Dr. Katz also pointed to some of the factors associated with cognitive dysfunction in people with RA, some of which are also seen in the general populations. These include certain medications, such as oral glucocorticoids. Comorbid conditions, such as cardiovascular disease and cerebrovascular disease, increase risk. Depression is an especially important factor to treat and address, as it may sometimes partly manifest with impaired cognitive function. Lifestyle issues, especially poor sleep and low levels of physical activity, also seem to play a role.
Scleroderma
More than half of people with scleroderma may experience bothersome symptoms affecting their memory and executive function, with at least one study reporting this number at 87%. In addition to factors already discussed, patients with scleroderma may have additional disease-related factors related to cognitive dysfunction, such as poorer nutrition and decreased oxygen intake.10-13
Dr. Chen emphasized the importance of providing patients with compensatory strategies to help them better navigate their cognitive challenges. For example, establishing routines, setting reminders (e.g., on a phone) and making to-do lists can all help patients better manage their lives.
Relatedly, Dr. Chen discussed her work with the Brain Boost Program, designed as an eight-week online educational group-based program as part of a pilot randomized, controlled trial. Through the program, participants play online brain games to sharpen their mental acuity and also learn cognitive strategies and lifestyle modifications to help them better manage their situation. Although results of the trial are not yet available, many participants have shared enthusiastic responses.14
Management Considerations
Sometimes, just asking about potential cognitive symptoms is enough to begin a helpful discussion. Dr. Whibley also recommended the National Institutes of Health (NIH) Toolbox Cognition Battery as a resource to provide brief initial screening and assessment, although this shouldn’t replace more thorough testing when needed. Dr. Chen also recommended the cognitive function measure on PROMIS (Patient-Reported Outcomes Measurement Information System), which assesses an individual’s perceived cognitive abilities.
Dr. Katz noted that disease control is an important element of addressing cognitive concerns, as patients with higher inflammation and pain are likely to have greater problems with cognitive functioning. She also recommended minimizing steroid use, controlling comorbidities, especially cardiovascular disease, and treating such mental health issues as depression. Encouraging exercise and screening for sleep problems are also critical.
Dr. Chen also suggested involving occupational and/or physical therapists who can help provide specific cognitive aids and strategies, help patients manage their energy and tailor exercise programs to patients’ specific abilities. If available, cognitive rehabilitation programs can also be beneficial.
