Thu0626-Hpr importance of a Systematic Cognitive Assessment: Implementation of a Cognitive Evaluation and Rehabilitation Clinic in Rheumatic Patients

Abstract

Background:Cognition is the ability to learn, process and remember information to be used later.(1) Cognitive impairment reflects a decrease in one or more cognitive domains: memory, language, reasoning, among others.(2) It has been reported in rheumatic diseases such as systemic lupus erythematosus, rheumatoid arthritis, fibromyalgia, and it is frequently found in young patients during the first years of their illness correlating the disease progression.(3) This condition can lead to anxiety and depression, compromising the quality of life. Given the lack of consensus regarding the best test to diagnose cognitive impairment, multiple tools have been used to address this problem.Objectives:To describe the systematical assessment in a Cognitive Evaluation and Rehabilitation Clinic in rheumatic patients from a University Hospital in Mexico.Methods:Observational and descriptive study. A multidisciplinary team met for 6 months to establish the structure a Cognitive Evaluation and Rehabilitation Clinic in a University Hospital in Mexico (Figure 1). As a pilot group we included outpatients from a Rheumatology clinic, referred by their physician (Table 1). The following psychological tests were used: Montreal Cognitive Assessment (MoCA) and Neurobehavioral Cognitive Status Examination (NCSE). After results (Table 2), the team decided to extend the evaluation with Automated Neuropsychological Assessment Metrics (ANAM), Wechsler Adult Intelligence Scale (WAIS-IV) and International Neuropsychiatric Interview (MINI) (Figure 2). Statistical analysis was performed with SPSS v.24, descriptive statistic were used with measures of central frequency trend.Table 1.Demographic characteristicsN=21Age, mean (SD)43.62 (14.68)Female, n (%)14 (66.66)Years of education, mean (SD)15.24 (2.70)Psychiatric disorderDepression, n (%)4 (19.04)Rheumatic diagnosisSystemic lupus erythematosus, n (%)13 (61.90)Rheumatoid arthritis, n (%)3 (14.30)Others, n (%)5 (23.80)Table 2.Comparison of MoCA and NCSE results.MoCAN=21NCSE N=21Total score, mean (SD)24.24 (3.49)38.52 (1.69)Level of cognitive impairmentNormal, n (%)7 (33.3)17 (81)Mild, n (%)13 (61.9)1 (4.8)Moderate, n (%)1(4.8)3 (14.2)Severe, n (%)0 (0)0 (0)MoCA, Montreal Cognitive Assessment; NCSE, Neurobehavioral Cognitive Status Examination.Figure 1.Pilot program of the Neurocognitive AssessmentFigure 2.Final Program of the Neurocognitive AssessmentResults:We evaluated 21 patients (66% females) with an average age of 43.62 years (SD 14.6) (Table 1). The total number of patients with cognitive impairment was 15 (71%), 14 (66%) diagnosed with MoCA, 6 (28%) with NCSE and a coincidence of both tests in 4 (19%) patients (Table 2).Conclusion:A high percentage of patients with cognitive impairment was found, also a discrepancy between the MoCA and NCSE results. We realized those tests were not enough to get a detail cognitive functioning, for this reason it was decided to make a more extensive evaluation adding ANAM, WAIS-IV and MINI. Neuropsychological evaluation should be performed as part of a multidisciplinary management for the patient and the rheumatologist should be aware of this manifestation and the importance of cognitive testing.References:[1]Gutierrez Rodriguez J, Guzman Gutierrez G. Definition and prevalence of mild cognitive impairment. Rev Esp Geriatr Gerontol. 2017;52 Suppl 1:3-6.[2]Quijano JP-CyTdS. Evaluación Neuropsicológica y Funcional de la Demencia. Barcelona1996.[3]Wijbrandts CA, Tak PP. Prediction of Response to Targeted Treatment in Rheumatoid Arthritis. Mayo Clin Proc. 2017;92(7):1129-43.Disclosure of Interests:None declared