Quality of Life and Executive Function Deficits in Inflammatory Arthritis: A Comparative Study of Rheumatoid and Psoriatic Arthritis
Abstract
1. Introduction
2. Methods
2.1. Participants
2.2. Assessment Tools
2.2.1. The Wisconsin Card Sorting Test (WCST)
2.2.2. The Stroop-TBAG Test
2.2.3. The Adult Executive Functioning Inventory (ADEXI)
2.2.4. Health Assessment Questionnaire (HAQ)
2.2.5. World Health Organization Quality of Life Instrument—Short Form (WHOQOL-BREF)
2.3. Statistical Analysis
3. Results
3.1. Sociodemographic and Clinical Characteristics
3.2. Cognitive and Functional Assessments
3.3. Associations Between Clinical and Cognitive Variables
3.4. Cognitive Function Based on Disease Activity
3.5. Cognitive Function Based on Treatment Groups
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Variable | RA (n = 70) | PsA (n = 70) | p-Value |
---|---|---|---|
Gender | 0.065 | ||
Female | 54 (77.1%) | 44 (62.9%) | |
Male | 16 (22.9%) | 26 (37.1%) | |
Occupation | 0.011 | ||
Employed | 12 (17.1%) | 27 (38.6%) | |
Homemaker | 47 (67.1%) | 31 (44.3%) | |
Retired | 10 (14.3%) | 8 (11.4%) | |
Student | 1 (1.5%) | 4 (5.7%) | |
Marital Status | 0.309 | ||
Married | 57 (81.4%) | 52 (74.3%) | |
Single | 13 (18.6%) | 18 (25.7%) | |
Comorbidity | 0.307 | ||
No | 49 (70.0%) | 42 (60.0%) | |
Yes | 21 (30.0%) | 26 (37.1%) | |
Medication | 0.085 | ||
csDMARD | 41 (58.6%) | 35 (50.0%) | |
Biologic | 5 (7.1%) | 10 (14.3%) | |
csDMARD + Biologic | 22 (31.4%) | 16 (22.9%) | |
None | 1 (1.4%) | 6 (8.6%) | |
Age (mean ± SD) | 52.4 ± 11.7 | 48.7 ± 12.0 | 0.066 |
Disease duration (years) | 12.4 ± 8.2 | 8.7 ± 6.6 | 0.006 |
Years of education | 9.2 ± 4.1 | 10.6 ± 4.8 | 0.090 |
DAS28-CRP | 2.7 ± 0.9 | 2.4 ± 1.0 | 0.036 |
Laboratory Parameters | |||
Urea (mg/dL) | 33.8 ± 46.7 | 29.0 ± 13.4 | 0.927 |
Creatinine (mg/dL) | 0.7 ± 0.2 | 0.7 ± 0.2 | 0.211 |
AST (U/L) | 18.0 ± 5.4 | 20.2 ± 11.3 | 0.663 |
ALT (U/L) | 19.1 ± 10.4 | 22.6 ± 13.5 | 0.181 |
CRP (mg/L) | 23.9 ± 116.5 | 6.3 ± 12.0 | 0.154 |
ESR (mm/h) | 17.5 ± 15.1 | 14.3 ± 11.6 | 0.317 |
Leukocyte (×109/L) | 8.7 ± 2.9 | 8.3 ± 2.3 | 0.772 |
Hemoglobin (g/dL) | 13.0 ± 1.5 | 13.2 ± 2.1 | 0.200 |
Platelet (×103/µL) | 305.3 ± 82.3 | 280.0 ± 76.6 | 0.031 |
Assessment Tool | RA (Mean ± SD) | PsA (Mean ± SD) | p-Value | Mean Difference | 95%CI |
---|---|---|---|---|---|
Stroop Test | |||||
Color–word time (s) | 38.0 ± 13.8 | 30.0 ± 11.8 | <0.001 | 8.00 | [3.69, 12.31] |
Self-corrections | 3.0 ± 2.7 | 1.6 ± 1.8 | 0.002 | 1.41 | [0.64, 2.19] |
Errors | 0.7 ± 1.2 | 0.1 ± 0.4 | <0.001 | 0.61 | [0.31, 0.92] |
Wisconsin Card Sorting Test (WCST) | |||||
Total responses | 121.4 ± 14.4 | 113.8 ± 20.5 | 0.012 | 7.60 | [1.64, 13.55] |
