Yan Jun, Guo Hua, Zhang Lin-Xin, Chen Pei, Du Yong-Ku, Li Juan, Gao Ya-Ya, Ye Nan
Department of Neurology, Xi'an Fifth Hospital, Xi'an, Shaanxi Province, China.
Department of Radiology, Xi'an Fifth Hospital, Xi'an, Shaanxi Province, China.
BMC Rheumatol. 2025 Jul 1;9(1):69. doi: 10.1186/s41927-025-00538-3.
Rheumatoid arthritis (RA) is a chronic autoimmune disorder characterized by joint destruction and systemic inflammation, both of which significantly impair patients' quality of life. Mild cognitive impairment (MCI), a reversible precursor to dementia, is increasingly prevalent among elderly RA patients. Early identification of MCI in this population allows for timely interventions to slow cognitive decline.
This study aims to identify independent risk factors for MCI in elderly patients with RA and to develop a predictive nomogram.
We enrolled 378 elderly RA patients, aged 60 to 80 years, from Xi'an Fifth Hospital between December 2023 and December 2024. Cognitive function was assessed using the Montreal Cognitive Assessment (MoCA), with scores ranging from 20 to 26 indicating MCI. We analyzed demographic, clinical, and laboratory data to identify risk factors through logistic regression and constructed a nomogram. The model's performance was evaluated using receiver operating characteristic (ROC) curves, calibration plots, and decision curve analysis (DCA).
Among the 378 patients, 94 (24.87%) were classified in the RA-MCI group. Multivariate analysis identified the course of disease (COD) (OR = 1.07, 95% CI: 1.03-1.10), elevated Disease Activity Score-28 (DAS28) (OR = 1.31, 95% CI: 1.13-1.53), high C-reactive protein (CRP) levels (OR = 1.01, 95% CI: 1.01-1.02), and osteoporosis (OP) (OR = 1.88, 95% CI: 1.14-3.13) as independent risk factors. The nomogram demonstrated moderate discrimination (AUC = 0.750, 95% CI: 0.696-0.805) and clinical utility.
The COD, OP, DAS28, and CRP levels are key predictors of MCI in elderly RA patients. The proposed nomogram provides a practical tool for early risk stratification, facilitating targeted interventions to delay cognitive decline.
This study conformed to the principles outlined in the Declaration of Helsinki and received approval from the Medical Ethics Committee of Xi'an Fifth Hospital (Approval No.: [2023] Ethics Review 55). Additionally, the trial was registered with the Chinese Clinical Trial Registry (Registration No.: ChiCTR2300077337, Registration Date: 2023-11-01). Written informed consent was obtained from all individual participants included in the study.
类风湿关节炎（RA）是一种慢性自身免疫性疾病，其特征为关节破坏和全身炎症，这两者均会严重损害患者的生活质量。轻度认知障碍（MCI）是痴呆的可逆前驱阶段，在老年RA患者中越来越普遍。早期识别该人群中的MCI有助于及时进行干预以减缓认知衰退。
本研究旨在确定老年RA患者发生MCI的独立危险因素，并开发一种预测列线图。
我们于2023年12月至2024年12月从西安市第五医院招募了378例年龄在60至80岁之间的老年RA患者。使用蒙特利尔认知评估量表（MoCA）评估认知功能，得分在20至26分之间表明存在MCI。我们分析了人口统计学、临床和实验室数据，通过逻辑回归确定危险因素并构建列线图。使用受试者工作特征（ROC）曲线、校准图和决策曲线分析（DCA）评估模型的性能。
在这378例患者中，94例（24.87%）被归类为RA-MCI组。多因素分析确定疾病病程（COD）（OR = 1.07，95%CI：1.03 - 1.10）、疾病活动评分-28（DAS28）升高（OR = 1.31，95%CI：1.13 - 1.53）、高C反应蛋白（CRP）水平（OR = 1.01，95%CI：1.01 - 1.02）和骨质疏松症（OP）（OR = 1.88，95%CI：1.14 - 3.13）为独立危险因素。列线图显示出中等区分度（AUC = 0.750，95%CI：0.696 - 0.805）和临床实用性。
COD、OP、DAS28和CRP水平是老年RA患者发生MCI的关键预测因素。所提出的列线图为早期风险分层提供了一种实用工具，有助于进行有针对性的干预以延缓认知衰退。
本研究符合《赫尔辛基宣言》中概述的原则，并获得了西安市第五医院医学伦理委员会的批准（批准号：[2023]伦理审查55）。此外，该试验在中国临床试验注册中心进行了注册（注册号：ChiCTR2300077337，注册日期：2023 - 11 - 01）。所有纳入研究的个体参与者均获得了书面知情同意。
