solving, selective attention, and attentional control) and psychopathology (including anxiety, depression, negative symptoms, psychotic experiences, attention-deficit/hyperactivity disorder, and hyperactive and inattentive symptoms) in childhood and adolescence. Results Polygenic risk scores for RA were generated for 7977 children and adolescents (3885 [48.7%] female). Of these 7977 participants, 9 (0.11%) had a known diagnosis of RA at age 22 years. Increased PRS for RA was associated with lower total IQ (β, -0.05; 95% CI, -0.07 to -0.02; P < .001), performance IQ (β, -0.03; 95% CI, -0.06 to -0.005; P = .02), and verbal IQ (β, -0.05; 95% CI, -0.08 to -0.02; P < .001) at age 8 years (mean [SD] age at measurement, 8.6 [0.3] years) and symptoms of hyperactivity and inattention from ages 4 to 16 years, with the strongest evidence of association at age 13 years (mean [SD] age at assessment, 13.2 [0.2] years). The odds ratio at this age per SD increase in PRS was 1.25 (95% CI, 1.12-1.39) (P < .001). There was little evidence of association between the RA PRS and other measures of cognition and psychopathology. Gene-based analyses indicated that polygenic signal for RA was enriched for immune pathways (q ≤ 0.05). No equivalent associations were seen for polygenic risk associated with inflammatory bowel disease or multiple sclerosis. Conclusions and Relevance These findings support an association between genetic risk for RA and neural phenotypes, suggesting that cognitive impairment in RA is not simply secondary to disease-related processes or treatment effects. These results may suggest that genetic susceptibility for RA might affect psychological well-being in early life and reinforce the emerging link between mental health and the immune system.
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Affiliation(s)
- Hannah J. Jones
- MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, United Kingdom
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust, University of Bristol, Bristol, United Kingdom
| | - Leon Hubbard
- Division of Psychological Medicine and Clinical Neurosciences, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, United Kingdom
| | - Ruth E. Mitchell
- MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, United Kingdom
| | - Simon A. Jones
- Division of Infection and Immunity, School of Medicine, Systems Immunity University Research Institute, College of Biomedical and Life Sciences, Cardiff University, Cardiff, United Kingdom
- The Hodge Centre for Neuropsychiatric Immunology, Cardiff University, Cardiff, United Kingdom
| | - Nigel M. Williams
- Division of Psychological Medicine and Clinical Neurosciences, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, United Kingdom
| | - Stanley Zammit
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust, University of Bristol, Bristol, United Kingdom
- Division of Psychological Medicine and Clinical Neurosciences, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, United Kingdom
| | - Jeremy Hall
- Division of Psychological Medicine and Clinical Neurosciences, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, United Kingdom
- The Hodge Centre for Neuropsychiatric Immunology, Cardiff University, Cardiff, United Kingdom
- Neuroscience and Mental Health Research Institute, Cardiff University, Cardiff, United Kingdom
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13
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Whitehouse CE, Fisk JD, Bernstein CN, Berrigan LI, Bolton JM, Graff LA, Hitchon CA, Marriott JJ, Peschken CA, Sareen J, Walker JR, Stewart SH, Marrie RA. Comorbid anxiety, depression, and cognition in MS and other immune-mediated disorders. Neurology 2019; 92:e406-e417. [PMID: 30635487 PMCID: PMC6369907 DOI: 10.1212/wnl.0000000000006854] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 09/27/2018] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE To determine whether anxiety and depression are associated with cognition in multiple sclerosis (MS), and whether these associations are similar in other immune-mediated inflammatory diseases (IMID; including inflammatory bowel disease [IBD] and rheumatoid arthritis [RA]) and in anxious/depressed individuals (ANX/DEP) without an IMID. METHODS Participants (MS: n = 255; IBD: n = 247; RA: n = 154; ANX/DEP: n = 308) completed a structured psychiatric interview, the Hospital Anxiety and Depression Scale, and cognitive testing, including the Symbol Digit Modalities Test, the California Verbal Learning Test, and Letter Number Sequencing test. Test scores were converted to age-, sex-, and education-adjusted z scores. We evaluated associations of anxiety and depression with the cognitive z scores using multivariate linear models, adjusting for disease cohort. RESULTS All cohorts exhibited higher rates of impairment (i.e., z less than or equal to -1.5) in the domains of processing speed, verbal learning, and delayed recall memory relative to general population norms. Higher levels of anxiety symptoms were associated with slower processing speed, lower verbal learning, and lower working memory performance (all p < 0.001); higher levels of depression symptoms were associated with slower processing speed. These associations did not differ across cohorts. CONCLUSION Anxiety and depression are associated with lower cognitive function in MS, with a similar pattern observed in persons with other IMID, including IBD and RA, and persons without an IMID. Managing symptoms of anxiety and of depression in MS, as well as other IMIDs, is important to mitigate their effect on cognition.
