Cognitive symptoms are common in immune thrombocytopenia and associate with autonomic symptom burden.

Objectives: 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. Conclusion: Immune thrombocytopenia is more than a bleeding disorder; cognitive symptoms are common and independently associate with autonomic symptoms but not disease severity.