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Fan KQ, Huang T, Yu JS, Li YY, Jin J. The clinical features and potential mechanisms of cognitive disorders in peripheral autoimmune and inflammatory diseases. FUNDAMENTAL RESEARCH 2024; 4:226-236. [PMID: 38933510 PMCID: PMC11197673 DOI: 10.1016/j.fmre.2022.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 10/15/2022] [Accepted: 12/05/2022] [Indexed: 12/26/2022] Open
Abstract
According to a study from World Health Organization's Global Burden of Disease, mental and neurological disorders have accounted for 13% of global diseases in recent years and are on the rise. Neuropsychiatric conditions or neuroinflammatory disorders are linked by the presence of an exaggerated immune response both peripherally and in the central nervous system (CNS). Cognitive dysfunction (CD) encompasses a complex group of diseases and has frequently been described in the field of autoimmune diseases, especially in multiple non-CNS-related autoimmune diseases. Recent studies have provided various hypotheses regarding the occurrence of cognitive impairment in autoimmune diseases, including that abnormally activated immune cells can disrupt the integrity of the blood-brain barrier (BBB) to trigger a central neuroinflammatory response. When the BBB is intact, autoantibodies and pro-inflammatory molecules in peripheral circulation can enter the brain to activate microglia, inducing CNS inflammation and CD. However, the mechanisms explaining the association between the immune system and neural function and their contribution to diseases are uncertain. In this review, we used clinical statistics to illustrate the correlation between CD and autoimmune diseases that do not directly affect the CNS, summarized the clinical features and mechanisms by which autoimmune diseases trigger cognitive impairment, and explored existing knowledge regarding the link between CD and autoimmune diseases from the perspective of the field of neuroimmunology.
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Affiliation(s)
- Ke-qi Fan
- MOE Laboratory of Biosystem Homeostasis and Protection, and Life Sciences Institute, Zhejiang University, Hangzhou 310058, China
- Department of Gastroenterology, Sir Run Shaw Hospital, College of Medicine Zhejiang University, Hangzhou 310016, China
| | - Tao Huang
- MOE Laboratory of Biosystem Homeostasis and Protection, and Life Sciences Institute, Zhejiang University, Hangzhou 310058, China
- Department of Gastroenterology, Sir Run Shaw Hospital, College of Medicine Zhejiang University, Hangzhou 310016, China
| | - Jian-shuai Yu
- MOE Laboratory of Biosystem Homeostasis and Protection, and Life Sciences Institute, Zhejiang University, Hangzhou 310058, China
| | - Yi-yuan Li
- Key Laboratory for Developmental Genes and Human Disease, Ministry of Education, Institute of Life Sciences, Jiangsu Province High-Tech Key Laboratory for Bio-Medical Research, Southeast University, Nanjing 210096, China
| | - Jin Jin
- MOE Laboratory of Biosystem Homeostasis and Protection, and Life Sciences Institute, Zhejiang University, Hangzhou 310058, China
- Department of Gastroenterology, Sir Run Shaw Hospital, College of Medicine Zhejiang University, Hangzhou 310016, China
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Koolvisoot A, Chumjang S. Prevalence of cognitive impairment and cognitive improvement in patients with systemic lupus erythematosus during a 6-month follow-up study. Lupus 2023; 32:1199-1210. [PMID: 37592859 DOI: 10.1177/09612033231196215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/19/2023]
Abstract
OBJECTIVES The Montreal Cognitive Assessment (MoCA) is a simple and reliable screening tool for early detection for cognitive impairment in systemic lupus erythematosus (SLE). Most previous studies were cross-sectional with small samples. Research on long-term cognitive changes and reversibility is limited. This study aimed to establish the prevalence of cognitive impairment and changes in SLE patients after 6 months and the associated factors. METHODS A prospective study was conducted in 200 patients with SLE between April 2021 and March 2022. Demographic data, disease activity, and medications were recorded. MoCA was administered at baseline and 6 months; for Thais, scores 17-24 indicate mild cognitive impairment, while ≤16 signifies severe impairment. Multivariate analysis identified factors associated with cognitive impairment and improvement. RESULTS The patients' median age was 44 years (range: 19-73), 96% were female, and 55% had < 12 years of education. The median disease duration was 11 years (range: 0-51.8), and 79% of patients had inactive disease. Cognitive impairment was found in 70% of patients (mild, 63%; severe, 7%). The most often affected domains were delayed recall (82%), abstraction (80.5%), language (76%) and visuospatial/executive function (70.5%), whereas orientation and naming were the least involved. Factors significantly associated with cognitive impairment were age > 40 years (OR, 3.71; 95% CI, 1.72-8.00), formal education < 12 years (OR, 3.11; 95% CI, 1.45-6.63), and prednisolone use (OR, 2.21; 95% CI, 1.08-4.51). Sixty-six (38.2%) of 173 patients completing the 6-month re-evaluation exhibited cognitive changes (52 [30.1%] improved; 14 [8.1%] deteriorated). Except for delayed recall, all commonly affected domains showed significant improvement. Disease activity, prednisolone, antimalarials, or immunosuppressant use did not predict cognitive improvement. CONCLUSIONS Mild cognitive impairment is prevalent among patients with SLE. Due to the possibility of reversibility, early recognition and additional research to identify relevant factors are required.
