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No Difference in Cognitive Dysfunction Among Patients with ANCA-Associated Vasculitis, Rheumatoid Arthritis or Chronic Kidney Disease

  • Natasha Alcocer-Castillejos (a1), Ariadna Jiménez-González (a2) and Andrea Hinojosa-Azaola (a2)


Objective: To characterize cognitive function in patients with antineutrophil cytoplasmic antibodies (ANCA)-associated vasculitis (AAV) in comparison with other chronic conditions, and to investigate its association with disease activity, and other psychological factors. Methods: Cross-sectional study including patients with AAV, rheumatoid arthritis (RA) (n = 30), and chronic kidney disease (CKD) (n = 29). Patients underwent a standardized neuropsychological battery (NEUROPSI). Sleep quality, fatigue, depression, and anxiety levels were assessed. Results: A total of 60 patients with AAV were included, median age of 54 years, and disease duration of 5.6 years. Prevalence of cognitive dysfunction (CD) in AAV patients was similar to RA and CKD (35%, 40%, and 39.3%, respectively, p = .88). When AAV patients with (n = 21) and without (n = 39) CD were compared, significantly more patients with CD had high disease activity (67% vs. 31%, p = .009). Abnormal performance was more frequent in the executive functions in the three groups (45% AAV, 51.7% RA, and 50% CKD), followed by language (25%, 13.8%, and 25%, respectively). Verbal and visual attentional tests were more frequently impaired in patients from the CKD group (p = .021), and psychomotor functions were more frequently affected in AAV patients (p < .05). Hospital Anxiety and Depression Scale (HADS) total score (especially anxiety) was higher in patients with memory impairment than in those with normal memory function (M = 6.79, SD = 4.53 vs. M = 4.5, SD = 3.6, p < .01). Neither Sleep Quality Index nor fatigue scale scores differed between those cognitively impaired and not impaired. Conclusions: No statistically significant differences were found in the frequency of CD among the three clinical populations. (JINS, 2019, 25, 595–602)


Corresponding author

Correspondence and reprint requests to: Andrea Hinojosa-Azaola, Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga No. 15, Col. Sección XVI, Tlalpan, Mexico City, CP 14000, Mexico. E-mail:


