Beyond Dryness: Mapping the Psychological and Cognitive Burden in Sjögren's Disease-A Narrative Review

Background: Sjögren's disease (SjD) is a chronic systemic autoimmune disorder characterized by persistent exocrine gland inflammation, possible multi-organ involvement and a marked predominance of mid-life women. Beyond dryness and fatigue, patients report mood disturbances and cognitive complaints such as "brain fog", which affect daily functioning and quality of life. Objective: To summarize and critically synthesize the literature on depression, anxiety, cognitive function, personality traits and quality of life assessment in adults with SjD and to highlight clinically relevant gaps. Methods: We performed a narrative review (PubMed, Cochrane, Embase through June 2025) of studies on psychological outcomes, cognitive function and quality of life in adults with SjD. Results: Depression and anxiety were frequently observed: depressive symptoms were present in roughly one-third to nearly half of patients, while anxiety symptoms were reported by about one-third. Cognitive impairment (affecting memory, attention and executive function) was also frequently described, often alongside severe fatigue and sleep disturbance. Overall, quality of life was reduced in SjD, driven mainly by fatigue and emotional distress rather than by classic disease activity. Neuroimmune mechanisms (e.g., chronic systemic inflammation and cytokine signalling such as IL-6 and TNF-α) may contribute to affective and cognitive symptoms. Overall, the evidence base remains largely cross-sectional and heterogeneous. Conclusions: Psychiatric symptoms and cognitive complaints represent a substantial and clinically relevant burden in SjD. Routine screening and multidisciplinary management that includes psychological assessment and support may improve well-being, adherence and quality of life.