Background: Neuropsychiatric symptoms have been well documented in several systemic
inflammatory conditions, for example, 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 of 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, with 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
Conclusion: 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.