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Longitudinal course of cognitive impairment in patients with atopic dermatitis

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Abstract

Atopic dermatitis (AD) is a common inflammatory skin disease. Cognitive dysfunction was recently demonstrated to be increased in adults and children with AD. However, little is known about the longitudinal course of cognitive impairment in AD and its relationship with pruritus. To investigate the longitudinal course and predictors of cognitive impairment in AD a prospective dermatology practice-based study was performed 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). Among patients with CI at baseline, 34.09% had persistent CI, 47.72% 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: 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 was associated with female gender and depressive symptoms [moderate-to-severe Patient Health Questionnaire-9 score (PHQ9)]. Latent class analysis identified two classes of cognitive dysfunction: normal cognition (77.23%), moderate dysfunction (16.21%) and severe impairment (6.55%). Black/African-American race (p = 0.02), moderate-to-severe SCORAD (p = 0.03), dermatology life quality index (p < 0.0001), PHQ9 (p < 0.0001), itch (p = 0.02) and skin pain (p < 0.0001) were more likely to experience moderate dysfunction or severe cognitive impairment. AD is associated with a heterogeneous longitudinal course of cognitive function in adults, with some patients experiencing persistent CI over time.

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Data availability

The participants of this study did not give consent for their data to be shared publicly. So, supporting data is not available.

Abbreviations

AD:

Atopic dermatitis

OR:

Odds ratio

aOR:

Adjusted odds ratio

ADD/ADHD:

Attention-deficit/hyperactivity disorder

ADSI:

Atopic Dermatitis Severity Index

PROMIS:

Patient-Reported Outcomes Measurement Information System

NRS:

Numeric Rating Scale

POEM:

Patient Oriented Eczema Measure

DLQI:

Dermatology Life Quality Index

EASI:

Eczema Area and Severity Index

SCORAD:

SCORing AD

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Funding

This publication was made possible with support from the Agency for Healthcare Research and Quality (AHRQ) grant number K12 HS023011, and the Dermatology Foundation.

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Authors and Affiliations

  1. AU/UGA Medical Partnership, The Medical College of Georgia at Augusta University, Athens, GA, USA

    Ladonya Jackson-Cowan

  2. Department of Dermatology, The George Washington University School of Medicine and Health Sciences, Suite 2B-425, 2150 Pennsylvania Avenue, Washington, DC, 20037, USA

    Jonathan I. Silverberg

  3. Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, USA

    Jonathan I. Silverberg

Authors
  1. Ladonya Jackson-Cowan
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  2. Jonathan I. Silverberg
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Contributions

LJC was responsible for data analysis, manuscript drafting. JIS was responsible for data collection, supervision, manuscript drafting.

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Correspondence to Jonathan I. Silverberg.

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Jackson-Cowan, L., Silverberg, J.I. Longitudinal course of cognitive impairment in patients with atopic dermatitis. Arch Dermatol Res 315, 1553–1560 (2023). https://doi.org/10.1007/s00403-023-02536-2

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  • DOI: https://doi.org/10.1007/s00403-023-02536-2

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