Objective tests strongly link sinusitis with worse cognition

Newly published evidence suggests that the millions of people who suffer from chronic rhinosinusitis (CRS) and who complain of brain fog might be experiencing measurable deficits involving memory and cognitive tasks.

“The preponderance of literature up to now has been based on patients self-reporting symptoms on surveys. We wanted to incorporate objective measurements of a variety of tasks that have been well established to measure brain functioning,” said Dr. Aria Jafari, the study’s lead author. He is a surgeon and an assistant professor of otolaryngology–head and neck surgery at the University of Washington School of Medicine.  

The paper was published Jan. 25 in the International Forum of Allergy and Rhinology.

Sinuses are the skull and face bone cavities that connect with the nasal passages. Sinusitis, an inflammation of sinus tissues, is one of the most common chronic conditions in the United States, with a prevalence of 10% to 12% of adults. The condition hugely affects not only healthcare systems but also workplaces due to lost productivity among employees whose concentration and executive function are adversely affected, Jafari said. 

In the study, 24 patients who had been diagnosed with CRS were administered two validated cognitive tests (the Montreal Cognitive Assessment-MoCA and the Neuro-QOL Cognitive Function) and separately assessed with saccadic eye-tracking software while performing onscreen tasks that can be compromised by impaired cognition. The patients also responded to a subjective quality-of-life questionnaire (the Sino-Nasal Outcome Test-22, known as the SNOT-22).

The cognitive test results and questionnaire responses of the patients with CRS were compared with those of 23 healthy control participants who had undergone the same battery of tests.

The eye-tracking assessment, Jafari said, measured the participants’ reactions and reaction times as they followed four distinct instructions — for example, to keep their focus on one dot in a set of three dots, or to keep their focus on a static space while averting their gaze from an intermittently blinking dot. The different tasks elicit information about a participant’s ability to visually attend to, or ignore, stimuli, and the speed of eye movement in response to stimuli.

Overall, patients with chronic rhinosinusitis were more likely to report cognitive dysfunction on the questionnaire and to demonstrate at least mild cognitive impairment on the administered tests than the control group, the researchers found.

Moreover, among patients with chronic rhinosinusitis, the authors found agreement among the administered tests and the self-reports about the extent to which symptoms affected their quality of life. 

“In two of the four behavioral (eye-tracking) assessments, the patients who did worse on those tasks also tended to have poorer scores on the MoCA and report a worse severity of symptoms on the SNOT-22 questionnaire,” Jafari said. “Almost half of our patients experienced some form of cognitive dysfunction as measured by rigorous, precise, noninvasive tests.”

Clinicians may be dismissive of complaints of brain fog among patients with chronic rhinosinusitis, Jafari said — for instance, attributing poorer ability to concentrate at work to disrupted sleep rather than to sinusitis itself.

“We’re getting a more sophisticated understanding of the extra-rhinologic symptoms manifested by CRS,” he said. “It’s not like you have sinusitis, so you’re slow to catch a ball. We think it’s more about the cognitive coordination and organization of tasks, the ability to inhibit yourself from cognitive impulsivity. I think acknowledging these phenomena as components of the condition is important in caring for the whole patient.

“From patients’ perspective, it’s less often the runny, stuffy nose that drives them to seek care in our clinic; it’s these cognitive symptoms and other vague secondary effects of CRS,” he added.

The next stage of study would be to follow patients’ treatment choices and to assess whether care that reduces patients’ chronic rhinosinusitis symptoms correlates with better scores on objective tests, Jafari said.

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