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Affiliation(s)
- Ajchara Koolvisoot
- Division of Rheumatology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Sasamon Chumjang
- Division of Rheumatology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Pentari A, Simos N, Tzagarakis G, Kagialis A, Bertsias G, Kavroulakis E, Gratsia E, Sidiropoulos P, Boumpas DT, Papadaki E. Altered hippocampal connectivity dynamics predicts memory performance in neuropsychiatric lupus: a resting-state fMRI study using cross-recurrence quantification analysis. Lupus Sci Med 2023; 10:e000920. [PMID: 37400223 DOI: 10.1136/lupus-2023-000920] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 06/13/2023] [Indexed: 07/05/2023]
Abstract
OBJECTIVE Τo determine whole-brain and regional functional connectivity (FC) characteristics of patients with neuropsychiatric SLE (NPSLE) or without neuropsychiatric manifestations (non-NPSLE) and examine their association with cognitive performance. METHODS Cross-recurrence quantification analysis (CRQA) of resting-state functional MRI (rs-fMRI) data was performed in 44 patients with NPSLE, 20 patients without NPSLE and 35 healthy controls (HCs). Volumetric analysis of total brain and specific cortical and subcortical regions, where significant connectivity changes were identified, was performed. Cognitive status of patients with NPSLE was assessed by neuropsychological tests. Group comparisons on nodal FC, global network metrics and regional volumetrics were conducted, and associations with cognitive performance were estimated (at p<0.05 false discovery rate corrected). RESULTS FC in patients with NPSLE was characterised by increased modularity (mean (SD)=0.31 (0.06)) as compared with HCs (mean (SD)=0.27 (0.06); p=0.05), hypoconnectivity of the left (mean (SD)=0.06 (0.018)) and right hippocampi (mean (SD)=0.051 (0.0.16)), and of the right amygdala (mean (SD)=0.091 (0.039)), as compared with HCs (mean (SD)=0.075 (0.022), p=0.02; 0.065 (0.019), p=0.01; 0.14 (0.096), p=0.05, respectively). Hyperconnectivity of the left angular gyrus (NPSLE/HCs: mean (SD)=0.29 (0.26) and 0.10 (0.09); p=0.01), left (NPSLE/HCs: mean (SD)=0.16 (0.09) and 0.09 (0.05); p=0.01) and right superior parietal lobule (SPL) (NPSLE/HCs: mean (SD)=0.25 (0.19) and 0.13 (0.13), p=0.01) was noted in NPSLE versus HC groups. Among patients with NPSLE, verbal episodic memory scores were positively associated with connectivity (local efficiency) of the left hippocampus (r2=0.22, p=0.005) and negatively with local efficiency of the left angular gyrus (r2=0.24, p=0.003). Patients without NPSLE displayed hypoconnectivity of the right hippocampus (mean (SD)=0.056 (0.014)) and hyperconnectivity of the left angular gyrus (mean (SD)=0.25 (0.13)) and SPL (mean (SD)=0.17 (0.12)). CONCLUSION By using dynamic CRQA of the rs-fMRI data, distorted FC was found globally, as well as in medial temporal and parietal brain regions in patients with SLE, that correlated significantly and adversely with memory capacity in NPSLE. These results highlight the value of dynamic approaches to assessing impaired brain network function in patients with lupus with and without neuropsychiatric symptoms.
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Affiliation(s)
- Anastasia Pentari
- Computational Bio-Medicine Laboratory, Institute of Computer Science, Foundation for Research and Technology - Hellas, Heraklion, Greece
| | - Nicholas Simos
- Computational Bio-Medicine Laboratory, Institute of Computer Science, Foundation for Research and Technology - Hellas, Heraklion, Greece
| | - George Tzagarakis
- Computational Bio-Medicine Laboratory, Institute of Computer Science, Foundation for Research and Technology - Hellas, Heraklion, Greece
| | - Antonios Kagialis
- Department of Psychiatry, University of Crete School of Medicine, Heraklion, Greece
- Department of Radiology, University of Crete School of Medicine, Heraklion, Greece
| | - George Bertsias
- Laboratory of Autoimmunity and Inflammation, Institute of Molecular Biology and Biotechnology, Heraklion, Greece
- Department of Rheumatology, Clinical Immunology and Allergy, School of Medicine, University of Crete, University Hospital of Heraklion, Heraklion, Greece
| | | | - Eirini Gratsia
- Department of Radiology, University of Crete School of Medicine, Heraklion, Greece
| | - Prodromos Sidiropoulos
- Department of Rheumatology, Clinical Immunology and Allergy, School of Medicine, University of Crete, University Hospital of Heraklion, Heraklion, Greece
| | - Dimitrios T Boumpas
- Department of Rheumatology, Clinical Immunology and Allergy, School of Medicine, University of Crete, University Hospital of Heraklion, Heraklion, Greece
- Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Efrosini Papadaki
- Computational Bio-Medicine Laboratory, Institute of Computer Science, Foundation for Research and Technology - Hellas, Heraklion, Greece
- Department of Radiology, University of Crete School of Medicine, Heraklion, Greece
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Gwinnutt JM, Toyoda T, Barraclough M, Verstappen SMM, Hornberger M, MacGregor A. Cognitive impairment in the immune-mediated inflammatory diseases compared with age-matched controls: Systematic review and meta-regression. Semin Arthritis Rheum 2023; 58:152131. [PMID: 36527929 DOI: 10.1016/j.semarthrit.2022.152131] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 10/31/2022] [Accepted: 11/11/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To compare the magnitude of cognitive impairment against age-expected levels across the immune mediated inflammatory diseases (IMIDs: systemic lupus erythematosus [SLE], rheumatoid arthritis [RA], axial spondyloarthritis [axSpA], psoriatic arthritis [PsA], psoriasis [PsO]). METHODS A pre-defined search strategy was implemented in Medline, Embase and Psychinfo on 29/05/2021. Inclusion criteria were: (i) observational studies of an IMID, (ii) healthy control comparison, (iii) measuring