Brain Fog: Testing Cognitive Dysfunction with Rheumatoid Arthritis / Disease

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The last few weeks I’ve been rereading abstracts from the ACR scientific meeting we attended in November. There were many fascinating studies presented, like the tendons investigation on the blog a couple days ago. This one on testing cognitive function jumps out at me:

The Relationship Between Perceived Cognitive Dysfunction and Objective Neuropsychological Performance in Persons with Rheumatoid Arthritis

Doctors at the University of California tested 120 people diagnosed with Rheumatoid Arthritis to compare two cognitive measures: First, each patient took a “Perceived Deficit Questionnaire” to assess the level of subjective cognitive impairment (did they feel impaired?). Second, each person completed a “battery of 12 standardized neuropsychological measures” to test the level to which they were actually impaired. The results showed no significant relationship between perceived cognitive dysfunction and performance on the objective neuropsychological test.

However, the researchers did find depression and fatigue associated significantly with perceived cognitive dysfunction.

Brain fog in rheumatoid arthritisAs with most studies, we not only learn something from these results, but also have new questions.

1) Perhaps people with RA experience cognitive dysfunction or notice mental fog on some days and so rate themselves lower, but still perform well on other days. The patients in the study were tested in a single clinic visit.

2) Perhaps fatigue and depression independently increase cognitive dysfunction. There is likely separate evidence of that, outside of rheumatology. For fun, try typing: “Does depression cause cognitive dysfunction?” into a Google search, or “Does fatigue cause brain fog?” You’ll see that Google reads cognitive dysfunction as a synonym for brain fog… and that there are lots of NIH studies and other articles relating fatigue and depression to cognitive dysfunction.

3) Perhaps something else plays a role, such as medications or pain levels. In addition to depression and fatigue, the study controlled for “gender, race, marital status, income, education, disease duration, and disease severity.” It would be good to have more information, and to have it from the patient point of view. I’d be curious what was used to rate “disease severity” since that measure often differs between RA patients and clinicians (more from an interesting abstract on that topic soon).

Medications are often blamed for any brain fog associated with Rheumatoid Arthritis.

And that makes sense too. Several medications make obvious suspects. This study didn’t separate patients based on medications, so it’s not possible to say whether methotrexate, pain medications, prednisone, nerve meds, sleep meds, or disease modifying treatments play a part.

What do you think? Can you tell whether you have brain fog or what causes it?

Postblog: What is brain fog anyway?

What is brain fog to you? I like that someone is investigating how people diagnosed with RA function mentally – and that they performed well! Severely low thyroid levels once made it impossible for me to even read. Obviously, I recovered with medication. With RA, I’ve only experienced mild short-term memory problems. For me, it does not associate with fatigue, depression, or medication so I still suspect the inflammation itself. We’d love to hear about your experience.

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Kelly Young. All rights reserved.

This entry was posted on Tuesday, April 16th, 2013 at 11:30 am and is filed under RA Research, Resources, and Rheumatology. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.


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