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Lymph And Mind: A New Perspective On Cognitive Dysfunction In Lymphedema
Melis Salman, MD, Shih-Lun Lo, MD, David Chon Fok Cheong, MD, Wei F. Chen, MD, FACS.
Cleveland Clinic, Cleveland, OH, USA.
PURPOSE: Lymphedema and cognitive impairment were once thought to be unrelated. However, recent discoveries of brain lymphatics and the systemic nature of primary lymphedema suggest a possible connection. Given frequent patient reports of cognitive impairment, this study investigates the relationship between primary lymphedema and cognitive dysfunction.
METHODS: We assessed cognitive function in 81 patients with primary lymphedema (67 females, 14 males; mean age 45) using the Montreal Cognitive Assessment (MoCA) and Brain Fog Scale (BFS). A comparative analysis was conducted against a historical control group of 1,046 healthy individuals. A subgroup analysis compared cognitive scores of patients who underwent lymphatic reconstruction (n=12) with those who did not (n=69). Statistical differences between groups were evaluated using independent t-tests.
RESULTS:Primary lymphedema patients had an average BFS score of 28.10±18.92 and a mean MoCA score of 27.92±2.28. Compared to controls, they showed significantly higher brain fog symptoms, including mental fatigue (10.58±5.44 vs. 8.62±4.63, p=0.0022), impaired cognitive acuity (10.57±8.44 vs. 7.81±6.18, p=0.0050), and confusion (6.95±6.56 vs. 5.18±5.71, p=0.0203). Patients with subjective cognitive complaints (n=21) had significantly higher BFS scores across all domains than those without (p<0.0001). Furthermore, patients who underwent lymphatic surgery reported lower brain fog symptoms, particularly in cognitive acuity (6.25±5.22 vs. 11.32±8.69, p=0.011) and total BFS score (19.75±11.87 vs. 29.55±19.59, p=0.027).
CONCLUSION: This study identifies a significant correlation between primary lymphedema and cognitive impairment. Post-surgical cognitive improvements suggest a mechanistic link between lymphatic function and cognitive performance, emphasizing the systemic nature of lymphedema and the necessity for cognitive assessments in affected patients.
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