Burning Fog: Cognitive Impairment in Burning Mouth Syndrome.

Federica Canfora,Elena Calabria,Luca D'Aniello,Gaetano Marenzi,Daniela Adamo,Giuseppe Buono,Lorenzo Ugga,Renato Cuocolo,Giuseppe Pecoraro,Massimo Aria,Michele Davide Mignogna,Roberta Gasparro

doi:10.3389/fnagi.2021.727417

Abstract

Background: Due to its common association with chronic pain experience, cognitive impairment (CI) has never been evaluated in patients with burning mouth syndrome (BMS). The purpose of this study is to assess the prevalence of CI in patients with BMS and to evaluate its relationship with potential predictors such as pain, mood disorders, blood biomarkers, and white matter changes (WMCs).Methods: A case-control study was conducted by enrolling 40 patients with BMS and an equal number of healthy controls matched for age, gender, and education. Neurocognitive assessment [Mini Mental State Examination (MMSE), Digit Cancellation Test (DCT), the Forward and Backward Digit Span task (FDS and BDS), Corsi Block-Tapping Test (CB-TT), Rey Auditory Verbal Learning Test (RAVLT), Copying Geometric Drawings (CGD), Frontal Assessment Battery (FAB), and Trail Making A and B (TMT-A and TMT-B)], psychological assessment [Hamilton Rating Scale for Depression and Anxiety (HAM-D and HAM-A), Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), and 36-Item Short Form Health Survey (SF-36)], and pain assessment [Visual Analogic Scale (VAS), Total Pain Rating index (T-PRI), Brief Pain Inventory (BPI), and Pain DETECT Questionnaire (PD-Q)] were performed. In addition, blood biomarkers and MRI of the brain were recorded for the detection of Age-Related WMCs (ARWMCs). Descriptive statistics, the Mann-Whitney U-test, the Pearson Chi-Squared test and Spearman's correlation analysis were used.Results: Patients with BMS had impairments in most cognitive domains compared with controls (p < 0.001**) except in RAVLT and CGD. The HAM-D, HAM-A, PSQI, ESS, SF-36, VAS, T-PRI, BPI and PD-Q scores were statistically different between BMS patients and controls (p < 0.001**) the WMCs frequency and ARWMC scores in the right temporal (RT) and left temporal (LT) lobe were higher in patients with BMS (p = 0.023*).Conclusions: Meanwhile, BMS is associated with a higher decline in cognitive functions, particularly attention, working memory, and executive functions, but other functions such as praxis-constructive skills and verbal memory are preserved. The early identification of CI and associated factors may help clinicians to identify patients at risk of developing time-based neurodegenerative disorders, such as Alzheimer's disease (AD) and vascular dementia (VD), for planning the early, comprehensive, and multidisciplinary assessment and treatment.

Highlights

The number of older people is rising, and the global prevalence of individuals aged more than 60 years will approximately double from about 12 to 22% by 2050 (Christensen et al, 2009)
The outcomes evaluated for the primary objective of the study were the presence of cognitive impairment (CI) as measured by Mini Mental State Exam (MMSE), Digit Cancellation Test (DCT); FDS and BDS, CBTT, Rey Auditory Verbal Learning Test (RAVLT) immediate and delayed, Copying Geometric Drawings Test (CGD), Frontal Assessment Battery (FAB), and Trail Making A and B (TMT-A and Trail Making Test (TMT)-B) and the reported pain as measured by Visual Analog Scale (VAS), Brief Pain Inventory (BPI), Pain DETECT Questionnaire (PD-Q), and Total Pain Rating Index Questionnaire (T-PRI), the psychological profile as measured by Hamilton rating scale for Depression (HAM-D), Hamilton rating scale for Anxiety (HAM-A), Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), and social functioning (SF)-36 with an aim to detect any potential differences between patients with Burning mouth syndrome (BMS) and healthy subjects
It is possible to consider as an adjuvant tool TMT because patients with BMS have shown to exhibit the worst performance compared with healthy controls in these tasks, suggesting a greater deterioration in attention and executive functions. This is the first study supporting the theory that patients with BMS show burning fog with a decrease in the global cognitive function, attention, working memory, and executive functions with a higher score of age-related white matter changes (ARWMCs) in the temporal lobes of the brain compared with healthy subjects

Summary

Introduction

The number of older people is rising, and the global prevalence of individuals aged more than 60 years will approximately double from about 12 to 22% by 2050 (Christensen et al, 2009) Due to this aging population, dementia (currently 50 million diagnosed cases), chronic pain (30.8%), and depression (7%) represent the prevalence of serious comorbidities in the elderly population, which cause a great impact on the economy, with the estimation of the annual global cost to be over 1 trillion USD (Zis et al, 2017). For this reason, the early detection of these conditions is becoming crucial for health-care providers (Zelaya et al, 2020). The purpose of this study is to assess the prevalence of CI in patients with BMS and to evaluate its relationship with potential predictors such as pain, mood disorders, blood biomarkers, and white matter changes (WMCs)

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