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Kammeyer R, Ogbu EA, Cooper JC, Stolz E, Piquet AL, Fuhlbrigge RC, Bennett JL, Hutaff-Lee C. [Formula: see text] Cognitive dysfunction in pediatric systemic lupus erythematosus: current knowledge and future directions. Child Neuropsychol 2024; 30:818-846. [PMID: 37902575 PMCID: PMC11058121 DOI: 10.1080/09297049.2023.2273573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 10/16/2023] [Indexed: 10/31/2023]
Abstract
Cognitive dysfunction (CD) is a neurologic complication of pediatric systemic lupus erythematosus (SLE) that remains poorly understood and understudied, despite the potential negative effects of CD on long-term socioeconomic status and quality of life. Data regarding the prevalence and risk factors for CD in pediatric SLE as well as the optimal screening, treatment, and long-term outcomes for CD are lacking. In this review, we present current knowledge on CD in pediatric SLE with a focus on the application to clinical practice. We discuss the challenges in diagnosis, clinical screening methods, potential impacts, and interventions for this complication. Finally, we discuss the remaining gaps in our knowledge of CD in pediatric SLE, and avenues for future research efforts.
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Affiliation(s)
- Ryan Kammeyer
- Departments of Pediatrics and Neurology, Sections of Child Neurology and Neuroimmunology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Ekemini A. Ogbu
- Division of Rheumatology, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jennifer C. Cooper
- Department of Pediatrics, Section of Pediatric Rheumatology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Erin Stolz
- Department of Child and Adolescent Psychiatry, Section of Pediatric Medical Psychology, John Hopkins Medicine, Baltimore, MA, USA
| | - Amanda L. Piquet
- Department of Neurology, Section of Neuroimmunology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Robert C. Fuhlbrigge
- Department of Pediatrics, Section of Pediatric Rheumatology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Jeffrey L. Bennett
- Departments of Neurology and Ophthalmology, Programs in Neuroscience and Immunology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Christa Hutaff-Lee
- Department of Pediatrics, Section of Neurology-Neuropsychology, University of Colorado School of Medicine, Aurora, CO, USA
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Elolemy G, Al Rashidi A, Youssry D, Elziat H, Baraka E. Headache in patients with systemic lupus erythematosus: characteristics, brain MRI patterns, and impact. EGYPTIAN RHEUMATOLOGY AND REHABILITATION 2021. [DOI: 10.1186/s43166-021-00078-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
The prevalence of primary headache in patients with systemic lupus erythematosus (SLE) varies widely and whether it should be attributed to neurological involvement is controversial. We aimed to investigate the prevalence and characteristics of headache in SLE patients, describe its association with disease-related variables and brain imaging, and explore its impact on life.
Results
The overall prevalence of headache was 54.4%, and migraine was the most common type among headache sufferers (48.4%). Headache severity (VAS) and impact (HIT-6) correlated with SLEDAI-2K (P = 0.019 and P < 0.001, respectively) as well as with each other (P = 0.006). Brain imaging abnormalities were found in 25.8%, with white-matter hyperintensities (WMH) being the most frequent pathology. Musculoskeletal manifestations, positive anti-phospholipid (aPL) antibodies, and SLEDAI score ≥ 13.5 were identified as predictors of headache.
Conclusion
Primary headache, especially migraine, is a common feature of patients with SLE, and its presence is associated with negative impact on quality of life. Musculoskeletal features, aPL positivity, and overall disease activity appear to predict primary headache in SLE.
