Screening for cognitive impairment in systemic lupus erythematosus: Application of the Montreal Cognitive Assessment (MoCA) in a Greek patient sample.

BACKGROUND: Cognitive impairment (CI) is one of the most frequent neuropsychiatric manifestations of systemic lupus erythematosus (SLE). Given that extensive neuropsychological testing is not always feasible in routine clinical practice, brief cognitive screening tools are desirable. The aim of this study was to evaluate the Montreal Cognitive Assessment (MoCA) as a screening tool for CI in SLE. METHODS: Consecutive SLE patients followed at a single centre were evaluated using MoCA and an extensive neuropsychological test battery (NPT), including the Digits Forward and Digits Backwards, Rey Auditory Verbal Learning Memory Test, Trail Making Test, Stroop Colour-Word Test, Semantic and Phonetic Verbal Fluency tests and a 25-problem version of the General Adult Mental Ability test. The criterion validity of MoCA was assessed through receiver operating characteristic (ROC) analyses using three different case definitions: i) against normative population data, ii) and iii) against average performance of a comparison group of rheumatoid arthritis (RA) patients, to adjust for possible confounding effects of chronic illness and inflammatory processes on cognitive performance. The effect of patient-related (age, years of education, anxiety, depression, fatigue and pain) and disease-related (activity, damage, age at diagnosis, disease duration, use of glucocorticoid, psychotropic and pain medication) parameters on the MoCA was examined. RESULTS: A total of 71 SLE patients were evaluated. MoCA significantly correlated with all NPT scores and was affected by education level (p < 0.001), but not by other demographic or clinical variables. The optimal cutoff for detecting CI, as defined on the basis of normative population data, was 23/30 points, demonstrating 73% sensitivity and 75% specificity. A cutoff of 22/30 points, using neuropsychological profiles of the RA group as inflammatory disease controls, exhibited higher sensitivity (100%, based on both definitions) and specificity (87% and 90%, depending on the definition). The standard cutoff of 26/30 points displayed excellent sensitivity (91-100%) with significant expenses in specificity (43-45%). CONCLUSION: The MoCA is an easily applied tool, which appears to be reliable for identifying CI in SLE patients. The standard cutoff score (26/30) ensures excellent sensitivity while lower cutoff scores (22-23/30) may, also, provide higher specificity.

Emotion regulation contributes to the well-being of patients with autoimmune diseases through illness-related emotions: A prospective study.

This prospective study aimed to examine whether illness-related negative emotions mediate the relationship of cognitive reappraisal and expressive suppression to the well-being of 99 patients with rheumatoid arthritis or multiple sclerosis. After adjusting for disease and patient-related parameters, only cognitive reappraisal was associated with physical and psychological well-being through emotions. Expressive suppression was associated with psychological well-being only for patients reporting less use of cognitive reappraisal. These results underscore the need for prospective studies that will investigate the long-term impact of emotion regulation on adaptation to chronic illness and the conditions under which this impact takes place.

The relation of spouse illness representations to patient representations and coping behavior: A study in couples dealing with a newly diagnosed cancer.

The central role of spouses/partners in patients' adaptation to cancer is well-established, but few studies have examined how partners facilitate adaptation. The Common Sense Model posits that a representation of illness as more controllable and less threatening promotes adaptive coping, but this has not been examined in a dyadic context. This cross-sectional study examined the relations of spouse illness representations of personal and treatment control, and emotional representations to recently diagnosed cancer patients' coping behaviors, through patient illness representations. One hundred forty-nine heterosexual couples (39.60% female patients; 77.18% dealing with early stage cancer) participated in the study. Structural Equation Modeling showed that spouse illness representations were related to patient coping directly and indirectly through patient illness representations. Both partners' representations of control were related to greater patient adaptive coping, and both partners' emotional representations were related to greater dysfunctional coping. These findings highlight the importance of partner illness representations in patients' adaptation to cancer. They also suggest that early intervention programs that address both partners' illness representations may enhance patients' adaptation to cancer.

Adaptation to inflammatory rheumatic disease: Do illness representations predict patients' physical functioning over time? A complex relationship.

Patients with an inflammatory rheumatic disease (IRD), are often faced with significant limitations in physical functioning. Illness representations are a key-factor of their illness-related experience. Our aim was to examine (a) whether illness representations can predict or only reflect IRD patients' physical functioning over time, and (b) the specific pathways through which representations and physical functioning at baseline are associated with representations and functioning at follow-up. Patients with rheumatoid arthritis (N = 54) or systemic lupus erythematosus (N = 58) participated in the two phases of the study, 1 year apart. According to the results, illness representations were rather predicted by physical functioning than the other way around. At the same time, illness representations at baseline and at follow-up seemed to form a chain that mediated the relation between physical functioning at baseline and 1 year later. These findings may help us better delineate the interplay between the ways patients understand their condition and adaptation to illness.

Patient and partner dispositional optimism as a long-term predictor of illness representations in autoimmune diseases.

