TNF and Cognitive impairment: In our study, on the other hand, the percentage of patients with cognitive impairment (defined as a MoCA score < 26) did not change significantly at the end of follow-up (60.0 vs. 54.4%, p = 0.321), suggesting that while TNF inhibitors improve specific cognitive domains, they may not be sufficient to completely reduce the risk of cognitive impairment in affected patients.