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TOPLINE:

Cognitive function may decline more quickly in patients with dementia who also have rheumatoid arthritis (RA), a new cohort study suggested. Having dementia and RA was also associated with a 15% higher risk for death than having dementia alone, investigators found.

METHODOLOGY:

• This propensity score-matched register-based cohort study included almost 1700 patients with both dementia and RA and more than 5000 matched patients with dementia only (both groups: mean age, 80 years; 73% women).
• All data were taken from the Swedish Registry for Cognitive/Dementia Disorders between 2007 and 2018.
• Researchers analyzed more than 111,000 Mini-Mental State Examination (MMSE) measurements over a median follow-up duration of 2.6 years for the RA group and 2.9 years for the non-RA group.
• The primary outcome was cognitive decline, determined by MMSE score changes over time; the secondary outcome was all-cause mortality.

TAKEAWAY:

• The RA group showed significantly faster cognitive decline than the non-RA group (β, −0.24 points/year; P = .001), and an increased risk for mortality (hazard ratio, 1.15; P =  .001).
• A longer duration of exposure to RA before dementia diagnosis (5-10 years) was associated with faster cognitive decline (P = .001), as was use of disease-modifying antirheumatic drugs with and without glucocorticoids (P < .03 and P < .001, respectively).
• Use of glucocorticoids was also linked to increased risk for all-cause mortality in patients with RA (P < .001) compared with patients without RA.
• Significant interactions were found between RA, baseline MMSE scores, living conditions, and cognitive decline (P for interaction < .05).

IN PRACTICE:

“Our findings highlight the importance of appropriate management and treatment for dementia patients with RA,” the investigators wrote.

SOURCE:

The study was led by Minjia Mo, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden. It was published online on February 7 in Neurology.

LIMITATIONS:

Potential unmeasured confounders, lack of data on the duration and severity of RA, potential medication influence, selection bias toward severe RA cases, high attrition in MMSE follow-ups, and MMSE’s limitations in detecting very severe cognitive decline were some of the limitations.

DISCLOSURES:

The registry received financial support from the Swedish Association of Local Authorities and Regions.The study was supported in part by grants from the Center for Innovative Medicine Foundation, Ake Wibergs stiftelse, U and L Angeby stiftelse, and the Swedish Research Council. Two investigators reported receiving funding from various organizations, and one reported being a consultant for various pharmaceutical companies and giving lectures at sponsored symposia. Full details are provided in the original article.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.