Longitudinal Course of Cognitive Impairment in Patients with Atopic Dermatitis

Abstract

Abstract Cognitive dysfunction was recently demonstrated to be increased in adults and children with atopic dermatitis (AD). Though, little is known about the longitudinal course of cognitive impairment in AD and its relationship with pruritus. In order to investigate this, we conducted a prospective dermatology practice-based study using questionnaires and evaluation by a dermatologist (n = 210). Patients with ≥ 2 visits were included (mean follow-up time: 318 days). Cognitive function was assessed using the Patient-Reported Outcomes Measurement Information System (PROMIS) Cognitive Function 8-item Short-Form. At baseline, 20.85% of patients had PROMIS T-scores ≤ 45, indicating cognitive impairment (CI). More than half (59.09%) had CI at ≥ 1 follow-up visit; only 0.25% had CI at ≥ 2 follow-up visits. Among patients with CI at baseline, 34.09% had persistent CI, 47.71% had a fluctuating course and 18.18% had sustained improvement of cognitive function. In repeated measures regression models, cognitive function scores declined overtime in patients with worse AD severity (SCORing Atopic Dermatitis [SCORAD]: p = 0.01, Atopic Dermatitis Severity Index [ADSI]: p = 0.001), increased itch (p = 0.01), skin pain (p < 0.001), and sleep disturbance (p = 0.001). In multivariable logistic regression models, persistent CI were associated with depressive symptoms (moderate to severe Patient Health Questionnaire-9 score (PHQ9). Latent class analysis identified 2 classes of cognitive dysfunction: normal (77.23%), moderate dysfunction (16.21%) and severe impairment (6.55%). Patients of Black/African American race (p = 0.02) were more likely to have moderate dysfunction or severe cognitive impairment. In conclusion, AD is associated with a heterogeneous longitudinal course of cognitive function in adults, with some patients experiencing persistent CI over time.