Rather than show evidence of global cognitive impairment, patients with systemic sclerosis may have differences in specific cognitive domains and higher anxiety compared with healthy controls, according to a study.
In a cross-sectional study, researchers evaluated 30 patients who had systemic sclerosis (SSc) compared with 40 patients who had rheumatoid arthritis (RA) and 30 healthy controls from a prior cohort. The participants were asked to complete standardized cognitive tests, including the Montreal Cognitive Assessment (MoCA), Trail Making Test (TMT), Victoria Stroop Test (VST), and a processing speed task from the Wechsler Adult Intelligence Scale, version 4 (WAIS), along with assessments of depression using the Beck Depression Inventory (BDI) and anxiety using the Spielberger State-Trait Anxiety Inventory (STAI).
Across groups, global cognitive performance was similar. Mean MoCA scores didn't differ statistically among patients with SSc, RA, and controls, although 53% of patients with SSc scored below the conventional threshold of 26 for normal cognition.
Differences emerged in domain-specific testing. Patients with SSc required more time to complete executive function tasks compared with controls, including about 114 seconds on the TMT-B vs about 68 seconds in controls and 96 in patients with RA. Similar trends were observed on Stroop-based measures, where patients with SSc had longer completion times across multiple conditions. WAIS error rates were largely comparable between patients with SSc and RA, although patients with SSc made more errors compared with controls.
Depressive symptoms were similar between patients with SSc and healthy controls based on BDI scores. Anxiety scores were higher in patients with SSc, particularly for trait anxiety, while levels were comparable between SSc and RA.
Correlation analyses showed that cognitive test performance was associated with age, sex, alcohol intake, SSc interstitial lung disease, and antinuclear antibody positivity but not with depression or anxiety scores. Depression and anxiety measures were correlated with each other but not with cognitive outcomes.
The study had several limitations. The sample size was small, and comparisons relied on historical control groups, which may have introduced differences in recruitment procedures, testing conditions, or clinical context. The cross-sectional design didn't allow assessment of causality or changes over time. Lifestyle factors such as alcohol use were broadly assessed, and observed differences were limited to specific cognitive domains rather than global impairment.
“[O]ur findings may suggest subtle differences in specific cognitive domains, particularly executive functions, rather than evidence of global cognitive impairment in patients with SSc,” wrote lead study author Vera Szekanecz, of the Department of Behavioural Sciences in the Faculty of Medicine at the University of Debrecen in Hungary, and colleagues.
The study was supported by European Union and Hungarian funding programs as well as co-financed by the European Social Fund. Vera Szekanecz reported employment with Robert Bosch Energy and Body Systems. The study authors reported no other conflicts of interest.
Source: Frontiers in Medicine
