Cognitive Dysfunction and AS: Causes and Remedies

Cognitive problems may not be a concern that looms large for most people withankylosing spondylitis(AS), but a number of studies in recent years have brought this issue into greater focus.

In onestudy, published in June 2017 in the journalAnnals of the Rheumatic Diseases, patients with different rheumatologic diseases underwent a cognitive assessment. Cognitive dysfunction was found to be more common inpeople with rheumatoid arthritis,lupus, systemic sclerosis, and AS than in a matched control group — although the difference was too small to be statistically significant for AS.

Anotherstudy, published in August 2017 in the journalBrain Imaging and Behavior, compared structural andfunctional magnetic resonance imaging(MRI) scans in people with AS versus a matched control group. Scans of people with AS showed “widespread brain connectivity alternations,” many of which correlated with blood markers of inflammation like erythrocyte sedimentation rate (ESR) and high-sensitivity C-reactive protein (hsCRP).

So what accounts for the risk of cognitive dysfunction in people with AS, and what can you do about it?

Experts point to a number of ways that having AS may raise your risk of cognitive problems — each of which points to a different strategy for reducing this risk. Here’s what you should know about each of these areas.

Central Pain in AS and Cognitive Risk

One potential link between AS and cognitive dysfunction is chronic centralized pain, which is described asfibromyalgiawhen it’s a primary diagnosis. But when it’s linked to an inflammatory disease like AS, many rheumatologists don’t view it as a separate disorder.

“I think there’s increasing recognition that in people with AS, a significant percentage — maybe 20 or 25 percent — may have a more centralized pain syndrome,” saysEric Ruderman, MD, arheumatologistand professor of medicine at Northwestern University Feinberg School of Medicine in Chicago. “And certainly in a lot of those people, you see this brain fog.”

Dr. Ruderman explains that there are two types of pain, broadly speaking. Nociceptive pain originates from a site in the body where something local sends a signal to the brain, while central, orneuropathic, pain doesn’t necessarily originate where it’s perceived in the body.

Sometimes, Ruderman says, central pain can be triggered by chronic nociceptive pain — in this case, the nervous system may respond to an onslaught of pain signals by overamplifying them generally. This may explain why central pain is linked to conditions like AS that cause pain in specific areas of the body.

If someone with AS experiences central pain along with “mental fog,” their rheumatologist will most likely diagnose and treat the pain disorder according totreatment guidelines for fibromyalgia, saysLenore Brancato, MD, a rheumatologist and clinical assistant professor of medicine at NYU Langone Health in New York City.

That means, Dr. Brancato says, possibly prescribing physical therapy, stress-reduction techniques, or certain drugs, including classes ofantidepressantsor muscle relaxants that can also target central pain.

Depression and Anxiety in AS and Cognitive Risk

Sometimes depression or anxiety leads to cognitive dysfunction in people with AS.

“With AS patients, because a lot of them develop the disease at a young age and it can be very limiting, it can have a lot of impact on their psychosocial well-being,” saysWei Wei Chi, MD, a rheumatologist and assistant professor of medicine at the Icahn School of Medicine at Mount Sinai in New York City.

理想情况下,气博士说,当我的有效的治疗方法tself will help resolve someone’s depression or anxiety by addressing the pain or physical limitations at the root of the mental health problems. Referring people to AS support groups may also help them alleviate this distress, she says.

But if optimizing AS treatment and support groups don’t do enough to resolve depression or anxiety, the next step is “referring them to mental health services so that they can start psychotherapy or mood disorder medication to control those symptoms,” says Chi.

Sleep Disturbances in AS and Cognitive Risk

Problems falling or staying asleep are common in people with AS, and can cause or exacerbate a variety of problems, according to Brancato.

“Having pain can lead to sleep disturbance, and having poor sleep or not enough sleep — or lack of restorative sleep —can lead to a lower pain threshold,” she notes. “And not sleeping well can also lead to fatigue.”

When people are sleep-deprived or fatigued, they often “recognize that they are not thinking coherently or responding quickly to external stimuli because of cognitive fog,” Brancato adds.

The first step in reducing sleep disturbances is to address any pain related to AS — “not necessarily with pain medication per se, but with medication targeting their ankylosing spondylitis,” says Chi.

Brancato notes thatattention to sleep hygiene— such as making sure you’re in a restful environment and following a consistentsleep schedule— can help many people reduce sleep disturbances.

Raising Cognitive Concerns With AS

Whatever the cause of any cognitive dysfunction you may be experiencing, it’s important to share any concerns with your rheumatologist, says Chi.

While your symptoms may be subtle, “it is something that people might notice if they’re experiencing related conditions, like anxiety or depression and sleep disturbances,” she says. “People who develop it probably will notice that they’re having trouble remembering things, or having a fogginess to their thinking.”

Your rheumatologist can help you figure out what factor — or combination of factors — may be contributing to your symptoms and help you get the treatment you need, although there may be some trial and error, says Chi, and no outcome is guaranteed.

“If we address the factors leading to it, people can have relief,” she notes. “That’s easier said than done for some people. It’s very individualized, the prognosis.”