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Yuen K, Green R, Bingham K, Ruttan L, Lee-Kim V, Tartaglia MC, Anderson M, Zandy M, Choi MY, Fritzler MJ, Wither JE, Beaton DE, Katz P, Touma Z. Metrics and definitions used in the assessment of cognitive impairment in systemic lupus erythematosus: A systematic review. Semin Arthritis Rheum 2021; 51:819-830. [PMID: 34157577 DOI: 10.1016/j.semarthrit.2021.05.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 05/03/2021] [Accepted: 05/31/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To review: 1) degree of conformity to the American College of Rheumatology neuropsychological battery (ACR-NB) among studies that used a NB, 2) review definitions of cognitive impairment (CI) from studies that used a NB, and 3) characterize measurement tools used to assess CI in systemic lupus erythematosus (SLE). METHODS The literature search was conducted in Ovid Medline, Embase, and PsycINFO for articles on CI in adult SLE patients. We reviewed studies that used a NB and compared their tests to the ACR-NB to assess the degree of conformity. Definitions of CI from studies that used a NB were reviewed when sufficient information was available. We reviewed and categorized CI measurement tools into four broad categories: NB, screening, incomplete/mixed batteries, and computerized batteries. RESULTS Of 8727 references, 118 were selected for detailed review and 97 were included in the final analysis. Of 43 studies that used a NB, none of the studies used the ACR-NB exactly as published. Many studies supplemented with other tests. Overall, there was inconsistent use of ACR-NB tests. Definitions for CI varied, with cut-offs ranging from 1 to 3 standard deviations below normative values on domains/tests varying in type and number. The most frequently used measurement tool for assessing CI in SLE was a NB. Use of screening tests and computerized batteries have also increased over the last decade. CONCLUSION The assessment and definition of CI in SLE remains heterogeneous. A consensus meeting to address existing inconsistencies should be considered to harmonize the field of CI in SLE.
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Affiliation(s)
- Kimberley Yuen
- Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital, University of Toronto Lupus Clinic, EW, 1-412, 399 Bathurst Street, Toronto, Ontario, Canada; Queen's University School of Medicine, Kingston, Ontario, Canada
| | - Robin Green
- University Health Network- Toronto Rehabilitation Institute, Toronto, Ontario, Canada
| | - Kathleen Bingham
- University Health Network Centre for Mental Health, Toronto, Ontario, Canada
| | - Lesley Ruttan
- University Health Network- Toronto Rehabilitation Institute, Toronto, Ontario, Canada
| | - Victoria Lee-Kim
- Queen's University School of Medicine, Kingston, Ontario, Canada
| | | | - Melanie Anderson
- Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Moe Zandy
- Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital, University of Toronto Lupus Clinic, EW, 1-412, 399 Bathurst Street, Toronto, Ontario, Canada
| | - May Y Choi
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Marvin J Fritzler
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Joan E Wither
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, Ontario, Canada
| | | | - Patricia Katz
- University of California at San Francisco, San Francisco, California, USA
| | - Zahi Touma
- Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital, University of Toronto Lupus Clinic, EW, 1-412, 399 Bathurst Street, Toronto, Ontario, Canada.
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Seet D, Allameen NA, Tay SH, Cho J, Mak A. Cognitive Dysfunction in Systemic Lupus Erythematosus: Immunopathology, Clinical Manifestations, Neuroimaging and Management. Rheumatol Ther 2021; 8:651-679. [PMID: 33993432 PMCID: PMC8217391 DOI: 10.1007/s40744-021-00312-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Accepted: 04/22/2021] [Indexed: 12/23/2022] Open
Abstract
Cognitive dysfunction (CD) is a common yet often clinically subtle manifestation that considerably impacts the health-related quality of life in patients with systemic lupus erythaematosus (SLE). Given the inconsistencies in CD assessment and challenges in its attribution to SLE, the reported prevalence of CD differs widely, ranging from 3 to 88%. The clinical presentation of CD in SLE is non-specific and may manifest concurrently with overt neuropsychiatric illness such as psychosis or mood disorders or as isolated impairment of attention, working memory, executive dysfunction or processing speed. Despite the lack of standardized and sensitive neuropsychological tests and validated diagnostic biomarkers of CD in SLE, significant progress has been made in identifying pathogenic neural pathways and neuroimaging. Furthermore, several autoantibodies, cytokines, pro-inflammatory mediators and metabolic factors have been implicated in the pathogenesis of CD in SLE. Abrogation of the integrity of the blood-brain barrier (BBB) and ensuing autoantibody-mediated neurotoxicity, complement and microglial activation remains the widely accepted mechanism of SLE-related CD. Although several functional neuroimaging modalities have consistently demonstrated abnormalities that correlate with CD in SLE patients, a consensus remains to be reached as to their clinical utility in diagnosing CD. Given the multifactorial aetiology of CD, a multi-domain interventional approach that addresses the risk factors and disease mechanisms of CD in a concurrent fashion is the favourable therapeutic direction. While cognitive rehabilitation and exercise training remain important, specific pharmacological agents that target microglial activation and maintain the BBB integrity are potential candidates for the treatment of SLE-related CD.
