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Legge AC, Hanly JG. Recent advances in the diagnosis and management of neuropsychiatric lupus. Nat Rev Rheumatol 2024:10.1038/s41584-024-01163-z. [PMID: 39358609 DOI: 10.1038/s41584-024-01163-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/19/2024] [Indexed: 10/04/2024]
Abstract
Neuropsychiatric manifestations of systemic lupus erythematosus (SLE) are common and frequently associated with a substantial negative impact on health outcomes. The pathogenesis of neuropsychiatric SLE (NPSLE) remains largely unknown, but a single pathogenic mechanism is unlikely to be responsible for the heterogeneous array of clinical manifestations, and a combination of inflammatory and ischaemic mechanistic pathways have been implicated. Currently, valid and reliable biomarkers for the diagnosis of NPSLE are lacking, and differentiating NPSLE from nervous system dysfunction not caused by SLE remains a major challenge for clinicians. However, correct attribution is essential to ensure timely institution of appropriate treatment. In the absence of randomized clinical trials on NPSLE, current treatment strategies are derived from clinical experience with different therapeutic modalities and their efficacy in the management of other manifestations of SLE or of neuropsychiatric disease in non-SLE populations. This Review describes recent advances in the understanding of NPSLE that can inform diagnosis and management, as well as unanswered questions that necessitate further research.
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Affiliation(s)
- Alexandra C Legge
- Division of Rheumatology, Department of Medicine, Dalhousie University and Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada
- Arthritis Research Canada, Vancouver, British Columbia, Canada
| | - John G Hanly
- Division of Rheumatology, Department of Medicine, Dalhousie University and Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada.
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Wang X, Huang L, Guo W, Tang L, Wu A, Wu P, Zhao X, Lin Q, Yu L. Cerebral Microstructural and Microvascular Changes in Non-Neuropsychiatric Systemic Lupus Erythematosus: A Study Using Diffusion Kurtosis Imaging and 3D Pseudo-Continuous Arterial Spin Labeling. J Inflamm Res 2023; 16:5465-5475. [PMID: 38026250 PMCID: PMC10676653 DOI: 10.2147/jir.s429521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 10/31/2023] [Indexed: 12/01/2023] Open
Abstract
Purpose The purpose of this study was to observe cerebral microstructure and microcirculation features, as well as changes in white matter (WM) and gray matter (GM) among patients with non-neuropsychiatric systemic lupus erythematosus (non-NPSLE). Methods We compared 36 female patients with non-NPSLE and 20 age- and gender-matched healthy controls (HCs) who underwent 3.0T MRI imaging with diffusion kurtosis imaging (DKI) and 3D pseudo-continuous Arterial Spin Labeling (pCASL). Mean kurtosis (MK), mean kurtosis tensor (MKT), and cerebral blood flow (CBF) values were obtained from 25 brain regions, including WM and GM. We analyzed the correlation between imaging indicators and clinical data. Results When compared with HCs, patients with non-NPSLE had reduced MK and MKT values in regional WM, deep GM, and the left frontal lobe cortical GM, and increased CBF in the right parietal lobe WM and right semioval center (SOC). The MK and MKT values were weakly correlated with CBF in some regions, including WM and GM. Complement 3 (C3) and Complement 4 (C4) showed a weak positive correlation with MK and MKT in some regions, including WM and deep GM, while platelet (PLT) was positively correlated with MKT in the left frontal lobe WM; dsDNA antibody was correlated negatively with MK in the right occipital lobe WM; and erythrocyte sedimentation rate (ESR) was correlated negatively with CBF in the left SOC. Conclusion Our findings revealed the presence of brain microstructural and microvascular abnormalities in non-NPSLE patients, indicating microstructural damage in the cortical GM, which was less commonly reported. We found DKI and pCASL useful in detecting early brain lesions, and MK was a more sensitive and beneficial indicator.
