Risk factors of cognitive function impairment in patients with systemic sclerosis

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OBJECTIVES: Systemic sclerosis (SSc) is characterised by generalised vasculopathy and multi-organ fibrosis. Cognitive impairment may develop among SSc patients, affecting attention, memory and solving complicated tasks. Previous studies have identified microvascular abnormalities in the brain; however, no complex investigation has clarified these cognitive symptoms. This study examined the associations between cognitive functions and detailed clinical parameters regarding SSc. METHODS: One hundred and sixty patients with SSc and 62 age- and sex-matched healthy controls were studied and followed up for a span of twelve months. Clinical data and results of neuropsychological tests were analysed, including the Mini-Mental State Examination (MMSE), Digit Span Forward-Backward, Trail Making A, B and Digit Symbol tests at baseline and one-year follow-up. RESULTS: In the early stages of the disease, there was no cognitive impairment, even in severe patients with diffuse cutaneous SSc. Based on linear regression models, the cognitive scores were independently influenced by patients' age, degree of education, pain intensity, employment status, presence of hypertension, level of haemoglobin, in addition cardiac function and muscle strength. One-year follow-up results in changes in the six-minute walk distance (6MWT) correlated with changes in the results of MMSE (p=0.002, rho=0.259). CONCLUSIONS: In addition to age, level of education, employment, presence of chronic hypertension and pain, which are well-known factors affecting cognitive abilities in general population, we have highlighted the role of cardiovascular function, the diastolic dysfunction, the level of haemoglobin and decreased muscle strength in SSc individuals. These cardiovascular function and muscle condition can be characterised by the 6MWT. CLINICAL TRIALS: gov ID: NCT06029335.

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