cognitive ability (overall, memory, complex attention/executive function, language/verbal fluency), and (iv) sufficient data for meta-analysis. Standardised mean differences (SMD) in cognitive assessments between IMIDs and controls were pooled using random-effects meta-analysis. IMIDs were compared using meta-regression. RESULTS In total, 65 IMID groups were included (SLE: 39, RA: 19, axSpA: 1, PsA: 2 PsO: 4), comprising 3141 people with IMIDs and 9333 controls. People with IMIDs had impairments in overall cognition (SMD: -0.57 [95% CI -0.70, -0.43]), complex attention/executive function (SMD -0.57 [95% CI -0.69, -0.44]), memory (SMD -0.55 [95% CI -0.68, -0.43]) and language/verbal fluency (SMD -0.51 [95% CI -0.68, -0.34]). People with RA and people with SLE had similar magnitudes of cognitive impairment in relation to age-expected levels. People with neuropsychiatric SLE had larger impairment in overall cognition compared with RA. CONCLUSIONS People with IMIDs have moderate impairments across a range of cognitive domains. People with RA and SLE have similar magnitudes of impairment against their respective age-expected levels, calling for greater recognition of cognitive impairment in both conditions. To further understand cognition in the IMIDs, more large-scale, longitudinal studies are needed.
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Affiliation(s)
- James M Gwinnutt
- Centre for Epidemiology Versus Arthritis, Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK.
| | - Task Toyoda
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Michelle Barraclough
- Centre for Epidemiology Versus Arthritis, Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK; NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, UK; Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, Canada
| | - Suzanne M M Verstappen
- Centre for Epidemiology Versus Arthritis, Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK; NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, UK
| | | | - Alex MacGregor
- Norwich Medical School, University of East Anglia, Norwich, UK; Rheumatology Department, Norfolk and Norwich University Hospitals NHS Trust, Norwich, UK
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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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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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Abstract
Cognitive deficits are common in patients with systemic lupus erythematosus (SLE) regardless of overt neuropsychiatric involvement; however, a clear neuropsychological profile of SLE has not emerged. This study undertook a literature search of the PubMed, Scopus and Ovid (PsychINFO) databases for studies investigating cognitive alterations in SLE, using standardized neuropsychological (NP) measures. The data were analysed using meta-analytical procedures. The results support the observation that relative to healthy controls, SLE (regardless of overt neuropsychiatric involvement) is associated with statistically significant, small effect-sized deficits in visual attention, cognitive fluency, immediate visual memory and visual reasoning. Moreover, the results support a gradient of cognitive disturbance in SLE with significantly greater cognitive impairment in NPSLE patients relative to non-NPSLE patients. Medium-sized deficits were observed in NPSLE patients relative to healthy controls across the domains of: complex attention, delayed verbal memory, language and verbal reasoning (with small or non-significant differences observed in non-NPSLE patients relative to healthy controls). These results are relevant to the understanding, assessment and rehabilitation of patients living with SLE, with or without overt neuropsychiatric involvement.
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Affiliation(s)
- B Leslie
- 97586 College of Science Health and Engineering, La Trobe University , School of Psychology and Public Health, Bundoora, Victoria, Australia
| | - S F Crowe
- 97586 College of Science Health and Engineering, La Trobe University , School of Psychology and Public Health, Bundoora, Victoria, Australia
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Gao Y, Cheung RTF, Gao J, Lau EYY, Wan JHY, Mok MY. Electrophysiological Study on Cognitive Function in Systemic Lupus Erythematosus Patients With Previous Neuropsychiatric Involvement. Clin EEG Neurosci 2017; 48:251-258. [PMID: 27468748 DOI: 10.1177/1550059416660956] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This study aimed to evaluate P300 as an electrophysiological marker of cognitive function in patients with systemic lupus erythematosus (SLE) who had previous neuropsychiatric (NPSLE) involvement and were diagnosed to have cognitive impairment by standard neuropsychological tests. Event-related potentials (ERPs) were assessed by the auditory and visual oddball paradigms. Amplitude and latency of P300 at the frontal (Fz), central (Cz), and parietal (Pz) regions were determined and compared with controls. P300 detection was performed in NPSLE patients with pre-diagnosed cognitive impairment (n = 9), matched SLE patients without previous NPSLE (non-NPSLE) (n = 9), and healthy controls (n = 15). Auditory oddball task did not show any P300 abnormality between groups. Visual oddball task revealed reduced amplitude of P300 over Fz ( P = .002) and Cz ( P = .009) electrodes in NPSLE patients compared with healthy controls and among those who had predominant memory deficit ( P = .01 at Fz). Abnormal P300 was also observed in non-NPSLE patients at Fz and Cz. Using visual oddball paradigm, abnormal P300 was found in NPSLE patients over frontal and parietal regions compared with normal controls but was not discriminative from possible subclinical disease in non-NPSLE patients. In conclusion, visual oddball paradigm was a more sensitive electrophysiological marker than auditory oddball paradigm for cognitive impairment in NPSLE patients.
