Cognitive impairment, depression, and anxiety in systemic sclerosis

Systemic sclerosis (SSc) has been associated with cognitive dysfunction (CD), depression and anxiety. We conducted a comprehensive study by using multiple standardized tests in a subset of SSc patients compared with rheumatoid arthritis (RA) and healthy controls. Moreover, we correlated cognitive scores various other parameters in SSc.

Thirty SSc patients were recruited for the study. Data of 40 RA patients and 30 healthy individuals from our previous study were used as controls. Montreal Cognitive Assessment (MoCA), Trail Making Test (TMT), Victoria Stroop Test (VST), and Wechsler Adult Intelligence Scale version 4 (WAIS-IV) tests were used for CD; Beck Depression Inventory (BDI) for depression; and Spielberger State-Trait Anxiety Inventory (STAI) for anxiety.

MoCA total score and TMT-A time were similar in SSc vs. RA or controls (p > 0.05). TMT-B time was longer in SSc vs. controls (p < 0.001), but similar vs. RA (p = 0.343). VST-A time was also longer in SSc vs. controls (p = 0.003) but similar vs. RA (p = 0.146). Similar observations were made regarding VST-B time (SSc vs. controls, p < 0.001) and VST-C time (SSc vs. controls, p < 0.001). BDI values were similar in SSc vs. controls (p = 0.458) but lower vs. RA (p = 0.035). STAI-S (p = 0.011) and STAI-T (p = 0.006) values were significantly higher in SSc vs. controls. Several associations were identified between age, sex, alcohol intake, SSc-ILD, ANA positivity vs. various cognitive scores.

Our findings may suggest subtle differences in specific cognitive domains, particularly executive functions, rather than evidence of global cognitive impairment in patients with SSc. SSc has also been associated with anxiety symptoms. These states may be associated with some disease-related factors. Thus, tailored cognitive behavioral therapy may be useful for our SSc patients.