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Affiliation(s)
- Dominic Seet
- Division of Rheumatology, Department of Medicine, University Medicine Cluster, National University Health System, 1E Kent Ridge Road, Level 10, NUHS Tower Block, Singapore, 119228 Singapore
| | - Nur Azizah Allameen
- Division of Rheumatology, Department of Medicine, University Medicine Cluster, National University Health System, 1E Kent Ridge Road, Level 10, NUHS Tower Block, Singapore, 119228 Singapore
| | - Sen Hee Tay
- Division of Rheumatology, Department of Medicine, University Medicine Cluster, National University Health System, 1E Kent Ridge Road, Level 10, NUHS Tower Block, Singapore, 119228 Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Jiacai Cho
- Division of Rheumatology, Department of Medicine, University Medicine Cluster, National University Health System, 1E Kent Ridge Road, Level 10, NUHS Tower Block, Singapore, 119228 Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Anselm Mak
- Division of Rheumatology, Department of Medicine, University Medicine Cluster, National University Health System, 1E Kent Ridge Road, Level 10, NUHS Tower Block, Singapore, 119228 Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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Yu Y, Chen L, Wang Q, Hu L, Ding Q, Jia X, Yang X. Altered Amplitude of Low-Frequency Fluctuations in Inactive Patients with Nonneuropsychiatric Systemic Lupus Erythematosus. Neural Plast 2019; 2019:9408612. [PMID: 31885539 PMCID: PMC6899324 DOI: 10.1155/2019/9408612] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 09/20/2019] [Accepted: 10/14/2019] [Indexed: 12/12/2022] Open
Abstract
Objective This study is aimed at investigating the characteristics of the spontaneous brain activity in inactive patients with nonneuropsychiatric systemic lupus erythematosus (non-NPSLE). Methods Thirty-one female inactive patients with non-NPSLE and twenty healthy controls were examined by resting-state functional magnetic resonance imaging (RS-fMRI). Three amplitude methods including amplitude of low-frequency fluctuations (ALFF), fractional amplitude of low-frequency fluctuations (fALFF), and percent amplitude of fluctuation (PerAF) (with and without standardization) were applied to evaluate the spontaneous brain activity. The correlation was performed between low-frequency oscillations and clinical and neuropsychological factors in inactive patients with non-NPSLE. Results Compared to healthy controls, patients with non-NPSLE showed increased standardized ALFF (mALFF) in the left inferior temporal gyrus and left putamen, decreased PerAF in the right postcentral gyrus and bilateral precentral gyrus, and increased standardized PerAF (mPerAF) in the left putamen and decreased mPerAF in the right postcentral gyrus and bilateral precentral gyrus. By standardized fALFF (mfALFF), no significant brain regions were found between the two groups. Correlation analysis revealed significantly positive correlations between glucocorticoid dose and PerAF in the right precentral gyrus and mPerAF in the left putamen, and Complement 3 (C3) and mPerAF in the right postcentral gyrus. There was a significant negative correlation between C3 and mALFF in the left putamen. Conclusion Abnormal low-frequency oscillations in multiple brain regions were found in inactive patients with non-NPSLE, indicating that the alteration of mALFF, PerAF, and mPerAF in specific brain regions might be an imaging biomarker of brain dysfunction in inactive patients with non-NPSLE.