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Affiliation(s)
- Yang Gao
- 1 Department of Medicine, Queen Mary Hospital, the University of Hong Kong, Hong Kong SAR
| | - Raymond Tak Fai Cheung
- 1 Department of Medicine, Queen Mary Hospital, the University of Hong Kong, Hong Kong SAR
| | - Junling Gao
- 1 Department of Medicine, Queen Mary Hospital, the University of Hong Kong, Hong Kong SAR
| | - Esther Y Y Lau
- 2 Department of Psychology, the University of Hong Kong, Hong Kong SAR
| | - Jacky Ho Yin Wan
- 2 Department of Psychology, the University of Hong Kong, Hong Kong SAR
| | - Mo Yin Mok
- 1 Department of Medicine, Queen Mary Hospital, the University of Hong Kong, Hong Kong SAR.,3 Department of Biomedical Sciences, the City University of Hong Kong, Hong Kong SAR
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Mikdashi JA, Esdaile JM, Alarcón GS, Crofford L, Fessler BJ, Shanberg L, Brunner H, Gall V, Kalden JR, Lockshin MD, Liang MH, Roberts N, Schneider M. Proposed response criteria for neurocognitive impairment in systemic lupus erythematosus clinical trials. Lupus 2016; 16:418-25. [PMID: 17664232 DOI: 10.1177/0961203307079044] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The objective of this study was to identify reliable and valid instruments to measure cognitive impairment in systemic lupus erythematosus (SLE), and to define minimally important change of cognitive impairment in SLE for clinical trials. Neurocognitive measures used in randomized clinical trials in SLE were reviewed, and response criteria were developed using consensus expert opinion. The definition of cognitive impairment in the ACR nomenclature for neuropsychiatric lupus syndrome was adopted. Cognitive impairment is a deficit of 2.0 or more standard deviations (SD) below the mean, compared to normative data, in the key domains of attention, memory and psychomotor speed. Cognitive decline is defined as a deficit of 1.5—1.9 SD below the mean. Focal decline is defined if impairment exists in one or more measures within one domain, and multifocal decline if impairment exists on measures spanning two or more domains. The combination of ACR neuropsychological battery and the Cognitive Symptoms Inventory (CSI) is recommended to quantitate cognitive function. A clinically important response is defined as an improvement of ≥ 1.0 SD with an effect size of 1.0 in the key domains of the ACR neuropsychological testing, and an improvement of ≥ 1.0 SD with an effect size of 1.0 in functional performance of the CSI. Lupus (2007) 16, 418—425
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Mani A, Shenavandeh S, Sepehrtaj SS, Javadpour A. Memory and learning functions in patients with systemic lupus erythematosus: A neuropsychological case-control study. EGYPTIAN RHEUMATOLOGIST 2015. [DOI: 10.1016/j.ejr.2015.02.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Mikdashi JA. Altered functional neuronal activity in neuropsychiatric lupus: A systematic review of the fMRI investigations. Semin Arthritis Rheum 2015; 45:455-62. [PMID: 26897255 DOI: 10.1016/j.semarthrit.2015.08.002] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2015] [Revised: 08/07/2015] [Accepted: 08/11/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Recent years have seen a rapid increase in the investigation of neuropsychiatric lupus (NPSLE) through the use of functional magnetic resonance imaging (fMRI). Measuring specific neuronal activity in regional brain structures during a cognitive task may identify possible biomarker for NPSLE. METHODS A systematic review of fMRI studies of systemic lupus erythematosus (SLE) is carried out to address common findings that characterize NPSLE. RESULTS A disturbance to the working memory and executive function brain regions is among the most well-replicated finding. Differences in brain activation may relate to an early primary dysfunction of these regions. Increased functional connectivity strength in the fronto-parietal cortex in the resting state is correlated with SLE disease activity in one study. Decrease functional connectivity is observed in lupus patients with long-term disease. However, there is strong evidence that points toward a lack of effective integration of distributed functional brain regions and disruptions in the subtle modulation of brain function in relation to task demands in SLE. Limitations of the literature to date include the use of small sample size and the lack of addressing the effect of confounding variables, including immunosuppressive treatment. CONCLUSION Careful definitions of the fMRI technique used both in the design, analyses, and interpretation of high dimensional data is needed, when dealing with a limited number of SLE subjects with heterogeneous manifestations and unknown pathophysiology.
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Affiliation(s)
- Jamal A Mikdashi
- Division of Rheumatology and Clinical Immunology, University of Maryland School of Medicine, 10 South Pine St, Suite 834, Baltimore, MD 21201.
