Session Opening

The session began with a patient speaker who talked about the impact of brain dysfunction and how this part of her AiArthritis disease affected and still affects her life.

• Before Diagnosis: The patient had a high level of cognitive functioning, working in a demanding role in Child Protective Services. Skills required included multitasking, working under pressure, planning, organizing, and focusing.
• After Diagnosis: Cognitive symptoms became disorganized, leading to difficulties in completing tasks, staying focused, and managing simple administrative duties. The patient experienced feelings of shame, frustration, and insecurity due to cognitive dysfunction.
  

What Helps with Brain Fog

Strategies for Management:

• Taking breaks, doing puzzles/memory games, planning, and sticking to a daily schedule.
• Developing routines, working in silence or with a focus-enhancing playlist, staying physically active.
• Creating to-do lists, prioritizing tasks, asking for help, and spending time outdoors.
• Reducing sensory stimuli when tired, using humor, and putting things into perspective.

Importance of Patient Education:

"Educating patients about cognitive dysfunction can empower them to manage their symptoms better. Healthcare professionals should actively address cognitive dysfunction with their patients." We agree! However, as people living with these diseases ourselves, after the session we asked one another if our rheumatologists had ever brought up brain fog. One person said yes, but it was out of a general desire to learn more, not because there was a plan to treat it. We know from our Early Symptoms of AiArthritis Study (2013) that over 30% of all patients, regardless of their AiArthritis disease diagnosis, report brain fog as a symptom. So we know it's something that needs to be addresses and we were happy to another session about it at EULAR 2024!*

Cognitive Dysfunction in RMDs:

Factors Contributing to Cognitive Dysfunction:

• Various factors like vitamin deficiencies, other diseases, and medications can contribute to cognitive dysfunction. A diagram presented in the session highlighted these factors.
• The speaker emphasized the need for further research focused solely on cognitive dysfunction.

Importance of Treating the Underlying Disease:

Managing the primary disease is crucial in mitigating cognitive dysfunction. The speaker observed that cognitive dysfunction peaks before infusions or during flares. Occupational therapy can be beneficial in coping with cognitive dysfunction by helping develop routines and memory aids.

Conclusions on Managing Cognitive Dysfunction:

Associated Factors:

• Cognitive dysfunction correlates with fatigue, pain, physical inactivity, psychological distress, and sleep problems. Managing these factors according to existing recommendations is essential.

Screening Tools:

• Several screening tools were mentioned, including the Mini Mental State Examination, Attenbrook's Cognitive Examination, and the Montreal Cognitive Assessment (MoCA) test.
• Self-report tools like the Multiple Abilities Self-Report Questionnaire (MASQ) and the Multidimensional Inventory of Subjective Cognitive Impairment (MISCI) were discussed. MISCI focuses on challenges like shifting between tasks, planning, finding the right words, and expressing oneself clearly.

Final Thoughts:

• Emphasis on managing the impact of cognitive dysfunction rather than the symptoms themselves. Hope for future research leading to better treatments or medications for cognitive dysfunction.
• Encouragement to the community, acknowledging the isolating nature of cognitive dysfunction but highlighting the progress being made in understanding and addressing it.

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*Check out additional reports from the American College of Rheumatology (ACR) and EULAR rheumatology research conventions regarding the brain by viewing the following patient debriefs from our "Go With Us!" to Conferences program:

• "Go With Us!" to EULAR 2023, overview of research generally about the brain and how studies about it are featured and later in the same debrief: The Brain and RMDs (Rheumatic and Musculoskeletal Diseases)
• "Go With Us! to ACR 2020, "Pain: It's All in Your Head. While this isn't about brain fog it's fascinating! It's all about how the pain we feel is interpreted in the brain and how this impacts pain management.