Ideational Fluency in Patients with Rheumatoid Arthritis

Background: Neuropsychiatric symptoms have been well documented in several systemic inflammatory conditions, e.g. systemic lupus erythematosus (SLE). Increased prevalence of cognitive decline and psychiatric issues has been reported in patients with rheumatoid arthritis (RA). However, there is limited evidence for which exact cognitive domains are affected and to what degree.

Aim: To test the performance of cognition in the domain of ideational fluency (Thing Categories Test in particular) in patients with RA and compare the results with the general population and to the results with cognitive and depression screening scores in both groups.

Methods: Patient Health Questionnaire 9 (PHQ-9), Generalized Anxiety Disorder 7 (GAD-7) assessment, Montreal Cognitive Assessment (MoCA), and Thing Categories Test (TCT) were used to evaluate patients with RA, as well as the control group.

Results: Twenty patients with RA and 20 controls were tested. 7 and 4 men, and 13 and 16 women in the study and control group, respectively. Average scores in TCT at three minutes were 7.50 (IQR6.0-10.0) and 6.0 (IQR3.0-8.0) for category “blue”; 17.50 (IQR15.0-19.0) and 16.0 (10.0-18.0) for category “round” in the control and study group, respectively. A statistically significant difference was established between the study and the control group in TCT for the category “blue” (p<0.025). The average score for GAD7 was 2.0 (IQR 0.0-5.75) and 3.0 (IQR0.50-6.00) in the control and study group, respectively. The average score for PHQ-9 was 2.0 (IQR0.25-4.75) and 4.0 (IQR2.00-5.50) in the control and study group, respectively. Finally, the average score for the MoCA scale was 27.0 (IQR25.25-28.00) and 26.0 (IQR23.50-28.00) in the control and study group, respectively.

Conclusions: Preliminary evidence suggests that RA at least partially affects the cognitive domain of ideational fluency. However, further research with larger experimental groups is needed to provide more conclusive evidence.

Keywords: Cattell-HornCarroll theory.; Cognitive impairment; anxiety; depression; ideational fluency; retrieval ability; rheumatoid arthritis.