ROMATOLOJİK HASTALIKLARDA KOGNİTİF DİSFONKSİYONLAR

Öz

Romatizmal hastalığı olan bireylerin yüzde 90'ından fazlasında dikkat ve hafıza problemleri görülmektedir. Kronik inflamasyon merkezi sinir sisteminde nöroinflamatuar strese yol açarak, günlük kognisyonla ilişkili aktivitelerin tamamlanmasında ek kortikal kaynakların kullanılmasına neden olabilir. Ayrıca, beyin bölgelerinin, ağrı ile olan meşguliyetleri nedeniyle kognitif görevlerini yerine getiremediklerinden dolayı kognitif disfonksiyon meydana gelebilir. Romatizmal hastalıklarda bilişsel bozulmaya katkıda bulunan faktörler hastalık türüne bağlı olabilir. Romatoid Artrit’li çoğu hasta, inflamasyon arttıkça izole kognitif görevleri sağlıklı bireylerle aynı düzeyde gerçekleştirebilmek için, daha fazla serebral korteks bölgesi kullanmaktadır. Lupus’ta kognitif disfonksiyonun altında yatan yollar hala araştırılmaktadır ve parametreler henüz tam olarak doğrulanıp geniş çapta kabul edilmemiştir. Sistemik Skleroz’lu hastalarda soğuğa maruz kalmanın zihinsel veya bilişsel etkilerine ilişkin çeşitli raporlar mevcuttur. Primer Sjögren Sendromu’nda sınırlı kanıtlar hipoperfüzyonun kognitif işlev bozukluğuyla ilişkili olabileceğini göstermektedir. Fibromiyalji’de ğrı derecesinin kognitif disfonksiyon düzeyi ile direk ilişkili olduğu ortak görüştür. Primer Sistemik Vaskülitler’de serebral hipoperfüzyon nedeniyle kognitif etkilenim olabilir. Behçet hastalığında kognitif disfonksiyon yaş, anksiyete-depresif bozukluklar, kronik stres etkenleri ve minör beyin multifokal subkortikal parankimal MRG lezyonları ile ilişkilidirler. Bazı faktörlerin kognitif disfonksiyona neden olduğu bulunmuştur. Ancak belirtiler arasında ayrım yapma konusunda özgüllükleri zayıftır, bu durum klinik kullanımı sınırlamaktadır (kafa karıştırıcı faktörlerin varlığı ve güvenilir biyobelirteçlerin eksikliği).

Anahtar Kelimeler

• Romatolojik Hastalık
• Kognitif Disfonksiyon
• Ağrı

COGNITIVE DYSFUNCTIONS IN RHEUMATOLOGICAL DISEASES

Öz

More than 90% of individuals with rheumatic diseases experience attention and memory problems. Chronic inflammation can lead to neuroinflammatory stress in the central nervous system, causing the use of additional cortical resources to complete activities related to daily cognition. Moreover, cognitive dysfunction may occur because brain regions cannot perform cognitive tasks due to their preoccupation with pain. Factors contributing to cognitive impairment in rheumatic diseases may depend on the type of disease. Most patients with Rheumatoid Arthritis use more cerebral cortex areas to perform isolated cognitive tasks at the same level as healthy individuals as inflammation increases. The pathways underlying cognitive dysfunction in Lupus are still being investigated, and the parameters have not yet been fully validated and widely accepted. In patients with Systemic Sclerosis, there are various reports on the mental or cognitive effects of exposure to cold. Limited evidence in Primary Sjogren's Syndrome suggests that hypoperfusion may be associated with cognitive dysfunction. In Fibromyalgia, it is a common view that the degree of pain is directly related to the level of cognitive dysfunction. In Primary Systemic Vasculitides, cognitive effects may occur due to cerebral hypoperfusion. In Behçet's disease, cognitive dysfunction is associated with age, anxiety-depressive disorders, chronic stress factors, and minor brain multifocal subcortical parenchymal MRI lesions. Some factors have been found to cause cognitive dysfunction. However, their specificity in distinguishing between symptoms is weak, limiting clinical use (due to the presence of confounding factors and the lack of reliable biomarkers).

Anahtar Kelimeler

• Rheumatic Disease
• Cognitive Dysfunction
• Pain

Kaynakça

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