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Affiliation(s)
- Christiane E Whitehouse
- From the Departments of Psychology and Neuroscience (C.E.W., J.D.F., S.H.S.), Psychiatry (J.D.F.), and Medicine (J.D.F.), Dalhousie University; Nova Scotia Health Authority (J.D.F.), Halifax; Departments of Internal Medicine (C.N.B., J.J.M., C.A.P., C.A.H., R.A.M.), Psychiatry (J.M.B., J.S.), Clinical Health Psychology (L.A.G., J.R.W.), and Community Health Sciences (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg; and Department of Psychology (L.I.B.), St. Francis Xavier University, Antigonish, Canada
| | - John D Fisk
- From the Departments of Psychology and Neuroscience (C.E.W., J.D.F., S.H.S.), Psychiatry (J.D.F.), and Medicine (J.D.F.), Dalhousie University; Nova Scotia Health Authority (J.D.F.), Halifax; Departments of Internal Medicine (C.N.B., J.J.M., C.A.P., C.A.H., R.A.M.), Psychiatry (J.M.B., J.S.), Clinical Health Psychology (L.A.G., J.R.W.), and Community Health Sciences (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg; and Department of Psychology (L.I.B.), St. Francis Xavier University, Antigonish, Canada
| | - Charles N Bernstein
- From the Departments of Psychology and Neuroscience (C.E.W., J.D.F., S.H.S.), Psychiatry (J.D.F.), and Medicine (J.D.F.), Dalhousie University; Nova Scotia Health Authority (J.D.F.), Halifax; Departments of Internal Medicine (C.N.B., J.J.M., C.A.P., C.A.H., R.A.M.), Psychiatry (J.M.B., J.S.), Clinical Health Psychology (L.A.G., J.R.W.), and Community Health Sciences (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg; and Department of Psychology (L.I.B.), St. Francis Xavier University, Antigonish, Canada
| | - Lindsay I Berrigan
- From the Departments of Psychology and Neuroscience (C.E.W., J.D.F., S.H.S.), Psychiatry (J.D.F.), and Medicine (J.D.F.), Dalhousie University; Nova Scotia Health Authority (J.D.F.), Halifax; Departments of Internal Medicine (C.N.B., J.J.M., C.A.P., C.A.H., R.A.M.), Psychiatry (J.M.B., J.S.), Clinical Health Psychology (L.A.G., J.R.W.), and Community Health Sciences (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg; and Department of Psychology (L.I.B.), St. Francis Xavier University, Antigonish, Canada
| | - James M Bolton
- From the Departments of Psychology and Neuroscience (C.E.W., J.D.F., S.H.S.), Psychiatry (J.D.F.), and Medicine (J.D.F.), Dalhousie University; Nova Scotia Health Authority (J.D.F.), Halifax; Departments of Internal Medicine (C.N.B., J.J.M., C.A.P., C.A.H., R.A.M.), Psychiatry (J.M.B., J.S.), Clinical Health Psychology (L.A.G., J.R.W.), and Community Health Sciences (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg; and Department of Psychology (L.I.B.), St. Francis Xavier University, Antigonish, Canada
| | - Lesley A Graff
- From the Departments of Psychology and Neuroscience (C.E.W., J.D.F., S.H.S.), Psychiatry (J.D.F.), and Medicine (J.D.F.), Dalhousie University; Nova Scotia Health Authority (J.D.F.), Halifax; Departments of Internal Medicine (C.N.B., J.J.M., C.A.P., C.A.H., R.A.M.), Psychiatry (J.M.B., J.S.), Clinical Health Psychology (L.A.G., J.R.W.), and Community Health Sciences (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg; and Department of Psychology (L.I.B.), St. Francis Xavier University, Antigonish, Canada
| | - Carol A Hitchon