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Affiliation(s)
- Xiaojuan Wang
- Department of Radiology, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, Fujian, 364000, People’s Republic of China
| | - Lingling Huang
- Department of Radiology, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, Fujian, 364000, People’s Republic of China
| | - Wenbin Guo
- Department of Pathology, Pingtan Comprehensive Experimental Area Hospital, Fuzhou, Fujian, 350400, People’s Republic of China
| | - Langlang Tang
- Department of Radiology, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, Fujian, 364000, People’s Republic of China
| | - Aiyu Wu
- Department of Rheumatology, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, Fujian, 364000, People’s Republic of China
| | - Peng Wu
- Philips Healthcare, Shanghai, 200000, People’s Republic of China
| | - Xiance Zhao
- Philips Healthcare, Shanghai, 200000, People’s Republic of China
| | - Qi Lin
- Department of Radiology, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, Fujian, 364000, People’s Republic of China
| | - Lian Yu
- Department of Rheumatology, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, Fujian, 364000, People’s Republic of China
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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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Hanly JG, Robertson JW, Legge A, Kamintsky L, Aristi G, Friedman A, Beyea SD, Fisk JD, Omisade A, Calkin C, Bardouille T, Bowen C, Matheson K, Hashmi JA. Resting state functional connectivity in SLE patients and association with cognitive impairment and blood-brain barrier permeability. Rheumatology (Oxford) 2023; 62:685-695. [PMID: 35699463 PMCID: PMC9891437 DOI: 10.1093/rheumatology/keac343] [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: 02/17/2022] [Revised: 06/03/2022] [Accepted: 06/03/2022] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE Extensive blood-brain barrier (BBB) leakage has been linked to cognitive impairment in SLE. This study aimed to examine the associations of brain functional connectivity (FC) with cognitive impairment and BBB dysfunction among patients with SLE. METHODS Cognitive function was assessed by neuropsychological testing (n = 77). Resting-state FC (rsFC) between brain regions, measured by functional MRI (n = 78), assessed coordinated neural activation in 131 regions across five canonical brain networks. BBB permeability was measured by dynamic contrast-enhanced MRI (n = 61). Differences in rsFC were compared between SLE patients with cognitive impairment (SLE-CI) and those with normal cognition (SLE-NC), between SLE patients with and without extensive BBB leakage, and with healthy controls. RESULTS A whole-brain rsFC comparison found significant differences in intra-network and inter-network FC in SLE-CI vs SLE-NC patients. The affected connections showed a reduced negative rsFC in SLE-CI compared with SLE-NC and healthy controls. Similarly, a reduced number of brain-wide connections was found in SLE-CI patients compared with SLE-NC (P = 0.030) and healthy controls (P = 0.006). Specific brain regions had a lower total number of brain-wide connections in association with extensive BBB leakage (P = 0.011). Causal mediation analysis revealed that 64% of the association between BBB leakage and cognitive impairment in SLE patients was mediated by alterations in FC. CONCLUSION SLE patients with cognitive impairment had abnormalities in brain rsFC which accounted for most of the association between extensive BBB leakage and cognitive impairment.
