Enrollment for the registry began in March 2003 and is ongoing. The Brigham and Women's Arthritis Rheumatoid Arthritis Sequential Study (BRASS) registry is a large prospective, observational cohort at the Brigham and Women's Arthritis Center in Boston, Massachusetts. In the present analysis, we studied RA patients followed since 2003 who reported yearly on their perceived cognition to better understand the risk factors for this outcome. However, little is known about how these factors may contribute in the setting of a chronic inflammatory condition such as RA, although one study in systemic lupus erythematosus reported similar risk 15. Potentially modifiable lifestyle factors such as inactivity and obesity are risk factors for cognitive decline in the general population 13, 14. Appreciating the role that clinical and psychological factors play in the perception of cognition is important because cognitive complaints are clinically meaningful to patients and may portend cognitive decline. However, in RA, cognitive impairment can co‐occur with markers of psychological distress 11, and self‐reported cognitive dysfunction can be influenced by symptoms of depression and fatigue 12. In healthy cohorts, investigations of preclinical Alzheimer's type dementia have suggested that subjective cognitive complaints may precede abnormalities detected on neuropsychological testing 9, 10. However, screening for cognitive impairment with neuropsychological testing presents challenges as its administration is costly, time intensive, and requires specialized personnel to administer and interpret tests. This impairment may limit self‐management of the disease and worsen functional outcomes 8. A recent review of cognitive impairment in RA 5 demonstrated that RA patients underperformed on cognitive function tests compared with controls especially in areas of memory, attention, and verbal function.

Measurable cognitive impairment is estimated to occur in 30% to 71% of patients with RA in several studies 1, 6 other studies have demonstrated an association between cognition and disease activity 7. Individuals with inflammatory diseases such as rheumatoid arthritis (RA) have an increased prevalence of cognitive impairment, and recent articles suggest an increase in rates of Alzheimer's dementia 1, 2, 3, 4, 5.

Dr jonathan coblyn