- From the Departments of Psychology and Neuroscience (C.E.W., J.D.F., S.H.S.), Psychiatry (J.D.F.), and Medicine (J.D.F.), Dalhousie University; Nova Scotia Health Authority (J.D.F.), Halifax; Departments of Internal Medicine (C.N.B., J.J.M., C.A.P., C.A.H., R.A.M.), Psychiatry (J.M.B., J.S.), Clinical Health Psychology (L.A.G., J.R.W.), and Community Health Sciences (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg; and Department of Psychology (L.I.B.), St. Francis Xavier University, Antigonish, Canada
| | - James J Marriott
- From the Departments of Psychology and Neuroscience (C.E.W., J.D.F., S.H.S.), Psychiatry (J.D.F.), and Medicine (J.D.F.), Dalhousie University; Nova Scotia Health Authority (J.D.F.), Halifax; Departments of Internal Medicine (C.N.B., J.J.M., C.A.P., C.A.H., R.A.M.), Psychiatry (J.M.B., J.S.), Clinical Health Psychology (L.A.G., J.R.W.), and Community Health Sciences (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg; and Department of Psychology (L.I.B.), St. Francis Xavier University, Antigonish, Canada
| | - Christine A Peschken
- From the Departments of Psychology and Neuroscience (C.E.W., J.D.F., S.H.S.), Psychiatry (J.D.F.), and Medicine (J.D.F.), Dalhousie University; Nova Scotia Health Authority (J.D.F.), Halifax; Departments of Internal Medicine (C.N.B., J.J.M., C.A.P., C.A.H., R.A.M.), Psychiatry (J.M.B., J.S.), Clinical Health Psychology (L.A.G., J.R.W.), and Community Health Sciences (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg; and Department of Psychology (L.I.B.), St. Francis Xavier University, Antigonish, Canada
| | - Jitender Sareen
- From the Departments of Psychology and Neuroscience (C.E.W., J.D.F., S.H.S.), Psychiatry (J.D.F.), and Medicine (J.D.F.), Dalhousie University; Nova Scotia Health Authority (J.D.F.), Halifax; Departments of Internal Medicine (C.N.B., J.J.M., C.A.P., C.A.H., R.A.M.), Psychiatry (J.M.B., J.S.), Clinical Health Psychology (L.A.G., J.R.W.), and Community Health Sciences (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg; and Department of Psychology (L.I.B.), St. Francis Xavier University, Antigonish, Canada
| | - John R Walker
- From the Departments of Psychology and Neuroscience (C.E.W., J.D.F., S.H.S.), Psychiatry (J.D.F.), and Medicine (J.D.F.), Dalhousie University; Nova Scotia Health Authority (J.D.F.), Halifax; Departments of Internal Medicine (C.N.B., J.J.M., C.A.P., C.A.H., R.A.M.), Psychiatry (J.M.B., J.S.), Clinical Health Psychology (L.A.G., J.R.W.), and Community Health Sciences (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg; and Department of Psychology (L.I.B.), St. Francis Xavier University, Antigonish, Canada
| | - Sherry H Stewart
- From the Departments of Psychology and Neuroscience (C.E.W., J.D.F., S.H.S.), Psychiatry (J.D.F.), and Medicine (J.D.F.), Dalhousie University; Nova Scotia Health Authority (J.D.F.), Halifax; Departments of Internal Medicine (C.N.B., J.J.M., C.A.P., C.A.H., R.A.M.), Psychiatry (J.M.B., J.S.), Clinical Health Psychology (L.A.G., J.R.W.), and Community Health Sciences (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg; and Department of Psychology (L.I.B.), St. Francis Xavier University, Antigonish, Canada
| | - Ruth Ann Marrie
- From the Departments of Psychology and Neuroscience (C.E.W., J.D.F., S.H.S.), Psychiatry (J.D.F.), and Medicine (J.D.F.), Dalhousie University; Nova Scotia Health Authority (J.D.F.), Halifax; Departments of Internal Medicine (C.N.B., J.J.M., C.A.P., C.A.H., R.A.M.), Psychiatry (J.M.B., J.S.), Clinical Health Psychology (L.A.G., J.R.W.), and Community Health Sciences (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg; and Department of Psychology (L.I.B.), St. Francis Xavier University, Antigonish, Canada.
