Background There is an increased appreciation of the burden of cognitive impairment in people with autoimmune diseases. Autoantibodies, cytokines and cardiovascular disease (CVD) risk factors have been shown to contribute in different levels. Furthermore, recent studies have demonstrated diffuse white matter involvement and cerebral hypoperfusion in Systemic Sclerosis (SSc) patients.
Objectives To evaluate the prevalence of cognitive impairment in SSc and to determine the role of disease related features and CVD risk factors in its occurrence.
Methods Consecutive SSc patients [42 (68.85%) limited SSc (lSSc) and 19 (31.15%) with diffuse SSc (dSSc)] from the State University of Campinas were enrolled. Controls were age and sex matched and had the same educational level and sociodemographic background as SSc patients. Montreal Cognitive Assessment (MoCA) was used to assess cognitive dysfunction and scores ≤26 were considered abnormal. Mood disorders were determined through Becks Depression and Anxiety Inventory in all participants. CVD risk factors (hypertension, diabetes mellitus, insulin resistance, obesity, dyslipidemia) were screened in all individuals according to 2009 Joint Interim Statement on Metabolic Syndrome. SSc patients were further clinically and laboratory assessed to determine organ involvement, autoantibody profile (anti-topoisomerase I, anticentromere, and anti-RNA polymerase III), disease activity (Valentine Activity Index) and disease severity (Medsger Severity Index). Data were compared by non-parametric tests.
Results A total of 61 SSc (55 female; mean age =50.9; SD ±11.6) and 40 health subjects (38 female; mean age=53.1; SD ±13.1) (p=0.7) were included in the study. Active disease was observed in 15 (24.59%) SSc patients. Cognitive impairment was identified in 53 (86.89%) SSc patients (38 lSSc and 15 dSSc) and in 5 (12.5%) health controls (p<0.001). Cognitive impaired SSc patients were significantly younger than controls (p=0.01). Cognitive impaired SSc patients were significantly older [mean age of 52.30 (SD=11.58); vs 41.95 (SD=9.17); p=0.016] and had higher insulin resistance evaluated by homeostatic model assessment (HOMA) (p=0.01) when compared to SSc without cognitive impairment. No association with other metabolic or disease related variables, disease's activity or severity was identified.
Conclusions An increased prevalence of cognitive impairment was observed in SSc and associated with age and insulin resistance. Nonetheless, cognitive impairment seems to be an early age-related process in SSc when compared to healthy controls.
Disclosure of Interest None declared