Background Patients with primary Sjogren’s syndrome frequently report cognitive symptoms. Self-report assessment tools can be used to screen patients who might benefit from neuropsychological evaluation, but no tool has been validated in Sjogren’s syndrome. The Brief Cognitive Symptoms Index (BCSI) consists of 6 items selected from the 21-item Cognitive Symptoms Inventory (CSI) developed by Pincus et al¹. In previous research, patients with pSS had more cognitive complaints than healthy controls and the BCSI overall score correlated with performance on tests of attention and cognitive efficiency²,³.
Objectives To validate the Brief Cognitive Symptoms Index (BCSI) in primary SS for use in clinical studies and clinical practice.
Methods One hundred and seventy subjects completed a health survey which included measures of fatigue: the Profile of Fatigue (ProF), the FSS and the FCIS; sleep (PSQI) and mood (CES-D). Three study groups were defined: pSS patient group A (n=64); SLE patient group B (n=74) and health controls, group C (n=23.) All SS met AECG (2002) criteria for primary SS. All SLE patients met ACR criteria for lupus. The total cognitive score distribution was analyzed to establish cutoff criteria for case definition. Pearson correlation coefficients were calculated to assess relationships between BCSI score and other clinical variables.
Results As expected, SLE and pSS patient groups had similar (p=0.66) BCSI scores and both groups (Table 1) were significantly different from controls (p<0.001). Cognitive scores correlated with the ProF mental domain scores (r=0.82) and to the (FCIS) (r=0.75, p≤0.0001). Correlations with measures of somatic fatigue (FSS r=.64; ProF-S. r=.57), depression (CES-D. r=.58) and sleep disorder (PSQI, r=.53) were also highly significant (all p’s ≤0.0001). A cut off score of 50 is suggested for the definition of cognitive dysfunction based on the finding that a score of 50 corresponded to 86% of the distribution.
Conclusions The BCSI is a promising screening instrument which is suitable for evaluation of patients with cognitive complaints in clinical research and practice settings. BCSI scores should be interpreted no further than as indicating that neuropsychological assessment and attention may be necessary, and should, therefore, be sought.
Pincus T, Callahan LF. A self-report cognitive symptoms inventory to assess patients with rheumatic diseases: results in eosinophillia-myalgia syndrome (EMS), fibromyalgia, rheumatoid arthritis and other rheumatic diseases. Arth Rheum 1996;29, S261.
Segal BM et al. Primary Sjogren’s syndrome: health experiences and predictors of health quality among patients in the United States. Health and Quality of Life Outcomes 2009;7:46.
Segal BM et al. Disruption of brain white matter microstructure in primary Sjogren’s syndrome: evidence from diffusion tensor imaging. Rheumatology 2010:49; 1530-1539.
Disclosure of Interest None Declared