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Tchessalova D, Posillico CK, Tronson NC. Neuroimmune Activation Drives Multiple Brain States. Front Syst Neurosci 2018; 12:39. [PMID: 30210310 PMCID: PMC6123349 DOI: 10.3389/fnsys.2018.00039] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 08/07/2018] [Indexed: 12/11/2022] Open
Abstract
Neuroimmune signaling is increasingly identified as a critical component of neuronal processes underlying memory, emotion and cognition. The interactions of microglia and astrocytes with neurons and synapses, and the individual cytokines and immune signaling molecules that mediate these interactions are a current focus of much research. Here, we discuss neuroimmune activation as a mechanism triggering different states that modulate cognitive and affective processes to allow for appropriate behavior during and after illness or injury. We propose that these states lie on a continuum from a naïve homeostatic baseline state in the absence of stimulation, to acute neuroimmune activity and chronic activation. Importantly, consequences of illness or injury including cognitive deficits and mood impairments can persist long after resolution of immune signaling. This suggests that neuroimmune activation also results in an enduring shift in the homeostatic baseline state with long lasting consequences for neural function and behavior. Such different states can be identified in a multidimensional way, using patterns of cytokine and glial activation, behavioral and cognitive changes, and epigenetic signatures. Identifying distinct neuroimmune states and their consequences for neural function will provide a framework for predicting vulnerability to disorders of memory, cognition and emotion both during and long after recovery from illness.
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Affiliation(s)
- Daria Tchessalova
- Neuroscience Graduate Program, School of Medicine, University of Michigan, Ann Arbor, MI, United States
| | | | - Natalie Celia Tronson
- Neuroscience Graduate Program, School of Medicine, University of Michigan, Ann Arbor, MI, United States.,Department of Psychology, University of Michigan, Ann Arbor, MI, United States
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Abstract
Rheumatoid arthritis (RA) patients may suffer from comorbid neuropsychiatric symptoms including mild cognitive impairment (MCI). Although comorbidity of MCI is common, there are currently no validated plasma biomarkers to aid MCI diagnosis. This study screened plasma from patients with RA with and without comorbid MCI to identify potential biomarkers useful in the differential diagnosis of comorbid MCI. Plasma samples were collected from patients with RA without comorbid MCI, with comorbid MCI, and from healthy controls. Plasma samples were examined by tandem mass tags (TMT) combined with two-dimensional liquid chromatography-tandem mass spectrometry (2D-LC-MSMS) to analyze protein expression. Differentially expressed proteins were identified by bioinformatics and validated by enzyme-linked immunosorbent assay (ELISA). A total of 746 reliable proteins and 158 differentially expressed proteins were identified. Fourteen patients with RA-MCI showed differential protein expression (six proteins upregulated and eight proteins downregulated) compared with those patients without MCI and with healthy controls. Bioinformatics analysis showed that the differentially expressed proteins were primarily involved in biological processes, such as cell adhesion, coagulation, apoptosis, and body fluid regulation. The results of the ELISA experiments, similar to those of the proteomic analysis, demonstrated that sonic hedgehog (SHH) was upregulated and serum paraoxonase (TTR) was downregulated in patients with RA-MCI. These results indicate that SHH and TTR may be candidate plasma biomarkers that could be used to distinguish patients with RA and comorbid MCI from those without comorbid MCI.
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