Exploring Cognitive Dysfunction in Rheumatology

CHICAGO—At a session of ACR Convergence 2025, speakers discussed the impacts of cognitive dysfunction in rheumatic diseases, such as fibromyalgia, rheumatoid arthritis (RA) and scleroderma, with an emphasis on how rheumatologists may manage such patients.

Personal Impact of Brain Fog

Many patients with rheumatic diseases report symptoms of impaired cognitive function, often described by patients as brain fog. This phenomenon has largely not been part of classical disease descriptions, and thus many patients have unsurprisingly felt that clinicians haven’t fully appreciated or acknowledged such complaints.

Such symptoms may be mild when considered on the full spectrum of cognitive dysfunction, cognitive impairment and dementia, but still highly significant to patients.

Ms. Mary Alore

Mary Alore, MBA, is a patient with systemic sclerosis and a peer mentor for the University of Michigan Scleroderma Program, Ann Arbor. She said, “You’re just not the way you were before. It may be invisible, but its impact is deeply felt.”

Ms. Alore shared how brain fog can make patients feel forgetful and make them second guess their actions. They might misinterpret directions or have difficulty following group discussions.

She explained how brain fog can lead to social isolation, to safety concerns, to falling short of responsibilities (e.g., paying bills). “This brain fog isn’t just an annoying symptom,” said Ms. Alore. “It affects our home, our work, our personal lives and our health.”

Another speaker, Yen Chen, PhD, a research assistant professor in the Department of Physical Medicine and Rehabilitation at the University of Michigan, partners with Ms. Alore on a cognitive rehabilitation program for patients with scleroderma, the Brain Boost Program. “Many scleroderma participants describe brain fog as one of their most bothersome symptoms,” she shared.

Dr. Yen Chen

Dr. Chen also pointed out that in addition to these personal impacts, cognitive symptoms can make it harder for patients to manage their disease, for example, through missing medications or medical appointments.

Cognitive Dysfunction in Different Rheumatic Conditions

Researchers have begun studying cognitive dysfunction across a variety of conditions, including fibromyalgia, systemic lupus erythematosus, rheumatoid arthritis and scleroderma.¹ Prevalence likely varies somewhat based on the specific disease, severity, comorbidities, medications, lifestyle choices and other factors, but much is still unknown.

One challenge assessing incidence and impact is that assessment for cognitive dysfunction hasn’t been standardized in this setting. Thus, some tests might miss milder levels of dysfunction, and some might not assess the key affected cognitive domains. Patient-reported outcomes can sometimes provide helpful insights, but these measures don’t always match up with objective tests in a laboratory setting.