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Affiliation(s)
- Yang Yu
- Department of Psychiatry, Second Affiliated Hospital, College of Medicine, Zhejiang University, 88 Jiefang Rd, Hangzhou 310009, China
| | - Liheng Chen
- Department of Rheumatology, Second Affiliated Hospital, College of Medicine, Zhejiang University, 88 Jiefang Rd, Hangzhou 310009, China
| | - Qiaohong Wang
- Department of Rheumatology, Second Affiliated Hospital, College of Medicine, Zhejiang University, 88 Jiefang Rd, Hangzhou 310009, China
| | - Lingzhen Hu
- Department of Rheumatology, Second Affiliated Hospital, College of Medicine, Zhejiang University, 88 Jiefang Rd, Hangzhou 310009, China
| | - Qiuping Ding
- Center for Brain Imaging Science and Technology, Key Laboratory for Biomedical Engineering of Ministry of Education, College of Biomedical Engineering and Instrumental Science, Zhejiang University, 38 Zheda Rd, Hangzhou 310027, China
| | - Xize Jia
- Center for Cognition and Brain Disorders, Institutes of Psychological Sciences, Hangzhou Normal University, Zhejiang Key Laboratory for Research in Assessment of Cognitive Impairments, No. 2318 Yuhangtang Rd, Hangzhou 311121, China
| | - Xuyan Yang
- Department of Rheumatology, Second Affiliated Hospital, College of Medicine, Zhejiang University, 88 Jiefang Rd, Hangzhou 310009, China
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Chung SW, Lee KM, Heo SH, Ra R, Hong SJ, Yang HI, Lee SH, Song R, Lee YA. A systemic lupus erythematosus patient with thunderclap headache: reversible cerebral vasoconstriction syndrome. Lupus 2019; 28:898-902. [PMID: 31042127 DOI: 10.1177/0961203319845485] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Headaches are common in patients with systemic lupus erythematosus (SLE). It is important to identify the exact cause of headaches in SLE to avoid unnecessary steroid or immunosuppressive therapy like in neuropsychiatric SLE. A 35-year-old woman with SLE suddenly developed severe headache. Magnetic resonance angiography showed multifocal segmental narrowing of cerebral arteries, suggestive of central nervous system vasculitis. However, lack of abnormal enhancement in vessel wall imaging indicated reversible cerebral vasoconstriction syndrome (RCVS) rather than central nervous system vasculitis. The patient was treated with oral nimodipine and she recovered over a period of two months. Following magnetic resonance angiography on day 90 was normal. Herein we report a case of reversible cerebral vasoconstriction syndrome in an SLE patient with literature review.
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Affiliation(s)
- S W Chung
- 1 Division of Rheumatology, Department of Internal Medicine, School of Medicine, Kyung Hee University, Seoul, South Korea
| | - K M Lee
- 2 Department of Radiology, School of Medicine, Kyung Hee University, Seoul, South Korea
| | - S H Heo
- 3 Department of Neurology, School of Medicine, Kyung Hee University, Seoul, South Korea
| | - R Ra
- 1 Division of Rheumatology, Department of Internal Medicine, School of Medicine, Kyung Hee University, Seoul, South Korea
| | - S-J Hong
- 1 Division of Rheumatology, Department of Internal Medicine, School of Medicine, Kyung Hee University, Seoul, South Korea
| | - H-I Yang
- 1 Division of Rheumatology, Department of Internal Medicine, School of Medicine, Kyung Hee University, Seoul, South Korea
| | - S-H Lee
- 1 Division of Rheumatology, Department of Internal Medicine, School of Medicine, Kyung Hee University, Seoul, South Korea
| | - R Song
- 1 Division of Rheumatology, Department of Internal Medicine, School of Medicine, Kyung Hee University, Seoul, South Korea
| | - Y-A Lee
- 1 Division of Rheumatology, Department of Internal Medicine, School of Medicine, Kyung Hee University, Seoul, South Korea
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Functional connectivity changes in core resting state networks are associated with cognitive performance in systemic lupus erythematosus. J Comp Neurol 2019; 527:1837-1856. [DOI: 10.1002/cne.24656] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 12/29/2018] [Accepted: 01/17/2019] [Indexed: 12/23/2022]
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Rayes HA, Tani C, Kwan A, Marzouk S, Colosimo K, Medina-Rosas J, Mustafa A, Su J, Lambiris P, Mosca M, Touma Z. What is the prevalence of cognitive impairment in lupus and which instruments are used to measure it? A systematic review and meta-analysis. Semin Arthritis Rheum 2018; 48:240-255. [DOI: 10.1016/j.semarthrit.2018.02.007] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2017] [Revised: 01/10/2018] [Accepted: 02/16/2018] [Indexed: 11/30/2022]
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Morad CS, Mansour HE, Ibrahim SE, Ahmad KA, Arafa SG. Subclinical neuropsychiatric dysfunctions in female patients with systemic lupus erythematosus. EGYPTIAN RHEUMATOLOGY AND REHABILITATION 2018. [DOI: 10.4103/err.err_46_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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10
