Cognitive issues affect nearly half of adults with ITP, study finds

Nearly half of adults with immune thrombocytopenia (ITP) had cognitive impairment, particularly difficulties with memory, decision-making, and problem solving, a study found.

However, the problems were not significantly associated with cerebral microbleeds, tiny areas of bleeding in the brain that were detected in nearly one-third of participants in the study.

The results were described in a correspondence to the editor, titled “Cognitive Impairment, Depression and Cerebral Microbleeds in Immune Thrombocytopenia (ITP),” which was published in the American Journal of Hematology.

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Episodic memory most commonly affected cognitive area

ITP occurs when the immune system attacks and destroys platelets, which are circulating cell fragments needed for proper blood clotting, leading to symptoms like easy bruising and bleeding.

Previous research has found small areas of bleeding in the brain, known as cerebral microbleeds (CMBs), in some people with ITP. These tiny areas can be detected using MRI and have been linked to cognitive problems in some neurological conditions. However, their significance in ITP remains unclear.

Researchers in the U.K. examined whether cognitive problems were common among adults with ITP and whether they were associated with CMBs or other measures of the disease.

The study included 68 participants. Median age was 31 years at diagnosis and 40 years at the time of cognitive test; 65% were women. Participants underwent cognitive testing using CANTAB Insight, an automated assessment that evaluated five areas of cognition, and brain MRI to look for CMBs.

Almost half (48.5%) had impairment in at least one cognitive area, while 19% showed impairment in more than one domain. Episodic memory was the most commonly affected area (23% of participants). Executive function — skills needed to manage everyday tasks such as making plans, solving problems and adapting to new situations — was impaired in 18%, processing speed in 16%, and working memory (retaining a small amount of information in a readily accessible form) in 12%. Attention was affected in 3% of patients.

MRI scans revealed CMBs in 22 participants (32%). However, neither the presence nor the number of CMBs was significantly associated with cognitive impairment.

Future trials in ITP should incorporate cognitive testing and patient-reported outcomes, particularly fatigue, to better align treatment goals with patients’ lived experiences and to identify effective interventions for non-hematological [bleeding] aspects of the disease.

The researchers also found no significant relationship between cognitive impairment and several measures of ITP, including disease duration, bleeding scores, platelet count, or the number of ITP treatments received.

Depressive symptoms were also relatively common, with 37% of the participants having scores suggesting or indicating depression. However, depression scores were also not significantly associated with cognitive impairment in the analysis.

The findings broadly agree with an earlier study that also used automated testing in people with ITP and found cognitive impairment in 59% of its participants. The researchers noted that differences in the cognitive domains most affected between the studies may reflect differences in testing methods.

“Longitudinal studies incorporating serial brain MRI and repeated cognitive assessments are needed to clarify temporal relationships and the potential contribution of cerebral microbleeds to cognitive impairment,” the investigators wrote. “Future trials in ITP should incorporate cognitive testing and patient-reported outcomes, particularly fatigue, to better align treatment goals with patients’ lived experiences and to identify effective interventions for non-hematological [bleeding] aspects of the disease.”