Total errors | 60.5 ± 24.7 | 46.3 ± 25.7 | 0.001 | 14.17 | [5.73, 22.61] |
Total correct responses | 61.0 ± 16.8 | 67.2 ± 14.8 | 0.029 | −6.20 | [−11.50, −0.90] |
Completed categories | 2.7 ± 2.2 | 4.1 ± 2.0 | <0.001 | 1.40 | [−2.11, −0.69] |
Perseverative responses | 43.0 ± 32.9 | 32.5 ± 27.6 | 0.042 | 10.51 | [0.35, 20.67] |
Perseverative errors | 34.8 ± 24.3 | 26.5 ± 21.4 | 0.031 | 8.31 | [0.64, 15.99] |
Non-perseverative errors | 25.6 ± 18.6 | 20.9 ± 16.9 | 0.131 | 4.68 | [−1.27, 10.63] |
Perseverative errors (%) | 27.7 ± 18.5 | 21.8 ± 15.9 | 0.049 | 5.91 | [0.13, 11.71] |
Responses to complete 1st category | 49.3 ± 49.8 | 26.5 ± 32.9 | 0.028 | 22.81 | [8.69, 36.93] |
Responses at the conceptual level | 40.8 ± 24.3 | 53.2 ± 20.0 | 0.003 | −12.34 | [−19.81, −4.88] |
Conceptual level responses (%) | 35.6 ± 23.8 | 50.0 ± 23.2 | 0.001 | −14.37 | [−22.25, −6.50] |
Failure to maintain set score | 1.0 ± 1.9 | 0.8 ± 1.3 | 0.794 | 0.21 | [−0.35, 0.78] |
Adult Executive Functioning Inventory | |||||
Working memory | 23.1 ± 7.1 | 21.7 ± 7.0 | 0.166 | 1.41 | [−0.96, 3.79] |
Inhibition | 13.9 ± 2.5 | 12.9 ± 3.0 | 0.013 | 1.01 | [0.08, 1.96] |
WHOQOL-BREF | |||||
Physical health | 20.4 ± 6.0 | 22.5 ± 5.8 | 0.041 | −2.05 | [−4.06, −0.06] |
Psychological health | 20.2 ± 4.2 | 21.4 ± 4.3 | 0.066 | −1.28 | [−2.72, 0,15] |
Social relationships | 10.6 ± 1.3 | 11.0 ± 1.4 | 0.156 | −0.37 | [−0.05, 0.10] |
Environmental health | 29.2 ± 3.6 | 30.3 ± 3.6 | 0.054 | −1.05 | [−2.28, 0,16] |
Health Assessment Questionnaire (HAQ) | 10.7 ± 10.2 | 8.2 ± 9.0 | 0.165 | 2.42 | [−0.80, 5.66] |
Measure | RA | PsA | ||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
Age | Disease Duration | DAS28-CRP | Age | Disease Duration | DAS28-CRP | |||||||
Stroop Test | r | p | r | p | r | p | r | p | r | p | r | p |
Color–word time | 0.383 | 0.001 | 0.110 | 0.363 | −0.008 | 0.948 | 0.501 | 0.000 | 0.347 | 0.003 | 0.219 | 0.068 |
Self-corrections | 0.160 | 0.185 | 0.193 | 0.112 | −0.153 | 0.211 | 0.090 | 0.468 | 0.105 | 0.398 | 0.241 | 0.049 |
Errors | 0.132 | 0.280 | −0.059 | 0.632 | 0.501 | 0.000 | 0.084 | 0.497 | −0.084 | 0.498 | 0.017 | 0.888 |
WCST | ||||||||||||
Total responses | 0.420 | 0.000 | 0.084 | 0.491 | 0.004 | 0.974 | 0.341 | 0.004 | 0.046 | 0.713 | 0.101 | 0.417 |
Total errors | 0.406 | 0.000 | 0.269 | 0.026 | 0.110 | 0.368 | 0.299 | 0.012 | 0.172 | 0.164 | 0.025 | 0.838 |
Total correct responses | −0.281 | 0.018 | −0.286 | 0.017 | −0.095 | 0.436 | 0.065 | 0.592 | −0.242 | 0.049 | 0.065 | 0.602 |
Completed categories | −0.325 | 0.006 | −0.118 | 0.336 | −0.050 | 0.683 | −0.289 | 0.015 | −0.116 | 0.349 | −0.066 | 0.597 |
Perseverative responses | 0.490 | 0.000 | 0.274 | 0.023 | −0.029 | 0.816 | 0.292 | 0.014 | 0.242 | 0.048 | 0.130 | 0.294 |