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Affiliation(s)
- John G Hanly
- Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Center and Dalhousie University
| | - Jason W Robertson
- Department of Anesthesia, Pain Management and Perioperative Medicine, Dalhousie University, Nova Scotia Health Authority
| | - Alexandra Legge
- Division of Rheumatology, Department of Medicine, Queen Elizabeth II Health Sciences Center and Dalhousie University
| | - Lyna Kamintsky
- Department of Medical Neuroscience, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Guillermo Aristi
- Department of Anesthesia, Pain Management and Perioperative Medicine, Dalhousie University, Nova Scotia Health Authority
| | - Alon Friedman
- Department of Medical Neuroscience, Dalhousie University, Halifax, Nova Scotia, Canada.,Departments of Cognitive and Brain Sciences, Physiology and Cell Biology, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Steven D Beyea
- Biomedical Translational Imaging Centre (BIOTIC), QEII Health Sciences Centre, and Department of Diagnostic Radiology
| | - John D Fisk
- Nova Scotia Health Authority, Halifax, Canada and the Departments of Psychiatry, Psychology & Neuroscience and Medicine, Dalhousie University
| | - Antonina Omisade
- Acquired Brain Injury (Epilepsy Program), Nova Scotia Health Authority
| | - Cynthia Calkin
- Department of Psychiatry and Department of Medical Neuroscience
| | | | - Chris Bowen
- Biomedical Translational Imaging Centre (BIOTIC), QEII Health Sciences Centre, and Department of Diagnostic Radiology
| | - Kara Matheson
- Research Methods Unit, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | - Javeria A Hashmi
- Department of Anesthesia, Pain Management and Perioperative Medicine, Dalhousie University, Nova Scotia Health Authority
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Cognitive dysfunction in SLE: An understudied clinical manifestation. J Autoimmun 2022; 132:102911. [PMID: 36127204 DOI: 10.1016/j.jaut.2022.102911] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 08/31/2022] [Indexed: 11/22/2022]
Abstract
Neuropsychiatric lupus (NPSLE) is a debilitating manifestation of SLE which occurs in a majority of SLE patients and has a variety of clinical manifestations. In the central nervous system, NPSLE may result from ischemia or penetration of inflammatory mediators and neurotoxic antibodies through the blood brain barrier (BBB). Here we focus on cognitive dysfunction (CD) as an NPSLE manifestation; it is common, underdiagnosed, and without specific therapy. For a very long time, clinicians ignored cognitive dysfunction and researchers who might be interested in the question struggled to find an approach to understanding mechanisms for this manifestation. Recent years, however, propelled by a more patient-centric approach to disease, have seen remarkable progress in our understanding of CD pathogenesis. This has been enabled through the use of novel imaging modalities and numerous mouse models. Overall, these studies point to a pivotal role of an impaired BBB and microglial activation in leading to neuronal injury. These insights suggest potential therapeutic modalities and make possible clinical trials for cognitive impairment.
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Papadaki E, Simos NJ, Kavroulakis E, Bertsias G, Antypa D, Fanouriakis A, Maris T, Sidiropoulos P, Boumpas DT. Converging evidence of impaired brain function in systemic lupus erythematosus: changes in perfusion dynamics and intrinsic functional connectivity. Neuroradiology 2022; 64:1593-1604. [DOI: 10.1007/s00234-022-02924-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 02/24/2022] [Indexed: 10/18/2022]
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Barraclough M, McKie S, Parker B, Elliott R, Bruce IN. The effects of disease activity, inflammation, depression and cognitive fatigue on resting state fMRI in systemic lupus erythematosus. Rheumatology (Oxford) 2021; 61:SI39-SI47. [PMID: 34747435 DOI: 10.1093/rheumatology/keab734] [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: 06/29/2021] [Accepted: 09/10/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Cognitive dysfunction (CD) and depression are interlinked comorbidities of SLE. They may be the result of altered brain mechanisms. This study aimed to examine SLE effects on functional connectivity (FC) within the default mode network (DMN) using resting state fMRI-and how depression may impact this. METHODS Demographic, clinical and psychiatric data were collected from 19 SLE-active, 23 SLE-stable and 30 healthy controls (HC) participants. A T2*-weighted rsfMR scan was acquired and analysed using independent component analysis (ICA). Group z-scores for nodes associated with the DMN were tested. Significant nodes were entered into a factor analysis. The combined factor was used in correlations with factors of interest. Significant variables were used in a mediation analysis. RESULTS 14 DMN nodes were defined using ICA. In five nodes, the SLE groups had significantly reduced FC compared with the HC group (p < 0.01). Factor analysis generated one factor that only depression score correlated with for both the HC group (rs=-0.510) and SLE groups combined (rs=-0.390). Mediation analysis revealed depression score accounted for 22% of the altered FC in the DMN. Disease state accounted for the remaining 78%. CONCLUSIONS Altered FC was evident in DMN nodes for SLE groups irrespective of disease activity. Depression accounts for some of this effect but SLE directly accounted for more. Further studies are needed to assess if these changes may be a precursor to CD in SLE. If so, rs-fMRI could be an early marker for CD in SLE and help in future CD in SLE treatment trials.
