The effects of different knee osteoarthritis criteria on trail‐making test times in an elderly Malaysian cohort

Abstract

AbstractBackgroundKnee osteoarthritis (KOA) is a common cause of morbidity among older people with its prevalence expected to increase with population ageing. The relationship between KOA and cognitive performance, however, is not well understood despite both conditions sharing common risk factors including age and metabolic syndrome. We evaluated the cognitive performance of individuals with and without KOA to evaluate this relationship.MethodData is from the Promoting Independence in our Seniors with Arthritis (PISA) study, which is comprised older adults with and without KOA recruited from an urban tertiary hospital and its catchment population. Basic demographics, physical and psychosocial characteristics were recorded. Cognitive performance was determined using the Trail‐Making Test (TMT). KOA was defined using the American College of Rheumatology (ACR) criteria, presence of knee pain, self‐reported physician diagnosis (SRPD), and the Kellgren‐Lawrence’s (KL) radiographic criteria. Multiple linear regression models were created and bootstrapping was used for Kellgren‐Lawrence in view of the smaller sample who had radiographic investigations.ResultTwo‐hundred and thirty participants, mean (SD) age of 66.93 (7.12) years, were recruited. KOA was present in 120 (58.0%), 94 (40.9%), 85 (39.9%), and 33 (57.9%) according to ACR, knee pain, SRPD and KL criteria respectively. TMT‐A scores were variably influenced by age, gender, years of education, grip strength, functional reach and presence of metabolic syndrome using the four KOA criteria. TMT‐B scores were influenced by age, gender, years of education, grip strength and depression scores differentially using the four KOA criteria. No significant associated was observed between KOA and TMT‐A or TMT‐B scores after adjustment for the potential confounders above.ConclusionKnee OA was not associated with differences in cognitive performance evaluated with TMT which is a cognitive screening tool which mainly evaluates attention, working memory and executive function. The presence of KOA did not influence TMT performance in this study, which suggests that KOA does not affect the above cognitive domains regardless of criteria for diagnosis. This suggests that cognitive impairment and KOA do not share common pathological processes despite the presence of common risk factors.