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Nishimura K, Omori M, Katsumata Y, Sato E, Gono T, Kawaguchi Y, Harigai M, Mimura M, Yamanaka H, Ishigooka J. Neurocognitive impairment in corticosteroid-naive patients with active systemic lupus erythematosus: a prospective study. J Rheumatol 2015; 42:441-8. [PMID: 25593228 DOI: 10.3899/jrheum.140659] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Neurocognitive impairment (NCI) has been intensively studied in patients with systemic lupus erythematosus (SLE). However, those studies have mostly included patients who were treated with corticosteroids, which may itself induce NCI. We investigated NCI in corticosteroid-naive people with SLE who did not exhibit any overt neuropsychiatric manifestations. METHODS Forty-three inpatients with SLE who had no current or past neuropsychiatric history participated in the study. Patients and 30 healthy control subjects with similar demographic characteristics were given a 1-h battery of neuropsychological tests. NCI was defined as scores at least 2 SD below the mean of the healthy control group on at least 2 of the 7 neurocognitive domains. Results of clinical, laboratory, and neurologic tests were compared regarding the presence of NCI. RESULTS NCI was identified in 12 patients (27.9%) with SLE and in 2 control subjects (6.7%). Patients with SLE showed a significant impairment compared with controls on tasks assessing immediate recall, complex attention/executive function, and psychomotor speed. We identified psychomotor speed (Digit Symbol Substitution Test) as the factor that best differentiated the 2 groups. Further, we identified the score of the SLE Disease Activity Index 2000 as an independent risk factor for NCI in patients with SLE. CONCLUSION We conclude that reduced psychomotor speed is an SLE-specific pattern of NCI. Verbal-memory deficits that have been reported in patients with SLE were not evident among patients who were corticosteroid-naive. Our results indicate that impaired psychomotor speed may be added to the symptoms of early SLE.
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Affiliation(s)
- Katsuji Nishimura
- From the Department of Psychiatry and Institute of Rheumatology, Tokyo Women's Medical University School of Medicine, Tokyo; Kanagawa Psychiatric Center, Yokohama; Department of Pharmacovigilance, Graduate School, Tokyo Medical and Dental University; Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan.K. Nishimura, MD, PhD; J. Ishigooka, MD, PhD, Department of Psychiatry, Tokyo Women's Medical University School of Medicine; M. Omori, MD, Kanagawa Psychiatric Center; Y. Katsumata, MD, PhD; E. Sato, MD; T. Gono, MD, PhD; Y. Kawaguchi, MD, PhD; H. Yamanaka, MD, PhD, Institute of Rheumatology, Tokyo Women's Medical University; M. Harigai, MD, PhD, Department of Pharmacovigilance, Graduate School, Tokyo Medical and Dental University; M. Mimura, MD, PhD, Department of Neuropsychiatry, Keio University School of Medicine.
| | - Masako Omori
- From the Department of Psychiatry and Institute of Rheumatology, Tokyo Women's Medical University School of Medicine, Tokyo; Kanagawa Psychiatric Center, Yokohama; Department of Pharmacovigilance, Graduate School, Tokyo Medical and Dental University; Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan.K. Nishimura, MD, PhD; J. Ishigooka, MD, PhD, Department of Psychiatry, Tokyo Women's Medical University School of Medicine; M. Omori, MD, Kanagawa Psychiatric Center; Y. Katsumata, MD, PhD; E. Sato, MD; T. Gono, MD, PhD; Y. Kawaguchi, MD, PhD; H. Yamanaka, MD, PhD, Institute of Rheumatology, Tokyo Women's Medical University; M. Harigai, MD, PhD, Department of Pharmacovigilance, Graduate School, Tokyo Medical and Dental University; M. Mimura, MD, PhD, Department of Neuropsychiatry, Keio University School of Medicine
| | - Yasuhiro Katsumata
- From the Department of Psychiatry and Institute of Rheumatology, Tokyo Women's Medical University School of Medicine, Tokyo; Kanagawa Psychiatric Center, Yokohama; Department of Pharmacovigilance, Graduate School, Tokyo Medical and Dental University; Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan.K. Nishimura, MD, PhD; J. Ishigooka, MD, PhD, Department of Psychiatry, Tokyo Women's Medical University School of Medicine; M. Omori, MD, Kanagawa Psychiatric Center; Y. Katsumata, MD, PhD; E. Sato, MD; T. Gono, MD, PhD; Y. Kawaguchi, MD, PhD; H. Yamanaka, MD, PhD, Institute of Rheumatology, Tokyo Women's Medical University; M. Harigai, MD, PhD, Department of Pharmacovigilance, Graduate School, Tokyo Medical and Dental University; M. Mimura, MD, PhD, Department of Neuropsychiatry, Keio University School of Medicine
| | - Eri Sato
- From the Department of Psychiatry and Institute of Rheumatology, Tokyo Women's Medical University School of Medicine, Tokyo; Kanagawa Psychiatric Center, Yokohama; Department of Pharmacovigilance, Graduate School, Tokyo Medical and Dental University; Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan.K. Nishimura, MD, PhD; J. Ishigooka, MD, PhD, Department of Psychiatry, Tokyo Women's Medical University School of Medicine; M. Omori, MD, Kanagawa Psychiatric Center; Y. Katsumata, MD, PhD; E. Sato, MD; T. Gono, MD, PhD; Y. Kawaguchi, MD, PhD; H. Yamanaka, MD, PhD, Institute of Rheumatology, Tokyo Women's Medical University; M. Harigai, MD, PhD, Department of Pharmacovigilance, Graduate School, Tokyo Medical and Dental University; M. Mimura, MD, PhD, Department of Neuropsychiatry, Keio University School of Medicine
| | - Takahisa Gono
