Background Rheumatoid arthritis (RA) is a complex inflammatory disease that has features of atherosclerosis and cognitive decline. Although the relationship between atherosclerosis and cognitive impairment has been studied and replicated, whether cognitive deficits in RA can be attributed to their atherosclerotic changes is not well understood.
Objectives This study investigated the cognitive function in patients with RA using the Korean version of the Consortium to Establish a Registry for Alzheimer's disease (CERAD-K) neuropsychological battery and evaluated whether cognitive function was affected by the carotid arterial atherosclerosis.
Methods We examined seventy RA patients and forty healthy controls. RA activity was assessed by disease activity score with 28 joints-erythrocyte sedimentation rate (DAS28-ESR) and objective memory impairment was defined as a performance score of 1.5 standard deviations below the respective age-specific, education-specific, and sex-specific normative means for at least one of the four episodic memory tests in CERAD-K; the Word List Memory, Word List Recall, Word List Recognition, and Constructional Recall tests . Carotid arteries were scanned for the presence of plaque and intima-media thickness (IMT). We assessed potential risk factors of cognitive impairment in RA patients using regression analyses.
Results Of the CERAD-K subtests, there were a significant difference between the RA patients and healthy controls in verbal fluency (12.97±3.73 vs 15.48±4.57, respectively; p=0.004) and Boston Naming Test (11.50±2.08 vs 12.30±1.77, respectively; p=0.035). Carotid ultrasound revealed significantly more plaques in the RA patients than in the healthy controls (39% vs 15%, respectively; p=0.017). RA patients with memory impairment have significantly higher score of DAS28-ESR (4.14±0.99 vs 2.60±0.88, respectively; p<0.001), age (65.71±7.71 vs 58.50±11.33, respectively; p=0.009), and mean cIMT (0.56±0.10 vs 0.50±0.08, respectively; p=0.027) compared to RA patients without memory impairment. In multivariable regression analysis, CERAD-K total score showed a significant negative correlation with age (β=-0.415, p<0.001) or DAS28-ESR (β=-4.685, p<0.001), but no correlation was found between CERAD-K total score and presence of plaque or cIMT (Table 1).
Conclusions Our results indicate that disease activity of RA and aging contribute to cognitive impairment, but there was no association between cognitive function and clinical or subclinical carotid atherosclerotic changes in RA patients.
Lee JH, Lee KU, Lee DY, Kim KW, Jhoo JH, Kim JH, et al. Development of the Korean version of the consortium to Establish a Registry for Alzheimer's disease Assessment Packet (CERAD-K): clinical and neuropsychological assessment batteries. J Gerontol B Psychol Sci Soc Sci 2002;57:47–53.
Disclosure of Interest None declared