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Affiliation(s)
- Michelle Barraclough
- Centre for Epidemiology Versus Arthritis, Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK and NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Shane McKie
- FBMH Platform Sciences, Enabling Technologies & Infrastructure, FBMH Research & Innovation, The University of Manchester & Manchester Academic Health Science Centre, Manchester, UK
| | - Ben Parker
- Centre for Epidemiology Versus Arthritis, Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK and NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Rebecca Elliott
- Neuroscience and Psychiatry Unit, Division of Neuroscience and Experimental Psychology, The University of Manchester, Manchester, UK
| | - Ian N Bruce
- Centre for Epidemiology Versus Arthritis, Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK and NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
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Wang Y, Jiang M, Huang L, Meng X, Li S, Pang X, Zeng Z. Altered Functional Brain Network in Systemic Lupus Erythematosus Patients Without Overt Neuropsychiatric Symptoms Based on Resting-State Functional Magnetic Resonance Imaging and Multivariate Pattern Analysis. Front Neurol 2021; 12:690979. [PMID: 34354663 PMCID: PMC8333697 DOI: 10.3389/fneur.2021.690979] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Accepted: 06/04/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: This study aims to investigate the alterations in functional brain network in systemic lupus erythematosus patients without overt neuropsychiatric symptoms [neuropsychiatric systemic lupus erythematosus (non-NPSLE)] from the perspective of degree centrality (DC) and functional connectivity (FC) using resting-state functional magnetic resonance imaging (MRI) and multivariate pattern analysis (MVPA) approach. Methods: DC analysis was performed based on the resting-state functional MRI data derived from 47 non-NPSLE patients and 47 healthy controls (HCs). Nodes with abnormal DC were utilized as seeds for further FC analysis. The correlation between MRI variables and clinical or neuropsychological data was analyzed using Pearson correlation analysis. Finally, MVPA classification based on DC was performed. Results: When compared with the HCs, the non-NPSLE patients exhibited remarkably higher DC in the bilateral hippocampus (HIP), right insula (INS), and lower DC in the left superior parietal gyrus. Furthermore, the patients displayed significantly higher FC between the left HIP and the left INS/left dorsolateral middle frontal gyrus/left supramarginal gyrus and higher FC between the right HIP and the right middle temporal gyrus/right dorsolateral middle frontal gyrus/right dorsolateral inferior frontal gyrus/right supramarginal gyrus (all imaging variables mentioned earlier underwent cluster-level false discovery rate corrections, the voxel threshold was p < 0.001, cluster threshold was p < 0.05). Correlation analysis revealed significantly negative correlations between DC values of the right INS and disease activity and the DC values of the right HIP and the Montreal Cognitive Assessment scores. The accuracy, sensitivity, and specificity of MVPA classification based on DC were 72.34, 63.83, and 80.85%, respectively. The most discriminative power brain regions were chiefly located within the temporal, parietal, and frontal regions. Conclusion: Patients with non-NPSLE exhibited abnormal DC and FC in the brain network. MVPA based on DC possessed commendable classification ability. Our study may provide a novel perspective on the neuropathological mechanisms underlying subclinical brain damage in non-NPSLE.
