Cognitive functioning and health related quality of life in patients with primary antiphospholipid syndrome

Section A: This paper reviews the literature surrounding cognitive functioning in patients with Antiphospholipid syndrome (APS) in the context of quality of life as an indicator of adaptation to chronic illness. The review focuses on cognitive functioning in APS patients and related clinical populations, describing and critiquing the empirical research literature exploring the evidence for cognitive deficits in these populations. Psychological theories of adaptation to chronic illness are discussed in relation to the concept of quality of life and research examining the relationship between cognitive dysfunction in APS and related clinical populations and health- related quality of life (HRQoL) is summarised. The limitations of previous research examining these factors are highlighted, demonstrating the need for empirical studies that address cognitive functioning and quality of life in patients with
primary APS (PAPS).
Section B: Objective: To explore the relationship between cognitive functioning and health related quality of life (HRQoL) in patients with PAPS.
Method: Cross sectional comparisons of PAPS patients (PAPS thrombosis; n = 15; PAPS pregnancy; n = 15) and healthy controls (n = 15) on a battery of neuropsychological assessments and a measure of HRQoL.
Results: PAPS thrombosis patients were twice as likely to be designated as cognitively impaired compared to PAPS pregnancy patients. PAPS thrombosis patients demonstrated lower performance on measures of memory and executive functioning compared to controls. PAPS pregnancy patients also performed more poorly on these measures compared to controls although not significantly. Both groups demonstrated poor HRQoL across physical and mental subscales. Both groups were significantly more impaired in all physical domains and one mental domain of HRQoL compared to controls. Neuropsychological outcomes in general intellectual abilities, memory and executive functioning were significantly associated with mental HRQoL subscales in PAPS thrombosis and executive functioning and memory were significantly associated with physical HRQoL subscales in PAPS pregnancy.
Conclusions: Cognitive impairment is associated with and is more prevalent in PAPS thrombosis patients when compared with PAPS pregnancy patients. Both PAPS groups demonstrate poor HRQoL which is associated with executive functioning and memory.
Section C: The critical review is structured to address four specific questions providing a reflective account of how the involvement in this project has contributed to the researcher’s skills and abilities and highlighted areas where further learning is necessary. The review also discusses further clinical applications and research for cognitive functioning and HRQoL in patients with PAPS.