Subclinical cognitive impairment in chronic pancreatitis is associated with reduced mobility and quality of life

Abstract

Objectives: This study explores how chronic pancreatitis (CP) relates to subclinical cognitive impairment (SCI), its prevalence, characteristics, risk factors, impact on patients’ quality of life (QoL) and physical performance. Methods: Patients with fulfilled CP criteria in imaging were prospectively enrolled. Overt encephalopathy, neurodegenerative disorders, decompensated cirrhosis or sepsis were exclusion criteria. All patients underwent psychometric testing, assessment of health-related QoL, such as mobility and strength. SCI was diagnosed when at least one test of the psychometric test battery was pathological. Results: Seventy-one patients were enrolled. The etiology was toxic (alcohol/ smoking) in most (49%) of the cases. SCI was prevalent in 41% of the patients, while 25% had only one and 16% had two or more pathological tests. Patients with SCI exhibited diminished overall QoL scores (p=0.048), primarily affecting physical functionality (p<0.001). This was reaffirmed in mobility tests, where patients with SCI were slower in the timed up-and-go test (p=0.008) and showed increased prevalence of abnormal chair rising tests (p=0.004). Among all variables analyzed, only alcohol abuse was an independent risk factor of SCI (OR 3.46; p=0.02) in a multivariable regression model together with the variables age, gender, education and compensated cirrhosis. Despite SCI affecting global QoL, sleep disturbance appeared to be the strongest variable independently associated with impaired QoL (OR 9.9; p=0.001). Conclusion: The largest study to the subject to date shows that SCI is common in CP patients and linked to significant morbidity. These findings suggest the need for addressing modifiable risk factors in CP patients to improve outcomes.