Perseverative errors | 0.498 | 0.000 | 0.275 | 0.022 | −0.023 | 0.855 | 0.269 | 0.025 | 0.200 | 0.104 | 0.118 | 0.342 |
Non-perseverative errors | −0.096 | 0.429 | 0.013 | 0.913 | 0.270 | 0.025 | 0.140 | 0.249 | −0.061 | 0.623 | −0.036 | 0.770 |
Perseverative errors (%) | 0.491 | 0.000 | 0.291 | 0.015 | −0.031 | 0.801 | 0.227 | 0.058 | 0.220 | 0.074 | 0.109 | 0.378 |
Responses to complete 1st category | 0.194 | 0.108 | 0.117 | 0.338 | 0.173 | 0.155 | 0.212 | 0.079 | 0.090 | 0.468 | −0.008 | 0.950 |
Conceptual level responses | −0.319 | 0.007 | −0.237 | 0.050 | −0.137 | 0.261 | −0.105 | 0.387 | −0.190 | 0.123 | 0.002 | 0.985 |
Conceptual level responses (%) | −0.394 | 0.001 | −0.223 | 0.066 | −0.139 | 0.253 | −0.315 | 0.008 | −0.147 | 0.235 | −0.051 | 0.683 |
Failure to maintain set | −0.135 | 0.264 | 0.173 | 0.155 | −0.019 | 0.877 | 0.209 | 0.083 | −0.081 | 0.515 | 0.071 | 0.569 |
ADEXI | ||||||||||||
Working memory | −0.016 | 0.894 | 0.164 | 0.177 | 0.239 | 0.048 | 0.125 | 0.304 | 0.179 | 0.148 | 0.189 | 0.126 |
Inhibition | −0.096 | 0.427 | −0.156 | 0.199 | 0.275 | 0.022 | −0.151 | 0.212 | 0.190 | 0.124 | −0.048 | 0.702 |
WHOQOL-BREF | ||||||||||||
Physical health | −0.223 | 0.064 | −0.169 | 0.165 | −0.497 | 0.000 | −0.214 | 0.075 | –0.157 | 0.203 | −0.287 | 0.018 |
Psychological health | −0.044 | 0.716 | −0.182 | 0.135 | −0.392 | 0.001 | −0.051 | 0.678 | –0.006 | 0.958 | −0.186 | 0.133 |
Social relationships | 0.084 | 0.490 | −0.161 | 0.187 | −0.135 | 0.270 | −0.085 | 0.084 | –0.135 | 0.276 | −0.074 | 0.554 |
Environmental health | −0.072 | 0.552 | −0.243 | 0.044 | −0.302 | 0.012 | 0.033 | 0.078 | 0.042 | 0.737 | −0.211 | 0.086 |
HAQ | 0.209 | 0.082 | 0.240 | 0.047 | 0.670 | 0.000 | 0.176 | 0.146 | 0.096 | 0.438 | 0.521 | 0.000 |
Measure | Remission (n = 36) | Low Activity (n = 9) | Moderate Activity (n = 24) | p-Value |
---|---|---|---|---|
Stroop Test | ||||
Color–word time | 39.2 ± 14.6 | 35.0 ± 11.0 | 37.2 ± 14.0 | 0.814 |
Self-corrections | 3.5 ± 2.6 | 3.1 ± 3.2 | 2.3 ± 2.6 | 0.184 |
Errors | 0.7 ± 1.0 | 0.7 ± 1.3 | 0.7 ± 1.4 | 0.770 |
WCST | ||||
Total responses | 123.3 ± 13.6 | 115.7 ± 17.3 | 120.3 ± 14.8 | 0.155 |
Total errors | 61.5 ± 24.1 | 57.5 ± 31.3 | 59.5 ± 24.3 | 0.967 |
Total correct responses | 61.8 ± 18.3 | 59.1 ± 20.7 | 60.7 ± 13.5 | 0.967 |
Completed categories | 2.4 ± 2.1 | 4.0 ± 2.2 | 2.7 ± 2.2 | 0.185 |
Perseverative responses | 48.8 ± 36.8 | 41.5 ± 32.1 | 36.1 ± 26.0 | 0.477 |
Perseverative errors | 39.1 ± 26.7 | 33.1 ± 24.8 | 30.0 ± 19.9 | 0.484 |
Non-perseverative errors | 22.3 ± 18.6 | 24.2 ± 19.7 | 29.5 ± 17.0 | 0.171 |
Perseverative errors (%) | 31.0 ± 20.5 | 26.9 ± 18.5 | 24.0 ± 15.1 | 0.501 |
Responses to complete 1st category | 51.2 ± 52.6 | 32.1 ± 37.5 | 49.7 ± 48.5 | 0.829 |
