The interplay between cognition, depression, anxiety, and sleep in primary Sjogren's syndrome patients

Abstract

Primary Sjögren's syndrome (pSS) is an autoimmune disease with frequent neurological involvement. Memory complaints are common, but their precise patterns remain unclear. We wanted to characterize patterns of neurocognitive profiles in pSS patients with cognitive complaints. Only pSS patients with memory complaints were included, prospectively. Cognitive profiles were compiled through a comprehensive cognitive evaluation by neuropsychologists. Evaluations of anxiety, depression, fatigue, sleep disorders and quality of life were performed for testing their interactions with cognitive profiles. All 32 pSS patients showed at least borderline cognitive impairment, and 17 (53%) exhibited a pathological cognitive profile: a hippocampal profile (37%), a dysexecutive profile (22%), and an instrumental profile (16%) (possible overlap). Regarding the secondary objectives: 37% of patients were depressed, and 48% exhibited a mild-to-severe anxiety trait. Sleep disorders were frequent (excessive daytime sleepiness (55%), high risk for sleep apnea (45%), and insomnia (77%)). Cognitive impairments could not be explained alone by anxiety, depression or sleep disorders. Fatigue level was strongly associated with sleep disorders. Our study highlights that cognitive complaints in pSS patients are supported by measurable cognitive impairments, apart from frequently associated disorders such as depression, anxiety or sleep troubles. Sleep disorders should be screened.

Figure 1

Distribution of neurocognitive profiles of 32 primary Sjögren’s syndrome patients with memory complaints.

Figure 2

Radar charts of (A) patient-reported health-related quality of life and (B) fatigue. Short-form 36 evaluation of quality of life, median score of subcomponent (low scores are associated with poor quality of life): PF Physical functioning, SF social functioning, RP role physical (limitations in daily activities associated to physical status), BP Bodily pain, GH general health, MH mental health, RE role emotional (limitations in daily activities associated to psychological status), VT vitality, HT health thinking. Fatigue evaluation according to patients’ self-reported fatigue (median, reported as percentage of total score; high score is associated with higher fatigue); ESSPRI EULAR Sjögren’s syndrome patient reported index, MFI Multidimensional fatigue inventory and its components. To improve clarity, scores were adjusted to 100.

Figure 3

Heatmap showing the distribution of cognitive profiles and associated psychiatric and sleep disorders among 32 primary Sjögren’s patients with cognitive complaints. Darker colours represent worse outcomes. The cluster of 8 patients with cognitive complaints, pathological cognitive disorders, but without anxiety or depression (outlined in red), suggests another underlying pathophysiological mechanism for cognitive troubles. Systemic involvement of the disease is more frequent among patients with pathological cognitive profile.