- From the Department of Psychiatry and Institute of Rheumatology, Tokyo Women's Medical University School of Medicine, Tokyo; Kanagawa Psychiatric Center, Yokohama; Department of Pharmacovigilance, Graduate School, Tokyo Medical and Dental University; Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan.K. Nishimura, MD, PhD; J. Ishigooka, MD, PhD, Department of Psychiatry, Tokyo Women's Medical University School of Medicine; M. Omori, MD, Kanagawa Psychiatric Center; Y. Katsumata, MD, PhD; E. Sato, MD; T. Gono, MD, PhD; Y. Kawaguchi, MD, PhD; H. Yamanaka, MD, PhD, Institute of Rheumatology, Tokyo Women's Medical University; M. Harigai, MD, PhD, Department of Pharmacovigilance, Graduate School, Tokyo Medical and Dental University; M. Mimura, MD, PhD, Department of Neuropsychiatry, Keio University School of Medicine
| | - Yasushi Kawaguchi
- From the Department of Psychiatry and Institute of Rheumatology, Tokyo Women's Medical University School of Medicine, Tokyo; Kanagawa Psychiatric Center, Yokohama; Department of Pharmacovigilance, Graduate School, Tokyo Medical and Dental University; Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan.K. Nishimura, MD, PhD; J. Ishigooka, MD, PhD, Department of Psychiatry, Tokyo Women's Medical University School of Medicine; M. Omori, MD, Kanagawa Psychiatric Center; Y. Katsumata, MD, PhD; E. Sato, MD; T. Gono, MD, PhD; Y. Kawaguchi, MD, PhD; H. Yamanaka, MD, PhD, Institute of Rheumatology, Tokyo Women's Medical University; M. Harigai, MD, PhD, Department of Pharmacovigilance, Graduate School, Tokyo Medical and Dental University; M. Mimura, MD, PhD, Department of Neuropsychiatry, Keio University School of Medicine
| | - Masayoshi Harigai
- From the Department of Psychiatry and Institute of Rheumatology, Tokyo Women's Medical University School of Medicine, Tokyo; Kanagawa Psychiatric Center, Yokohama; Department of Pharmacovigilance, Graduate School, Tokyo Medical and Dental University; Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan.K. Nishimura, MD, PhD; J. Ishigooka, MD, PhD, Department of Psychiatry, Tokyo Women's Medical University School of Medicine; M. Omori, MD, Kanagawa Psychiatric Center; Y. Katsumata, MD, PhD; E. Sato, MD; T. Gono, MD, PhD; Y. Kawaguchi, MD, PhD; H. Yamanaka, MD, PhD, Institute of Rheumatology, Tokyo Women's Medical University; M. Harigai, MD, PhD, Department of Pharmacovigilance, Graduate School, Tokyo Medical and Dental University; M. Mimura, MD, PhD, Department of Neuropsychiatry, Keio University School of Medicine
| | - Masaru Mimura
- From the Department of Psychiatry and Institute of Rheumatology, Tokyo Women's Medical University School of Medicine, Tokyo; Kanagawa Psychiatric Center, Yokohama; Department of Pharmacovigilance, Graduate School, Tokyo Medical and Dental University; Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan.K. Nishimura, MD, PhD; J. Ishigooka, MD, PhD, Department of Psychiatry, Tokyo Women's Medical University School of Medicine; M. Omori, MD, Kanagawa Psychiatric Center; Y. Katsumata, MD, PhD; E. Sato, MD; T. Gono, MD, PhD; Y. Kawaguchi, MD, PhD; H. Yamanaka, MD, PhD, Institute of Rheumatology, Tokyo Women's Medical University; M. Harigai, MD, PhD, Department of Pharmacovigilance, Graduate School, Tokyo Medical and Dental University; M. Mimura, MD, PhD, Department of Neuropsychiatry, Keio University School of Medicine
| | - Hisashi Yamanaka
- From the Department of Psychiatry and Institute of Rheumatology, Tokyo Women's Medical University School of Medicine, Tokyo; Kanagawa Psychiatric Center, Yokohama; Department of Pharmacovigilance, Graduate School, Tokyo Medical and Dental University; Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan.K. Nishimura, MD, PhD; J. Ishigooka, MD, PhD, Department of Psychiatry, Tokyo Women's Medical University School of Medicine; M. Omori, MD, Kanagawa Psychiatric Center; Y. Katsumata, MD, PhD; E. Sato, MD; T. Gono, MD, PhD; Y. Kawaguchi, MD, PhD; H. Yamanaka, MD, PhD, Institute of Rheumatology, Tokyo Women's Medical University; M. Harigai, MD, PhD, Department of Pharmacovigilance, Graduate School, Tokyo Medical and Dental University; M. Mimura, MD, PhD, Department of Neuropsychiatry, Keio University School of Medicine
| | - Jun Ishigooka
- From the Department of Psychiatry and Institute of Rheumatology, Tokyo Women's Medical University School of Medicine, Tokyo; Kanagawa Psychiatric Center, Yokohama; Department of Pharmacovigilance, Graduate School, Tokyo Medical and Dental University; Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan.K. Nishimura, MD, PhD; J. Ishigooka, MD, PhD, Department of Psychiatry, Tokyo Women's Medical University School of Medicine; M. Omori, MD, Kanagawa Psychiatric Center; Y. Katsumata, MD, PhD; E. Sato, MD; T. Gono, MD, PhD; Y. Kawaguchi, MD, PhD; H. Yamanaka, MD, PhD, Institute of Rheumatology, Tokyo Women's Medical University; M. Harigai, MD, PhD, Department of Pharmacovigilance, Graduate School, Tokyo Medical and Dental University; M. Mimura, MD, PhD, Department of Neuropsychiatry, Keio University School of Medicine
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Reversible Amygdala and Parahippocampal Lesions of Brain 18Fluorodeoxy Glucose-Positron Emission Tomography in Neuropsychiatric Systemic Lupus Erythematosus. Dement Neurocogn Disord 2015. [DOI: 10.12779/dnd.2015.14.1.48] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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14
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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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15