Responses at the conceptual level | 40.7 ± 24.8 | 47.3 ± 23.4 | 39.5 ± 24.7 | 0.711 |
Conceptual level responses (%) | 34.5 ± 23.1 | 43.4 ± 24.6 | 35.1 ± 25.1 | 0.531 |
Failure to maintain set | 1.1 ± 2.0 | 0.4 ± 0.8 | 1.0 ± 2.0 | 0.663 |
ADEXI | ||||
Working memory | 21.7 ± 6.0 | 25.3 ± 7.1 | 23.7 ± 7.7 | 0.382 |
Inhibition | 13.0 ± 2.2 | 14.5 ± 2.2 | 14.9 ± 2.5 | 0.043 * |
WHOQOL-BREF | ||||
Physical health | 22.6 ± 6.1 | 20.4 ± 4.2 | 17.0 ± 5.2 | 0.002 * |
Psychological health | 21.1 ± 4.4 | 21.4 ± 2.2 | 18.2 ± 4.1 | 0.020 * |
Social relationships | 10.7 ± 1.2 | 10.7 ± 0.8 | 10.4 ± 1.7 | 0.757 |
Environmental health | 29.9 ± 3.2 | 28.7 ± 3.4 | 28.4 ± 4.1 | 0.172 |
HAQ | 6.0 ± 8.1 | 13.2 ± 7.6 | 17.1 ± 10.6 | 0.000 * |
Measure | Remission (n = 43) | Low Activity (n = 10) | Moderate Activity (n = 14) | p-Value |
---|---|---|---|---|
Stroop Test | ||||
Color–word time | 30.0 ± 12.4 | 31.5 ± 14.2 | 29.7 ± 9.6 | 0.809 |
Self-corrections | 1.7 ± 1.9 | 1.4 ± 1.4 | 1.7 ± 1.7 | 0.970 |
Errors | 0.9 ± 0.4 | 0.3 ± 0.9 | 0.0 ± 0.0 | 0.490 |
WCST | ||||
Total responses | 113.4 ± 20.3 | 114.6 ± 20.8 | 115.4 ± 20.4 | 0.931 |
Total errors | 47.2 ± 26.2 | 44.4 ± 23.7 | 46.5 ± 27.4 | 0.946 |
Total correct responses | 65.8 ± 15.4 | 70.2 ± 12.1 | 68.8 ± 16.4 | 0.692 |
Completed categories | 4.0 ± 2.0 | 4.4 ± 1.8 | 4.0 ± 2.2 | 0.908 |
Perseverative responses | 34.0 ± 32.2 | 29.4 ± 15.4 | 31.5 ± 21.0 | 0.745 |
Perseverative errors | 27.4 ± 24.5 | 25.0 ± 13.8 | 26.0 ± 17.4 | 0.861 |
Non-perseverative errors | 21.6 ± 18.1 | 19.4 ± 11.6 | 20.5 ± 17.9 | 0.994 |
Perseverative errors (%) | 22.8 ± 18.3 | 20.3 ± 9.9 | 20.9 ± 12.7 | 0.874 |
Responses to complete 1st category | 29.2 ± 37.4 | 17.0 ± 7.7 | 26.0 ± 32.8 | 0.869 |
Responses at the conceptual level | 52.1 ± 20.8 | 57.8 ± 15.1 | 52.8 ± 23.0 | 0.791 |
Conceptual level responses (%) | 49.2 ± 23.7 | 53.2 ± 20.3 | 48.7 ± 24.7 | 0.916 |
Failure to maintain set | 0.8 ± 1.5 | 0.6 ± 0.9 | 0.7 ± 1.1 | 0.934 |
ADEXI | ||||
Working memory | 20.8 ± 6.2 | 23.3 ± 6.6 | 22.4 ± 12.5 | 0.619 |
Inhibition | 12.8 ± 3.1 | 13.0 ± 3.4 | 9.0 ± 2.8 | 0.934 |
WHOQOL-BREF | ||||
Physical health | 23.2 ± 5.9 | 21.0 ± 6.6 | 21.2 ± 5.7 | 0.323 |
Psychological health | 22.0 ± 4.3 | 19.5 ± 5.7 | 21.1 ± 3.0 | 0.312 |
Social relationships | 11.0 ± 1.3 | 10.7 ± 1.8 | 11.1 ± 1.4 | 0.945 |
Environmental health | 30.7 ± 3.6 | 28.5 ± 4.2 | 30.6 ± 2.9 | 0.239 |
HAQ | 5.4 ± 7.5 | 9.7 ± 6.0 | 13.9 ± 10.5 | 0.001 * |
Measure | csDMARD (n = 76) | Biologic DMARD (n = 15) | Biologic + csDMARD (n = 38) | p-Value |
---|---|---|---|---|
Stroop Test | ||||
Color–word time | 34.8 ± 13.5 | 31.7 ± 8.5 | 33.0 ± 13.7 | 0.661 |
Self-corrections | 2.5 ± 2.5 | 2.0 ± 2.2 | 2.1 ± 2.2 | 0.881 |
