Cognitive impairment in autoimmune rheumatic diseases: a comprehensive review

To synthesize current evidence on the prevalence, pathophysiological mechanisms, clinical impact, and management of cognitive impairment (CI) in autoimmune rheumatic diseases (ARDs), including rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), Sjögren's syndrome (SS), systemic sclerosis (SSc), and antineutrophil cytoplasmic antibody-associated vasculitis (AAV).A comprehensive narrative review was conducted through a structured search of PubMed/MEDLINE, Scopus, and Web of Science, covering articles published up to February 2025.A total of 84 references were included following title and abstract screening and full-text assessment applying predefined inclusion and exclusion criteria.CI affects 30%~88% of ARD patients depending on the disease and assessment method.The cognitive domains most consistently impaired include attention, memory, executive function, and processing speed.Pathophysiological mechanisms are multifactorial and disease-specific: in RA, inflammatory cytokines, vascular dysfunction, and chronic pain are central drivers; in SLE, autoantibodies such as anti-NR2, anti-ribosomal P, and antiphospholipid antibodies, together with blood-brain barrier disruption and cerebral small vessel disease, play a dominant role; in SS, white matter lesions and autoimmune-mediated encephalopathy are prominent; in SSc, endothelial injury and cerebral hypoperfusion appear critical; and in systemic vasculitis, vascular inflammation and ischemia underlie cognitive decline.CI negatively impacts health-related quality of life, employment, and treatment adherence across all ARDs.CI remains underdiagnosed in ARDs due to inconsistent screening methods and overlap with fatigue, depression, and pain.Standardized cognitive assessment batteries tailored to ARDs are urgently needed.Future research should prioritize longitudinal studies, biomarker discovery, and therapeutic interventions combining immune modulation with cognitive rehabilitation.