COGNITIVE DYSFUNCTIONS IN RHEUMATOLOGICAL DISEASES

Aim: This review examines cognitive dysfunctions and their causes in rheumatological diseases on a disease-specific basis. The rheumatological diseases include rheumatoid arthritis, spondyloarthitis, systemic lupus erythematosus, systemic sclerosis, primary sjögren syndrome, fibromyalgia, primary systemic vasculitis, and behçet's disease. Method: A synthesis of existing literature highlights that chronic inflammation can lead to neuroinflammatory stress in the central nervous system, requiring the use of additional cortical resources to complete daily cognition-related activities. It also emphasizes that cognitive dysfunction may occur because brain regions are unable to perform cognitive tasks due to their preoccupation with pain. Results: Another finding is that the factors contributing to cognitive impairment in rheumatic diseases may depend on the type of disease. Many patients with rheumatoid arthritis use more cerebral cortex areas to perform isolated cognitive tasks at the same level as healthy individuals as inflammation increases. The pathways underlying cognitive dysfunction in Lupus are still being investigated, and the parameters have not yet been fully validated and widely accepted. In patients with Systemic Sclerosis, there are various reports on the mental or cognitive effects of exposure to cold. Limited evidence in Primary Sjogren's Syndrome suggests that hypoperfusion may be associated with cognitive dysfunction. In Fibromyalgia, it is commonly believed that the degree of pain is directly related to the level of cognitive dysfunction. Cognitive function may be affected due to cerebral hypoperfusion in primary systemic vasculitis. In Behçet's disease, cognitive dysfunction is associated with age, anxiety-depressive disorders, chronic stress factors, and minor brain multifocal subcortical parenchymal MRI lesions. Conclusion: In conclusion, some disease-specific factors may cause cognitive dysfunction in rheumatological diseases. However, their clinical utility is limited due to the presence of confounding factors and the lack of reliable biomarkers.