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Altered white matter microstructure in lupus patients: a diffusion tensor imaging study. Arthritis Res Ther 2018; 20:21. [PMID: 29415762 PMCID: PMC5803933 DOI: 10.1186/s13075-018-1516-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 01/10/2018] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND The purpose of this study was to investigate whether white matter microstructure is altered in patients suffering from systemic lupus erythematosus (SLE), and if so, whether such alterations differed between patients with and without neuropsychiatric symptoms. METHODS Structural MRI and diffusion tensor imaging (DTI) were performed in 64 female SLE patients (mean age 36.9 years, range 18.2-52.2 years) and 21 healthy controls (mean age 36.7 years, range 23.3-51.2 years) in conjunction with clinical examination, laboratory tests, cognitive evaluation, and self-assessment questionnaires. The patients were subgrouped according to the American College of Rheumatology Neuropsychiatric Systemic Lupus Erythematosus case definitions into non-neuropsychiatric SLE (nonNPSLE) and neuropsychiatric SLE (NPSLE). RESULTS Comparisons between the SLE group and healthy controls showed that the mean fractional anisotropy (FA) was significantly reduced in the right rostral cingulum (p = 0.038), the mid-sagittal corpus callosum (CC) (p = 0.050), and the forceps minor of the CC (p = 0.015). The mean diffusivity (MD) was significantly increased in the left hippocampal cingulum (p = 0.017). No significant differences in MD or FA values were identified between NPSLE and nonNPSLE patients. Disease duration among all SLE patients correlated significantly with reduced FA in the CC (p < 0.05). No correlations were found between DTI parameters and white matter hyperintensities, SLE Disease Activity Index-2000, Systemic Lupus International Collaborating Clinical/ACR Organ Damage Index, or Montgomery Asberg Depression Rate Score Self-report. CONCLUSIONS We found alterations of white matter microstructure in SLE patients that were related to disease duration and fatigue. Our results indicate that cerebral involvement in SLE is not isolated to the NPSLE subgroup.
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Alessi H, Dutra LA, Braga Neto P, Pedroso JL, Toso FF, Kayser C, Barsottini OGP. Neuropsychiatric Lupus in clinical practice. ARQUIVOS DE NEURO-PSIQUIATRIA 2016; 74:1021-1030. [DOI: 10.1590/0004-282x20160150] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Accepted: 08/11/2016] [Indexed: 12/20/2022]
Abstract
ABSTRACT Systemic lupus erythematosus (SLE) is a chronic autoimmune disease involving multiple organs, characterized by the production of autoantibodies and the development of tissue injury. The etiology of SLE is partially known, involving multiple genetic and environmental factors. As many as 50% of patients with SLE have neurological involvement during the course of their disease. Neurological manifestations are associated with impaired quality of life, and high morbidity and mortality rates. Nineteen neuropsychiatric syndromes have been identified associated with SLE, and can be divided into central and peripheral manifestations. This article reviews major neuropsychiatric manifestations in patients with SLE and discusses their clinical features, radiological findings and treatment options.
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Affiliation(s)
| | | | - Pedro Braga Neto
- Universidade Estadual do Ceará, Brasil; Universidade Federal do Ceará, Brasil
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12
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Massardo L, Bravo-Zehnder M, Calderón J, Flores P, Padilla O, Aguirre JM, Scoriels L, González A. Anti-N-methyl-D-aspartate receptor and anti-ribosomal-P autoantibodies contribute to cognitive dysfunction in systemic lupus erythematosus. Lupus 2014; 24:558-68. [DOI: 10.1177/0961203314555538] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Accepted: 09/23/2014] [Indexed: 12/28/2022]
Abstract
Objective Autoantibodies against N-methyl-D-aspartate receptor (anti-NMDAR) and ribosomal-P (anti-P) antigens are potential pathogenic factors in the frequently observed diffuse brain dysfunctions in patients with systemic lupus erythematosus (SLE). Although studies have been conducted in this area, the role of anti-NMDAR antibodies in SLE cognitive dysfunction remains elusive. Moreover, the specific contribution of anti-P antibodies has not been reported yet. The present study attempts to clarify the contribution of anti-NMDAR and anti-P antibodies to cognitive dysfunction in SLE. Methods The Cambridge Neuropsychological Test Automated Battery (CANTAB) was used to assess a wide range of cognitive function areas in 133 Chilean women with SLE. ANCOVA models included autoantibodies, patient and disease features. Results Cognitive deficit was found in 20%. Higher SLEDAI-2K scores were associated with impairment in spatial memory and learning abilities, whereas both anti-NMDAR and anti-P antibodies contributed to deficits in attention and spatial planning abilities, which reflect fronto-parietal cortex dysfunctions. Conclusions These results reveal an association of active disease together with specific circulating autoantibodies, such as anti-NMDAR and anti-P, with cognitive dysfunction in SLE patients.
