title: Cognitive symptoms are common in immune thrombocytopenia and associate with autonomic symptom burden.
abstract: OBJECTIVE
  People with adult immune thrombocytopenia (ITP) are commonly thought to have an isolated blood disorder, but many also describe memory and concentration problems. Cognitive impairment commonly associates with autonomic dysfunction. Here, we quantified cognitive symptoms in a large cohort of patients with ITP compared with controls and explored the relationship with autonomic symptoms.
  
  
  METHODS
  Patients with ITP were approached in the UK via the national ITP Support Association and invited to complete Composite Autonomic Symptom Scale (COMPASS; measure of autonomic symptoms) and Cognitive Failures Questionnaire (CFQ) together with one from a friend of similar age and sex without ITP.
  
  
  RESULTS
  Three hundred and ninety-eight patients with ITP completed measures with paired data from a representative group of 189 patients and controls (47%). Both autonomic and cognitive symptom burden were higher in ITP compared with controls (COMPASS score (48 ± 14 vs. 38 ± 12; P > 0.0001); CFQ (43 ± 17 vs. 36 ± 13; P < 0.0001). A positive relationship was seen between increasing cognitive symptoms and higher COMPASS score (P < 0.0001; r(2) = 0.1). Increasing cognitive symptoms did not associate with platelet count (P = 0.08, r(2) = 0.008). Multivariate analysis confirmed age and COMPASS independently associated with higher CFQ but not platelet count.
  
  
  CONCLUSIONS
  Immune thrombocytopenia is more than a bleeding disorder; cognitive symptoms are common and independently associate with autonomic symptoms but not disease severity.
authors: Institute for Ageing and Health and UK NIHR Biomedical Research Centre in Ageing, Newcastle University, Newcastle upon Tyne, UK.
authors: James
authors: J
authors: Frith
authors: Shirley
authors: S
authors: Watson
authors: Paula H B
authors: PH
authors: Bolton Maggs
authors: Julia L
authors: JL
authors: Newton
mesh_terms: D000328:Adult; D000368:Aged; D001342:Autonomic Nervous System Diseases / Q000150:complications* / Q000453:epidemiology; D003072:Cognition Disorders / Q000150:complications* / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D016553:Purpura, Thrombocytopenic, Idiopathic / Q000150:complications* / Q000453:epidemiology; D011795:Surveys and Questionnaires