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Affiliation(s)
- Yiling Wang
- Department of Radiology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Muliang Jiang
- Department of Radiology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Lixuan Huang
- Department of Radiology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Xia Meng
- Department of Radiology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Shu Li
- Department of Radiology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Xiaoqi Pang
- Department of Radiology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Zisan Zeng
- Department of Radiology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
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Bonacchi R, Rocca MA, Ramirez GA, Bozzolo EP, Canti V, Preziosa P, Valsasina P, Riccitelli GC, Meani A, Moiola L, Rovere-Querini P, Manfredi AA, Filippi M. Resting state network functional connectivity abnormalities in systemic lupus erythematosus: correlations with neuropsychiatric impairment. Mol Psychiatry 2021; 26:3634-3645. [PMID: 33051605 DOI: 10.1038/s41380-020-00907-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 09/16/2020] [Accepted: 10/01/2020] [Indexed: 02/08/2023]
Abstract
Neuropsychiatric manifestations are highly prevalent in systemic lupus erythematosus (SLE)-patients. We aimed to unravel the substrates of these manifestations by investigating abnormalities of resting state (RS) functional connectivity (FC) and their correlations with neuropsychiatric variables in SLE-patients. Thirty-two SLE-patients and 32 age- and sex-matched healthy controls (HC) underwent brain 3T RS fMRI. Neuropsychological assessment was performed for all SLE-patients. The main large-scale cognitive and psychiatric functional networks were derived and between-group comparisons and correlations with neuropsychological measures were performed. Compared to HC, SLE-patients exhibited increased RS FC in the right middle cingulate cortex and decreased RS FC in the left precuneus within default-mode network (DMN). They also showed increased RS FC in the left cerebellar crus I and left posterior cingulate cortex, and decreased RS FC in the left angular gyrus within working-memory networks (WMN). Compared to HC, SLE-patients exhibited increased RS FC in the left insular cortex and decreased RS FC in the right anterior cingulate cortex within salience network (SN), as well as decreased RS FC in the right middle frontal gyrus within executive-control network (ECN). Correlation analysis indicated a maladaptive role for left angular gyrus and cerebellar RS FC abnormalities in WMN, affecting memory and executive functions; and for precuneus and insular abnormalities in DMN and SN for psychiatric symptoms. Cingulate cortex modifications within DMN and SN correlated with better memory and global cognitive performance. Significant RS FC alterations in relevant cognitive and psychiatric networks occur in SLE-patients and participate in the pathophysiology of neuropsychiatric symptoms.
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Affiliation(s)
- Raffaello Bonacchi
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Maria A Rocca
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giuseppe A Ramirez
- Vita-Salute San Raffaele University, Milan, Italy.,Unit of Immunology, Rheumatology, Allergy and Rare Diseases & Division of Immunology, Transplantation and Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Enrica P Bozzolo
- Unit of General Medicine and Advanced Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Valentina Canti
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases & Division of Immunology, Transplantation and Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Paolo Preziosa
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Paola Valsasina
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Gianna C Riccitelli
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alessandro Meani
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Lucia Moiola
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Patrizia Rovere-Querini
- Vita-Salute San Raffaele University, Milan, Italy.,Unit of Immunology, Rheumatology, Allergy and Rare Diseases & Division of Immunology, Transplantation and Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Angelo A Manfredi
- Vita-Salute San Raffaele University, Milan, Italy.,Unit of Immunology, Rheumatology, Allergy and Rare Diseases & Division of Immunology, Transplantation and Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Massimo Filippi
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy. .,Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy. .,Vita-Salute San Raffaele University, Milan, Italy. .,Neurophysiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.
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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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Chen L, Sun J, Wang Q, Hu L, Zhang Y, Ma H, Jia X, Yang X. Altered Temporal Dynamics of Brain Activity in Multiple-Frequency Bands in Non-Neuropsychiatric Systemic Lupus Erythematosus Patients with Inactive Disease. Neuropsychiatr Dis Treat 2021; 17:1385-1395. [PMID: 33994788 PMCID: PMC8113012 DOI: 10.2147/ndt.s292302] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 03/15/2021] [Indexed: 12/02/2022] Open
Abstract
PURPOSE In this study, we seek to investigate dynamic changes of brain activity in non-neuropsychiatric systemic lupus erythematosus (non-NPSLE) patients with inactive disease. PATIENTS AND METHODS Thirty-one non-NPSLE patients with inactive disease and 20 matched healthy controls underwent the blood oxygenation level-dependent fMRI examination. Dynamic regional homogeneity (ReHo) and fractional amplitude of low-frequency fluctuations (fALFF) were used to analyze the brain activity in typical band (0.01-0.08 Hz), slow-4 (0.027-0.073 Hz) and slow-5 (0.01-0.027 Hz). Pearson's correlation analysis was performed to correlate dynamic regional homogeneity (dReHo) and dynamic fractional amplitude of low-frequency fluctuations (dfALFF) values for clusters of voxels where significant group differences were found with clinical variables in non-NPSLE patients with inactive disease. RESULTS In typical band, non-NPSLE patients showed increased dReHo in left middle occipital gyrus (MOG) compared to healthy controls. Meanwhile, patients showed decreased dfALFF in right superior frontal gyrus (SFG) and bilateral middle frontal gyrus (MFG) in typical band. In slow-4, increased dReHo in left MOG was found in non-NPSLE patients. In slow-5, non-NPSLE patients showed increased dReHo in left MOG, left calcarine fissure and surrounding cortex, right precentral gyrus (PreCG) and left postcentral gyrus (PoCG). Meanwhile, non-NPSLE patients showed decreased dfALFF in left SFG, right MFG, and right PreCG in slow-5. Moreover, the glucocorticoid dose showed significantly negative correlations with dReHo values in right PreCG in slow-5, left PoCG in slow-5, and left MOG in typical band. CONCLUSION dReHo and dfALFF abnormalities in different frequency bands may be the key characteristics in the pathogenesis mechanism of non-NPSLE.
