Background: Systemic Sclerosis (SSc) is a chronic autoimmune disease characterized by widespread fibrosis and vasculopathy in the skin and internal organs [1]. Although physical functional impairments, fatigue, and pain symptoms that significantly limit daily living activities and health-related quality of life (HRQoL) are well-defined in patients with SSc, changes in cognitive performance are not sufficiently elucidated [2]. The limited studies currently available also present conflicting results. Furthermore, the potential impact of cognitive performance on patients’ physical performance and disease-specific HRQoL has not been comprehensively investigated in patients with SSc [3].

Objectives: The secondary objective was to investigate the relationship between these cognitive performance scores, physical performance (mobility, muscle strength), and disease-specific HRQoL.

Methods: This cross-sectional study included 20 patients with SSc. Cognitive performance was evaluated using the Montreal Cognitive Assessment (MoCA), Flanker Test, and Corsi Block-Tapping Test. Functional performance was assessed via the Timed Up and Go Test (TUG) and 30-Second Sit-to-Stand Test (STST). Functional status and HRQoL were determined using the Health Assessment Questionnaire (HAQ) and Scleroderma Health Assessment Questionnaire (SHAQ).

Results: Participants had a mean age of 60.90 ± 10.40 years. The median (IQR) values for cognitive and functional assessments were as follows: MoCA 21.0 (13.0–29.0), Flanker Accuracy 0.95 (0.57–0.98), Flanker Response Time 563.53 ms (420.30–710.68), Corsi Response Time 5.66 s (3.12–9.45), TUG 8.30 s (6.30–13.10), and 30-second STST 11.0 (6.0–21.0). The MoCA score demonstrated a moderate negative correlation with TUG duration (r=-0.591, p=0.006) and a moderate positive correlation with 30-second STST scores (r=0.486, p=0.03)12. Regarding the Flanker Test, the number of correct responses showed strong correlations with both TUG (r=0.724, p<0.001) and 30-second STST (r=-0.760, p<0.001). Additionally, TUG duration correlated with Flanker mean response time (r=0.502,p=0.024) and Corsi mean response time (r=0.591,p=0.006), indicating moderate associations. Furthermore, Flanker correct responses were significantly correlated with both HAQ (r=-0.527, p=0.017) and SHAQ (r=-0.482, p=0.031) total scores.

Conclusions: Our findings demonstrate that cognitive performance is impaired in patients with SSc, particularly in attention and visual memory domains, and is strongly associated with physical performance and quality of life. For this reason, focusing solely on physical symptoms in SSc management may be insufficient. Cognitive performance should be routinely evaluated in clinical practice alongside physical assessments. In addition, integrating cognitive training (e.g., dual-task exercises) into rehabilitation programs is essential to improve both functional capacity and overall quality of life.

REFERENCES: [1] Review of recent studies on the pathogenesis of Systemic Sclerosis: focus on fibrosis pathways. Frontiers in Immunology , 16:1551911, 2025.

[2] Cognitive impairment in systemic autoimmune and inflammatory diseases: A narrative review focused on ANCA-associated vasculitis, sarcoidosis, Sjögren’s syndrome, systemic sclerosis, and Behçet’s disease. Autoimmunity Reviews , 24(3):103721, 2025.

[3] Role of cognitive impairment and malnutrition as determinants of quality of life in patients with systemic sclerosis. Journal of Scleroderma and Related Disorders , 9(2):143-153, 2024.

Acknowledgments: NIL.

Disclosure of Interests: None declared.