We examined whether the dispositional optimism of patients suffering from an autoimmune disease as well as of their partners can predict, at a dyadic level, their representations of illness consequences, and personal and treatment control, assessed 1 year later. Patient optimism predicted several patient and partner illness representations. Partner optimism was unrelated to own or patient illness representations. Results highlight the strong long-term predictive power of patient optimism and underline the importance of the interpersonal function of personality traits. At the same time, study findings indicate that the dyadic effects of optimism are complex and probably conditional on several factors.

Cognitive deficits early in the course of rheumatoid arthritis.

OBJECTIVE: The aim was to examine the severity and prevalence of cognitive difficulties in persons with rheumatoid arthritis (RA) within the first three years of diagnosis. METHOD: One hundred consecutive RA patients aged 28-67 years (90% women) were administered a battery of 6 neuropsychological tests yielding 14 cognitive indices. Self-reported measures of trait anxiety, depression, impact of disease on daily activities, and pain severity were also obtained along with physician-rated disease severity. RESULTS: Twenty percent of RA patients were classified as cognitively impaired, defined as age- and education-adjusted scores at least 1.5 standard deviations below the population mean on 3 or more cognitive indices. Impaired performance, controlling for age, education, and premorbid cognitive capacity, was detected primarily on measures of short-term memory, immediate and delayed episodic recall, and phonemic fluency. There were modest negative associations between cognitive indices and measures of perceived disease severity (pain level, impact of disease on daily functionality, and overall health quality). CONCLUSIONS: Cognitive deficits on several domains are frequently encountered in relatively young RA patients during the first few years of the disease and may need to be taken into account as important correlates of disease severity and progression.

Illness representations and psychological adjustment of Greek couples dealing with a recently-diagnosed cancer: dyadic, interaction and perception-dissimilarity effects.

The aim was to examine the impact of the dyadic, interaction and dissimilarity effects of the illness representations on the psychological health of recently diagnosed cancer patients and spouses in Greece. The sample consisted of 298 individuals nested in 149 couples. Effects were examined with the Actor-Partner Interdependence Model. Both actor (i.e., within person) and partner (i.e., between partners) effects were detected for both patients' and spouses' psychological symptoms. The negative association of patients' psychological symptoms with their representations of illness coherence was weak at the higher and medium levels, and stronger at the lower levels of spouse corresponding representations. Patient-partner discrepancy in perceived illness consequences was associated with more psychological symptoms in patients. Adaptation to cancer is a dyadic process within the context of which patient and partner psychological well-being is affected by each other's understanding of illness. Thus, the parallel examination of the illness representations of both partners is needed from the early phases of the illness trajectory.

Adaptation to an autoimmune disorder: Does mental flexibility impact illness-related self-regulation?

OBJECTIVE: To examine whether mental flexibility moderates the relationship between illness representations of control and coping behaviour in individuals suffering from rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE). DESIGN: Recently, diagnosed RA (N = 80) and SLE (N = 75) patients completed questionnaires about illness representations of personal and treatment control and four coping behaviours: instrumental coping, adherence to medical advice, palliative coping and wishful thinking. Mental flexibility was assessed with the Trail Making Test Part B (TMT-B), while visuomotor processing speed, as a confounder, was assessed with the Trail Making Test Part A (TMT-A). Moderated mediation models were tested within a bootstrapped multiple regression framework. RESULTS: TMT-A scores had no statistically significant moderation effects on the relation between representations and coping behaviour. Conversely, in those participants with SLE, TMT-B scores moderated the relation of personal control to wishful thinking and palliative coping, as well as the relation of treatment control to both wishful thinking and palliative coping. All significant effects were restricted to the SLE group. CONCLUSION: Interactions between neurocognitive factors and the process of illness adaptation may emerge early during the course of SLE. The present findings highlight the role of cognitive functioning as an integral part of the illness-related self-regulation mechanism.

The association of type 2 diabetes patient and spouse illness representations with their well-being: a dyadic approach.

BACKGROUND: The aim of this study was to examine the relation between certain illness representations and the physical and psychological well-being of persons with type 2 diabetes mellitus and their spouses. PURPOSE: In this study, we examined the relation of type 2 diabetes patients and their spouses' representations of illness consequences and timeline (chronicity and cyclicality/predictability) to the physical and psychological well-being of both. The interaction between patient and spouse illness representations was also studied. METHODS: A dyadic analysis approach was employed, while the Actor-Partner Interdependence Model was used to examine dyadic effects. One hundred and sixty-eight individuals nested in 84 couples participated. RESULTS: Regarding illness representations, both actor (i.e., the effects of a person's own characteristics on own outcomes) and partner (i.e., the effects of the partner's characteristics on a person's outcomes) effects were identified but only for patients' well-being. Certain significant interactions were also found: patients' timeline-cyclical representations were weakly associated with their anxiety and depression symptoms when spouses perceived diabetes as less unpredictable. Also, spouses' perceptions of consequences were more strongly related to their anxiety when patients perceived diabetes as less burdensome. CONCLUSIONS: Overall, the findings indicate a type of synergy between patient and spouse illness representations. They also emphasize the interdependence between diabetes patients and their partners, and the need to examine adaptation to illness within a dyadic-regulation framework as well.