Risk factors and predictive model for mild cognitive impairment in elderly patients with rheumatoid arthritis
Bibliographic record
Abstract
BACKGROUND: Rheumatoid arthritis (RA) is a chronic autoimmune disorder characterized by joint destruction and systemic inflammation, both of which significantly impair patients' quality of life. Mild cognitive impairment (MCI), a reversible precursor to dementia, is increasingly prevalent among elderly RA patients. Early identification of MCI in this population allows for timely interventions to slow cognitive decline. OBJECTIVE: This study aims to identify independent risk factors for MCI in elderly patients with RA and to develop a predictive nomogram. METHODS: We enrolled 378 elderly RA patients, aged 60 to 80 years, from Xi'an Fifth Hospital between December 2023 and December 2024. Cognitive function was assessed using the Montreal Cognitive Assessment (MoCA), with scores ranging from 20 to 26 indicating MCI. We analyzed demographic, clinical, and laboratory data to identify risk factors through logistic regression and constructed a nomogram. The model's performance was evaluated using receiver operating characteristic (ROC) curves, calibration plots, and decision curve analysis (DCA). RESULTS: Among the 378 patients, 94 (24.87%) were classified in the RA-MCI group. Multivariate analysis identified the course of disease (COD) (OR = 1.07, 95% CI: 1.03-1.10), elevated Disease Activity Score-28 (DAS28) (OR = 1.31, 95% CI: 1.13-1.53), high C-reactive protein (CRP) levels (OR = 1.01, 95% CI: 1.01-1.02), and osteoporosis (OP) (OR = 1.88, 95% CI: 1.14-3.13) as independent risk factors. The nomogram demonstrated moderate discrimination (AUC = 0.750, 95% CI: 0.696-0.805) and clinical utility. CONCLUSION: The COD, OP, DAS28, and CRP levels are key predictors of MCI in elderly RA patients. The proposed nomogram provides a practical tool for early risk stratification, facilitating targeted interventions to delay cognitive decline. TRIAL REGISTRATION: This study conformed to the principles outlined in the Declaration of Helsinki and received approval from the Medical Ethics Committee of Xi'an Fifth Hospital (Approval No.: [2023] Ethics Review 55). Additionally, the trial was registered with the Chinese Clinical Trial Registry (Registration No.: ChiCTR2300077337, Registration Date: 2023-11-01). Written informed consent was obtained from all individual participants included in the study.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".