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Affiliation(s)
- L Massardo
- Departamento de Inmunología Clínica y Reumatología, Facultad de Medicina
| | - M Bravo-Zehnder
- Departamento de Inmunología Clínica y Reumatología, Facultad de Medicina
- Centro de Envejecimiento y Regeneración, Departamento de Biología Celular y Molecular, Facultad de Ciencias Biológicas
| | | | | | - O Padilla
- Departamento de Salud Pública, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | | | - L Scoriels
- Institute of Biomedical Sciences, Universidade Federal do Rio de Janeiro, Brazil
| | - A González
- Departamento de Inmunología Clínica y Reumatología, Facultad de Medicina
- Centro de Envejecimiento y Regeneración, Departamento de Biología Celular y Molecular, Facultad de Ciencias Biológicas
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Calderón J, Flores P, Babul M, Aguirre JM, Slachevsky A, Padilla O, Scoriels L, Henríquez C, Cárcamo C, Bravo-Zehnder M, González A, Massardo L. Systemic lupus erythematosus impairs memory cognitive tests not affected by depression. Lupus 2014; 23:1042-53. [DOI: 10.1177/0961203314536247] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective Our aim was to assess the contribution of depression to cognitive impairment in patients with systemic lupus erythematosus (SLE). Methods Clinical features, education, age, and Hospital Anxiety and Depression Scale (HADS) were evaluated in 82 patients with SLE and 22 healthy controls, all Chilean women. The Cambridge Neuropsychological Test Automated Battery (CANTAB eclipseTM) assessing attention, spatial memory, and learning and executive function domains was applied. Cognitive deficit definition: a cut-off for definite impairment was defined as a score below -2 standard deviations in at least one outcome measure in two or more domains. ANCOVA with stepwise selection evaluated influences of health status (SLE or control), age, education, and HADS depression and anxiety scores on cognitive outcomes. To avoid overfitting, a shrinkage method was performed. Also, adjusted p-values for multiple comparisons were obtained. Results Cognitive deficit affected 16 (20%) patients, and no controls ( p = 0.039). Median HADS depression score in SLE patients was 6 (range 0–19) and in controls was 0 (0–19), p < 0.001). ANCOVA and shrinkage models showed that worse cognitive performance in sustained attention and spatial working memory tests was explained by the presence of SLE but not depression, whereas depression only affected a measure of executive function (I/ED Stages completed). Conclusion Depression has a limited role in cognitive impairment in SLE. Impairments in sustained attention and spatial working memory are distinctly influenced by yet-unknown disease-intrinsic factors.
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Affiliation(s)
- J Calderón
- Department of Psychiatry, School of Medicine, Pontificia Universidad Católica de Chile, Chile
| | - P Flores
- Department of Psychiatry, School of Medicine, Pontificia Universidad Católica de Chile, Chile
| | - M Babul
- Department of Psychiatry, School of Medicine, Pontificia Universidad Católica de Chile, Chile
| | - JM Aguirre
- Department of Psychiatry, School of Medicine, Pontificia Universidad Católica de Chile, Chile
| | - A Slachevsky
- Department of Neurological Sciences Oriente, Facultad de Medicina, Universidad de Chile, Chile
| | - O Padilla
- Department of Public Health, School of Medicine, Pontificia Universidad Católica de Chile, Chile
| | - L Scoriels
- Institute of Biomedical Sciences, Universidade Federal do Rio de Janeiro, Brazil
| | - C Henríquez
- Department of Clinical Immunology and Rheumatology, School of Medicine, Pontificia Universidad Católica de Chile, Chile
| | - C Cárcamo
- Department of Neurology, School of Medicine, Pontificia Universidad Católica de Chile, Chile
| | - M Bravo-Zehnder
- Department of Clinical Immunology and Rheumatology, School of Medicine, Pontificia Universidad Católica de Chile, Chile
| | - A González
- Department of Clinical Immunology and Rheumatology, School of Medicine, Pontificia Universidad Católica de Chile, Chile
- Center for Aging and Regeneration, Facultad de Ciencias Biológicas, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - L Massardo
- Department of Clinical Immunology and Rheumatology, School of Medicine, Pontificia Universidad Católica de Chile, Chile
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