Detection of underlying dementia in bullous pemphigoid patients using cognitive evaluation tests: a multicenter case-control study

Abstract

Background: Preliminary observation in clinical practice showed that subjective neurocognitive complaints are relatively common in bullous pemphigoid (BP) patients. Yet, little has been done to investigate the neurocognitive status in BP. Methods: This is a multicenter observational case-control study comprised of 61 BP patients and 65 matched control subjects from 3 medical centers in China from 2014 to 2019. To evaluate the cognitive function between BP patients and matched controls, all the subjects finished the mini-mental state examination (MMSE) and montreal cognitive assessment (MoCA).Results: The overall scores were significantly lower in BP than in controls (P MoCA <0.001). The percentage of patients screened positive for cognitive impairment in the BP group was significantly higher than in the control group (P MMSE <0.001, P MoCA <0.001). On multivariate analysis, BP was associated with increased odds of cognitive impairment by MMSE and MoCA (P MMSE =0.017, P MoCA =0.007).Conclusions: BP patients had decreased cognitive abilities and were at a higher risk of cognitive impairment. The evaluation of cognitive impairment may be warranted for BP patients in clinical practice for early diagnosis and therapy of dementia.

An integrated approach is recommended in bullous pemphigoid

“…Those patients should be referred to neurologists for further assessments and treatment. Remarkably, in a study 2 on 38 BP patients, a neurological impairment was found in up to 28% for MMSE and 89% for MoCA of the patients. MoCA scale tends to have higher sensitivity for the diagnosis of mild cognitive impairment (MCI).…”

Pemphigus and pemphigoid are associated with Alzheimer’s disease in older adults: evidence from the US Nationwide inpatient sample 2016–2018

“…Preliminary observations in the clinic indicate that subjective neurocognitive complaints are relatively common in patients with bullous pemphigoid. A previous multicenter observational case-control study noted cognitive decline and a higher risk of developing cognitive impairment in patients with pemphigoid [ 20 ]. Those authors suggested that assessment of cognitive impairment in such patients may be required in clinical practice for early diagnosis and treatment of dementia.…”

“…Previous studies have reported that several neurological disorders with central nervous system inflammation or degeneration, including epilepsy, Parkinson’s disease, and multiple sclerosis, are associated with pemphigoid [ 18 , 19 ]. Recently, significantly high levels of pemphigoid antibodies were detected in stroke patients [ 20 ]. The role of neuropsychiatric symptoms in progression to dementia is not well understood [ 21 ].…”

The Relationship Between Alzheimer’s Disease and Skin Diseases: A Review

“… 21 A multi-centered case-control study evaluated the cognitive function using Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) scores and found decreased cognitive abilities and a higher risk of cognitive impairment in BP patients, which showed that these patients were more likely to develop dementia. 12 However, in a single-centered cohort study with 183 BP patients, Alzheimer’s disease was the only neurological disorder with no significant association with BP. 22 …”