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Shin SY, Julian L, Katz P. The relationship between cognitive function and physical function in rheumatoid arthritis. J Rheumatol 2013; 40:236-43. [PMID: 23322467 DOI: 10.3899/jrheum.120871] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To examine the relationship between cognitive impairment and functional limitations and disability in persons with rheumatoid arthritis (RA). METHODS Individuals from a longitudinal cohort study of RA participated in study visits that included physical, psychosocial, and biological metrics. Cognitive function was assessed using a battery of 12 standardized neuropsychological measures yielding 16 indices covering a range of cognitive domains. On each test, subjects were classified as "impaired" if they performed 1 SD below age-based population norms. Total cognitive function scores were calculated by summing the number of tests on which individuals were classified as "impaired" (higher scores = greater impairment). Performance-based and self-reported functional limitations were assessed with the Short Physical Performance Battery (SPPB) and the Health Assessment Questionnaire (HAQ), respectively. Self-reported disability was measured with the Valued Life Activities (VLA) scale. Multiple regression analyses controlling for sex, race, education, cardiovascular comorbidity, disease duration, disease severity, and depression were conducted to identify whether cognitive impairment was independently associated with physical function difficulties. RESULTS There were 122 subjects with mean (SD) age of 58.4 (± 10.8) years; 62% were female and 80% were white. In multivariate regression models, total cognitive function score was significantly associated with greater functional limitations (SPPB: β = -0.24, p = 0.014; HAQ: β = 0.24, p = 0.003) but not with disability (VLA: β = 0.10, p = 0.207). CONCLUSION Cognitive impairment was significantly associated with greater functional limitations in patients with RA, suggesting that cognitive impairment may play a role in poor functional status in persons with RA.
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Affiliation(s)
- So Young Shin
- College of Nursing, Keimyung University, Daegu, South Korea.
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Cognitive and Emotional Abnormalities in Systemic Lupus Erythematosus: Evidence for Amygdala Dysfunction. Neuropsychol Rev 2012; 22:252-70. [DOI: 10.1007/s11065-012-9213-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2012] [Accepted: 07/27/2012] [Indexed: 12/23/2022]
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17
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Comparison of neuropsychological impairment and vocational outcomes in systemic lupus erythematosus and multiple sclerosis patients. J Int Neuropsychol Soc 2012; 18:530-40. [PMID: 22410107 DOI: 10.1017/s1355617712000057] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Systemic lupus erythematosus (SLE) and multiple sclerosis (MS) are chronic immunologic diseases that can cause cognitive dysfunction. MS is a central nervous system (CNS) disease characterized by demyelination and progressive brain atrophy. SLE is an autoimmune disease capable of damaging multiple organ systems, including the CNS. Cognitive disturbances are seen in both SLE and MS. The present study is concerned with understanding the similarities and differences between the cognitive profiles of SLE and MS as well as the relationship between cognitive impairment and vocational disability in these patients. We examined 47 SLE patients, 47 MS patients, and 44 healthy controls. The groups were well matched on demographics and the patient groups were also matched on disease duration and severity. Group comparisons revealed that generative verbal fluency and visual-spatial memory are more profoundly affected in MS than SLE; whereas depression, fatigue, and working memory deficits are similarly involved in both diseases. Logistic regression analysis revealed that executive function, in particular, was predictive of vocational outcomes in SLE and MS patients.
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18
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Cognitive impairment in non-neuropsychiatric systemic lupus erythematosus. EGYPTIAN RHEUMATOLOGIST 2012. [DOI: 10.1016/j.ejr.2012.02.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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CAVACO SARA, MARTINS da SILVA ANA, SANTOS ERNESTINA, COUTINHO ESTER, MARINHO ANTÓNIO, MOREIRA INÊS, GONÇALVES ALEXANDRA, PINTO CLÁUDIA, TEIXEIRA-PINTO ARMANDO, VASCONCELOS CARLOS. Are Cognitive and Olfactory Dysfunctions in Neuropsychiatric Lupus Erythematosus Dependent on Anxiety or Depression? J Rheumatol 2012; 39:770-6. [DOI: 10.3899/jrheum.110574] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Objective.Depressed mood and cognitive impairments are common findings in systemic lupus erythematosus (SLE) and frequently coexist. We assessed the neuropsychological functioning of patients with SLE and investigated its association with psychopathological symptoms.Methods.A total of 85 patients with SLE (28 with neuropsychiatric syndromes: NPSLE) and 85 healthy control subjects with similar demographic characteristics were asked to perform a series of neuropsychological tests. A self-report questionnaire (the Hospital Anxiety and Depression Scale) was used to screen for psychopathology symptoms. Patients with SLE underwent a neurological examination.Results.Patients with NPSLE were more depressed and were more frequently impaired in cognitive and olfactory functions than controls or non-NPSLE patients. The NPSLE group remained statistically different from the other 2 groups on a series of neuropsychological measures (the Auditory Verbal Learning Test, Trail Making Test – Part A, Nine-Hole Peg Test, and Brief Smell Identification Test) even after control for elevated anxiety and depressed mood. Non-NPSLE and control groups were not significantly different regarding either psychopathological symptoms or neuropsychological functioning.Conclusion.Verbal memory, psychomotor speed, and olfaction are particularly vulnerable to dysfunction in NPSLE; impairment in these neuropsychological domains is not completely explained by psychopathology symptoms.