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Adhikari, A., Piatti, A., & Luggen, M. (2011). Cognitive dysfunction in SLE: development of a screening tool. Lupus, 20, 11421146.
Aletaha, D., Neogi, T., Silman, A.J., Funovits, J., Felson, D.T., Bingham, C.O. 3rd, Birnbaum, N.S., Burmester, G.R., Bykerk, V.P., Cohen, M.D., Combe, B., Costenbader, K.H., Dougados, M., Emery, P., Ferraccioli, G., Hazes, J.M., Hobbs, K., Huizinga, T.W., Kavanaugh, A., Kay, J., Kvien, T.K., Laing, T., Mease, P., Ménard, H.A., Moreland, L.W., Naden, R.L., Pincus, T., Smolen, J.S., Stanislawska-Biernat, E., Symmons, D., Tak, P.P., Upchurch, K.S., Vencovský, J., Wolfe, F., & Hawker, G. (2010). 2010 Rheumatoid arthritis classification criteria: an American College of Rheumatology/European League against Rheumatism collaborative initiative. Arthritis & Rheumatology, 62, 25692581.
Bjelland, I., Dahl, A.A., Haug, T.T., & Neckelmann, D. (2002). The validity of the Hospital Anxiety and Depression Scale: an updated literature review. Journal of Psychosomatic Research, 52, 6977.
Boada-Grau, J., Merino-Tejedor, E., Gil-Ripoll, C., Segarra-Pérez, G., & Vigil-Colet, A. (2014). Adaptación al español del Inventario Multidimensional de Fatiga al entorno laboral. Universitas Psychologica, 13, 1523.
Buysse, D.J., Reynolds, C.F. 3rd, Monk, T.H., Berman, S.R., & Kupfer, D.J., (1989). The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Research, 28, 193213.
Capra, R., Gregorini, G., Mattioli, F., Santostefano, M., & Galluzzi, S. (1998). Rapid onset dementia in patients with microscopic polyangiitis. [asbtract]. Journal of Neurology, 245, 397.
Colgecen, E., Celikbilek, A., & Keskin, D.T. (2016). Cognitive impairment in patients with psoriasis: a cross-sectional study using the Montreal Cognitive Assessment. American Journal of Clinical Dermatology, 17, 413419.
Covey, T.J., Shucard, J.L., Shucard, D.W., Stegen, S. & Benedict, R.H. (2012). Comparison of neuropsychological impairment and vocational outcomes in systemic lupus erythematosus and multiple sclerosis patients. Journal of the International Neuropsychological Society, 18(3), 530540.
Duarte-García, A., Romero-Díaz, J., Juárez, S., Cicero-Casarrubias, A., Fragoso-Loyo, H., Núñez-Alvarez, C., Llorente, L., Sánchez-Guerrero, J. (2018). Disease activity, autoantibodies, and inflammatory molecules in serum and cerebrospinal fluid of patients with systemic lupus erythematosus and cognitive dysfunction. PLoS One, 13. doi: 10.1371/journal.pone.0196487.
Exley, A.R., Bacon, P.A., Luqmani, R.A., Kitas, G.D., Gordon, C., Savage, C.O.S., & Adu, D. (1997). Development and initial validation of the vasculitis damage index for the standardized clinical assessment of damage in the systemic vasculitides. Arthritis & Rheumatology, 40, 371380.
Godefroy, O., Azouvi, P., Robert, P., Roussel, M., LeGall, D., Meulemans, T., & Behalf of the Groupe de Réflexion sur l’Evaluation des Fonctions Exécutives Study Group. (2010). Dysexecutive syndrome: diagnostic criteria and validation study. Annals of Neurology, 68, 855864.
Hanly, J.G. (2014). Diagnosis and management of neuropsychiatric SLE. Nature Reviews Rheumatology, 10(6), 338347.
Hinojosa-Azaola, A., Jiménez-González, A., & Alcocer-Castillejos, N. (2018). Patient and physician perspectives on the impact of health-related quality of life in Mexican patients with ANCA-associated vasculitis. Rheumatology International, 38, 631640.
Jarrot, P.A. & Kaplanski, G. (2016). Pathogenesis of ANCA-associated vasculitis: an update. Autoimmunity Reviews, 15, 704713.
Jennette, J.C., Falk, R.J., Bacon, P.A., Basu, N., Cid, M.C., Ferrario, F., Flores-Suarez, L.F., Gross, W.L., Guillevin, L., Hagen, E.C., Hoffman, G.S., Jayne, D.R., Kallenberg, C.G., Lamprecht, P., Langford, C.A., Luqmani, R.A., Mahr, A.D., Matteson, E.L., Merkel, P.A., Ozen, S., Pusey, C.D., Rasmussen, N., Rees, A.J., Scott, D.G., Specks, U., Stone, J.H., Takahashi, K., & Watts, R.A. (2013). 2012 Revised International Chapel Hill Consensus Conference Nomenclature of Vasculitides. Arthritis & Rheumatology, 65, 111.
Leavitt, R.Y., Fauci, A.S., Bloch, D.A., Michel, B.A., Hunder, G.G., Arend, W.P., Calabresse, L.H., Fries, J.F., Lie, J.T., Lightfoot, R.W., Masi, A.T., McShane, D.J., Mills, J.A., Stevens, M.B., Wallace, S.L., & Zvaifler, N.J. (1990). The American College of Rheumatology 1990 criteria for the classification of Wegener’s granulomatosis. Arthritis & Rheumatology, 33, 11011107.
Levin,, A. & Stevens, P.E. (2014). Summary of KDIGO 2012 CKD guideline: behind the scenes, need for guidance, and a framework for moving forward. Kidney International, 85, 4961.
Matioli, M.N.P.S. & Caramelli, P. (2012). NEUROPSI battery subtest profile in subcortical vascular dementia and Alzheimer’s disease. Dementia & Neuropsychologia, 6, 170174.
Mattioli, F., Capra, R., Rovaris, M., Chiari, S., Codella, M., Miozzo, A., Gregorini, G., & Filippi, M. (2002). Frequency and patterns of subclinical cognitive impairment in patients with ANCA-associated small vessel vasculitides. Journal Neurological Sciences, 195, 161166.
Meade, T., Manolios, N., Cumming, S.R., Conaghan, P.G., & Katz, P. (2018). Cognitive impairment in rheumatoid arthritis: a systematic review. Arthritis Care & Research (Hoboken), 70, 3952.
Mollayeva, T., Thurairajah, P., Burton, K., Mollayeva, S., Shapiro, C.M., & Colantonio, A. (2016). The Pittsburgh sleep quality index as a screening tool for sleep dysfunction in clinical and non-clinical samples: a systematic review and meta-analysis. Sleep Medicine Reviews, 25, 5273.
Oldham, M. (2017). Autoimmune encephalopathy for psychiatrists: when to suspect autoimmunity and what to do next. Psychosomatics, 58(3), 228244.
Ostrosky-Solis, F., Ardila, A., & Rosselli, M. (1999). NEUROPSI: a brief neuropsychological test battery in Spanish with norms by age and educational level. Journal of the International Neuropsychological Society, 5, 413433.
Robson, J.C., Dawson, J., Cronholm, P.F., Milman, N., Kellom, K.S., Ashdown, S., Easley, E., Farrar, J.T., Gebhart, D., Lanier, G., McAlear, C.A., Peck, J., Luqmani, R.A., Shea, J.A., Tomasson, G., & Merkel, P.A. (2018). Health-related quality of life in ANCA-associated vasculitis and item generation for a disease-specific patient-reported outcome measure. Patient Related Outcome Measures, 9, 1734.
Stone, J.H., Hoffman, G.S., Merkel, P.A., Min, Y.I., Uhlfelder, M.L., Hellmann, D.B., Specks, U., Allen, N.B., Davis, J.C., Spiera, R.F., Calabrese, L.H., Wigley, F.M., Maiden, N., Valente, R.M., Niles, J.L., Fye, K.H., McCune, J.W., St Clair, E.W., & Luqmani, R.A. (2001). A disease specific activity index for Wegener’s granulomatosis: modification of the Birmingham Vasculitis Activity Score. International Network for the Study of the Systemic Vasculitides (INSSYS). Arthritis & Rheumatology, 44, 912920.
Yates, M. & Watts, R. (2017). ANCA-associated vasculitis. Clinical Medicine (London), 17, 6064.
Yilmaz, N., Mollahasanoglu, A., Gurvit, H., Can, M., Tuncer, N., Inanc, N., & Yavuz, S. (2012). Dysexecutive syndrome: a specific pattern of cognitive impairment in systemic sclerosis. Cognitive and Behavioral Neurology, 25, 5762.
Zigmond, A.S. & Snaith, R.P. (1983). The hospital anxiety and depression scale. Acta Psychiatrica Scandinavica, 67, 361370.


No Difference in Cognitive Dysfunction Among Patients with ANCA-Associated Vasculitis, Rheumatoid Arthritis or Chronic Kidney Disease

  • Natasha Alcocer-Castillejos (a1), Ariadna Jiménez-González (a2) and Andrea Hinojosa-Azaola (a2)


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