Can immune thrombocytopenia lead to cognitive impairment? Learn more about this condition from a poster session presented at the 64th Annual American Society of Hematology Meeting.
While immune thrombocytopenia (ITP) has typically been associated with a low platelet count and an increased risk of bleeding and bruising, can this condition also lead to cognitive impairment? One clinical study, published in 2020, found that 43 percent of adult ITP patients had occult cerebral bleeds (CMBs) on susceptibility-weighted magnetic resonance imaging (SW-MRI), pointing to the potential association between ITP and cognitive impairment.
To better understand this association, a recent study presented on a poster at the 2022 American Society of Hematology Annual Meeting aimed to establish the prevalence of cognitive impairment and identify which cognitive domains may be impaired in patients with ITP.
Researchers recruited patients with ITP who attended the Imperial College Healthcare NHS ITP center and who had a nadir platelet count ≤ 30 x 109/L at any time over the course of their disease. And using an automated neuropsychological test battery (CANTAB), completion of SMOG (skin, mucosae, organs) bleeding questionnaire, cerebral SW-MRI to identify CMBs, and a full blood count, these patients underwent thorough cognitive testing. The primary method of testing, the CANTAB, explored five key cognitive domains:
- Episodic memory
- Executive function
- Processing speed
- Working memory
Key clinical data, including date of diagnosis, nadir platelet count, number of ITP treatments received and co-morbidities was also gathered from all patients recruited for the study.
A total of 69 patients completed CANTAB cognitive testing and MRI. The median age of these patients was 40 years and the median age at diagnosis was 31 years. The median duration of the disease was 69 months, the median nadir platelet count was 5 x 109/L (range 0-30), the median platelet count at the time of the test was 95 x 109/L (range 4-653), and the median ITP treatments received were 4 (range 0-14).
Of the 69 patients tested, 50 percent had at least one impaired cognitive domain. More specifically, 29 percent had one impaired cognitive domain, 17 percent had at least two impaired cognitive domains, and 4 percent had at least three impaired cognitive domains. And for each domain in particular:
- 22 percent had impairment with episodic memory
- 19 percent had impairment with executive function
- 16 percent had impairment with processing speed
- 13 percent had impairment with memory
- 3 percent had impairment with attention
The results of this study demonstrate that patients with ITP suffer from cognitive impairment, with episodic memory being the most effective. And these results suggest that ITP is not just a low platelet disease but could have lifelong impacts on executive function, processing speed, memory, and more. However, given that this is the first study to objectively measure cognitive impairment in patients with ITP, more research is needed to better understand this correlation.