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Whitelaw DA, Spangenberg JJ. An investigation in the possible effect of chronic headache on neuropsychological function in aCL-negative patients with SLE. Lupus 2009; 18:613-7. [PMID: 19433461 DOI: 10.1177/0961203308101282] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Controversy exists as to whether patients with migraine may suffer cortical damage. We investigate the possible association between impaired cognitive function and chronic headache in lupus patients. Sixty one patients with systemic lupus erythematosus but without the antiphospholipid (Hughes) syndrome were questioned about headaches and formally assessed for cognitive function. They were also subjected to magnetic resonance imaging (MRI). Twenty one patients denied any significant headaches, 19 reported migrainous headaches and 11 experienced an aura. Eleven patients experienced headaches with features of migraine but did not fulfill the criteria, and seven patients had tension headaches. All patients had stable lupus; there was no difference in the incidence of hypertension, age or previous episodes of neuropsychiatric lupus. Patients with migrainous headaches without aura had marginally shorter duration of disease. There was no difference between the groups with respect to eight different cognitive tests or the ventriculo brain index on MRI. We failed to detect cognitive impairment in lupus patients with chronic headaches including migrainous headaches.
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Affiliation(s)
- D A Whitelaw
- Division of Rheumatology Tygerberg Hospital, Parow 5705 South Africa
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Neuropsychological impairment in systemic lupus erythematosus: a comparison with multiple sclerosis. Neuropsychol Rev 2008; 18:149-66. [PMID: 18521755 DOI: 10.1007/s11065-008-9061-2] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2008] [Accepted: 03/16/2008] [Indexed: 01/18/2023]
Abstract
In this manuscript, we review literature describing the neuropsychological and brain imaging characteristics of systemic lupus erythematosus (SLE) patients. The findings are compared and contrasted with multiple sclerosis (MS) studies, revealing similarities and differences of interest to clinicians and researchers. While cognitive impairment is somewhat less common in SLE than MS, the diseases share a similar cognitive profile with deficits most prominent on tests emphasizing the speed of information processing, working memory, and visual/spatial learning, and memory. In early or more mildly affected patients, diffuse white matter damage, which may not be apparent on conventional brain imaging, plays a major role in clinical presentation and cognitive testing. The causes of white matter damage are very different, however, and in later stages of the disease MS and SLE appear to give rise to different forms of cerebral pathology. MS may be characterized by increasing brain atrophy affecting especially the cortical and deep gray matter, at least after conversion to secondary progressive course. There is less evidence for neurodegenerative changes in SLE, but patients are increasingly at risk for cerebrovascular disease. We conclude by offering some suggestions for future clinical and imaging research.
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DiFrancesco MW, Holland SK, Ris MD, Adler CM, Nelson S, DelBello MP, Altaye M, Brunner HI. Functional magnetic resonance imaging assessment of cognitive function in childhood-onset systemic lupus erythematosus: a pilot study. ACTA ACUST UNITED AC 2008; 56:4151-63. [PMID: 18050246 DOI: 10.1002/art.23132] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To investigate changes in brain activation patterns detected by functional magnetic resonance imaging (FMRI), and the relationship between FMRI activation patterns and results of formal neuropsychological testing, in patients with childhood-onset systemic lupus erythematosus (SLE). METHODS Ten patients with childhood-onset SLE underwent formal neuropsychological testing and FMRI using 3 paradigms: a continuous performance task (CPT) to evaluate attention, an N-Back task to assess working memory, and verb generation to evaluate language processing. Composite Z maps were generated to summarize the brain activation patterns for each FMRI paradigm in patients with childhood-onset SLE and to compare these patterns with those observed in healthy controls. Between-group comparison Z maps showing differences in activation between childhood-onset SLE patients and controls were generated, using a significance level of P < 0.05 in a general linear model. RESULTS Compared with the control group, the childhood-onset SLE group showed statistically significant increased activation of brain areas involved in the CPT, N-Back, and verb generation tasks. In contrast, in the absence of active stimulus, e.g., during times of the paradigm control tasks, childhood-onset SLE patients consistently undersuppressed activity in the expected brain areas. Activation in selected cortical areas was found to correlate negatively with results of a subset of individual neuropsychological test scores. CONCLUSION FMRI abnormalities are present in childhood-onset SLE, manifesting as an imbalance between active and inhibitory responses to an array of stimuli. Differences in brain activation patterns compared with those observed in controls suggest that childhood-onset SLE may be associated with abnormalities in white matter connectivity resulting in neuronal network dysfunction, rather than injury of specific gray matter areas.
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Affiliation(s)
- Mark W DiFrancesco
- Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229, USA
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