Errors | 0.4 ± 0.9 | 0.5 ± 1.4 | 0.3 ± 0.7 | 0.953 |
WCST | ||||
Total responses | 116.9 ± 19.5 | 118.8 ± 16.4 | 119.4 ± 15.9 | 0.555 |
Total errors | 53.7 ± 27.2 | 51.3 ± 22.9 | 55.0 ± 25.4 | 0.717 |
Total correct responses | 63.0 ± 15.9 | 67.4 ± 15.0 | 64.3 ± 17.2 | 0.739 |
Completed categories | 3.3 ± 2.2 | 3.8 ± 1.9 | 3.2 ± 2.3 | 0.717 |
Perseverative responses | 39.0 ± 31.7 | 32.2 ± 19.7 | 37.2 ± 30.4 | 0.961 |
Perseverative errors | 31.4 ± 24.0 | 27.0 ± 16.3 | 30.3 ± 22.7 | 0.967 |
Non-perseverative errors | 22.3 ± 18.3 | 24.2 ± 14.1 | 24.6 ± 17.2 | 0.328 |
Perseverative errors (%) | 25.3 ± 18.1 | 22.1 ± 12.1 | 24.5 ± 17.2 | 0.990 |
Responses to complete 1st category | 37.4 ± 43.1 | 27.4 ± 30.4 | 44.2 ± 48.4 | 0.798 |
Responses at the conceptual level | 46.5 ± 22.5 | 53.3 ± 16.5 | 43.7 ± 25.6 | 0.693 |
Conceptual level responses (%) | 43.0 ± 25.1 | 46.4 ± 17.3 | 38.9 ± 25.1 | 0.480 |
Failure to maintain set | 0.8 ± 1.7 | 0.9 ± 1.2 | 0.8 ± 1.6 | 0.897 |
ADEXI | ||||
Working memory | 21.8 ± 6.4 | 21.4 ± 7.8 | 23.3 ± 7.6 | 0.468 |
Inhibition | 13.5 ± 2.9 | 13.4 ± 2.2 | 13.3 ± 2.7 | 0.938 |
WHOQOL-BREF | ||||
Physical health | 22.2 ± 5.4 | 23.6 ± 6.6 | 18.7 ± 5.7 | 0.009 * |
Psychological health | 21.3 ± 4.1 | 22.8 ± 3.8 | 19.0 ± 4.0 | 0.014 * |
Social relationships | 11.0 ± 1.3 | 11.2 ± 0.9 | 10.2 ± 1.6 | 0.197 |
Environmental health | 29.9 ± 3.4 | 31.4 ± 3.4 | 28.7 ± 3.8 | 0.173 |
HAQ | 7.0 ± 6.7 | 8.1 ± 9.9 | 14.7 ± 12.3 | 0.016 * |
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Cekmece, C.; Tayyare, B.C.; Karadag, D.; Sade, S.I.; Cefle, A.; Dursun, N. Quality of Life and Executive Function Deficits in Inflammatory Arthritis: A Comparative Study of Rheumatoid and Psoriatic Arthritis. Healthcare 2025, 13, 1928. https://doi.org/10.3390/healthcare13151928
Cekmece C, Tayyare BC, Karadag D, Sade SI, Cefle A, Dursun N. Quality of Life and Executive Function Deficits in Inflammatory Arthritis: A Comparative Study of Rheumatoid and Psoriatic Arthritis. Healthcare. 2025; 13(15):1928. https://doi.org/10.3390/healthcare13151928
Chicago/Turabian StyleCekmece, Cigdem, Begum Capa Tayyare, Duygu Karadag, Selime Ilgin Sade, Ayse Cefle, and Nigar Dursun. 2025. "Quality of Life and Executive Function Deficits in Inflammatory Arthritis: A Comparative Study of Rheumatoid and Psoriatic Arthritis" Healthcare 13, no. 15: 1928. https://doi.org/10.3390/healthcare13151928
APA StyleCekmece, C., Tayyare, B. C., Karadag, D., Sade, S. I., Cefle, A., & Dursun, N. (2025). Quality of Life and Executive Function Deficits in Inflammatory Arthritis: A Comparative Study of Rheumatoid and Psoriatic Arthritis. Healthcare, 13(15), 1928. https://doi.org/10.3390/healthcare13151928