Cognitive Impairment among Patients with Chronic Skin Inflammatory Disorder: A Hidden Link

BACKGROUND: A limited number of studies have associated the prevalence of cognitive impairment among patients with chronic inflammatory skin disorders. AIM AND OBJECTIVE: The objective of the study was to evaluate cognitive impairment among patients with chronic inflammatory skin disorders. PATIENTS AND METHODS: This was a cross-sectional study with a convenience sampling technique. A total of 200 patients with a diagnosis of psoriasis and vitiligo (100 each) were included. Participants were evaluated on the Hindi version of the Montreal cognitive assessment (MoCA) for cognitive impairment, patient health questionnaire-9 (PHQ-9) for depression, generalized anxiety disorder-7 (GAD-7) for anxiety disorder, and metabolic syndrome as per the consensus criteria given by the World Health Organization. RESULTS: A total of 200 patients were recruited. Those with psoriasis were significantly older ( P < 0.001), had notably fewer years of education ( P = 0.006), and were from rural areas ( P = 0.007).Those with psoriasis had a higher age at onset of illness ( P = 0.043), with a longer duration of illness ( P = 0.013), and reported significantly more presence of substance abuse ( P = 0.001). Overall, 68.5% had a presence of cognitive impairment. Those with psoriasis (75%) had a significantly higher frequency of cognitive impairment compared with those with vitiligo (62%). Those with psoriasis scored significantly low on the overall score of MoCA and all the domains of MoCA except orientation. These significant differences persisted even after controlling for factors such as the age of the patient, number of years of education, locality, age at onset of illness, duration of illness, substance use, alcohol use, tobacco use, hypertension, and central obesity. LIMITATIONS: It was a cross-sectional study; temporal association could not be elicited. Generalization of findings could not be done as only those who sought medical consultation from a tertiary care center were included. There was no age-gender matched control group. CONCLUSION: The prevalence of cognitive impairment was very high in patients with chronic inflammatory skin disorders. It is recommended to evaluate patients with psoriasis and vitiligo for cognitive impairment for early identification and treatment to prevent further deterioration of cognitive functions.