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Affiliation(s)
- Liheng Chen
- Department of Rheumatology, Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310009, People’s Republic of China
| | - Jiawei Sun
- School of Information and Electronics Technology, Jiamusi University, Jiamusi, People’s Republic of China
- Integrated Medical Research School, Jiamusi University, Jiamusi, People’s Republic of China
| | - Qiaohong Wang
- Department of Rheumatology, Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310009, People’s Republic of China
| | - Lingzhen Hu
- Department of Rheumatology, Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310009, People’s Republic of China
| | - Yi Zhang
- Department of Rheumatology, Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310009, People’s Republic of China
| | - Huibin Ma
- School of Information and Electronics Technology, Jiamusi University, Jiamusi, People’s Republic of China
- Integrated Medical Research School, Jiamusi University, Jiamusi, People’s Republic of China
| | - Xize Jia
- Institute of Psychological Sciences, Hangzhou Normal University, Hangzhou, People’s Republic of China
- Zhejiang Key Laboratory for Research in Assessment of Cognitive Impairments, Hangzhou, People’s Republic of China
| | - Xuyan Yang
- Department of Rheumatology, Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310009, People’s Republic of China
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12
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Abnormal topological organization in systemic lupus erythematosus: a resting-state functional magnetic resonance imaging analysis. Brain Imaging Behav 2021; 15:14-24. [PMID: 31903526 DOI: 10.1007/s11682-019-00228-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Using resting-state functional magnetic resonance imaging and graph theory approaches to investigate the topological characteristics of functional networks and their potential correlations with clinical information in patients with systemic lupus erythematosus (SLE). A total of 41 patients and 35 volunteers were consecutively recruited. Detailed clinical data of all participants were recorded. All participants underwent a resting-state functional magnetic resonance imaging examination. Functional networks were constructed by a Pearson correlation matrix of 116 brain regions. The topological properties were analyzed by graph theory. Parametric tests were used to compare the topological properties between the groups. Partial correlation analysis was used to identify relationships between the abnormal topological properties and the clinical data. The nodal network metrics were abnormal in the SLE patients compared to the controls. Decreased nodal efficiency was identified in the right insula, bilateral putamen, and bilateral Heschl's gyrus in the SLE patients. Decreased degree centrality was also found in the right amygdala and bilateral Heschl's gyrus. In addition, the SLE patients showed decreased network functional connectivity (FC) between several regions, particularly between the basal ganglia and the cerebellum. Moreover, FC values between the right putamen and vermis 6 were positively correlated with Mini-Mental State Examination scores. The nodal efficiency and the degree centrality values in the left Heschl's gyrus were both positively correlated with the course of the disease. The topological structure of the functional network was apparently abnormal in SLE patients. FC values between the right putamen and vermis 6 may serve as a neuroimaging marker for evaluating the progressive cognitive decline in SLE patients. Decreased synergy between the basal ganglia region and the cerebellum in the extrapyramidal system may be one cause of cognitive dysfunction in SLE patients.
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13
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Barraclough M, McKie S, Parker B, Elliott R, Bruce IN. The effects of disease activity on neuronal and behavioural cognitive processes in systemic lupus erythematosus. Rheumatology (Oxford) 2021; 61:195-204. [PMID: 33760068 DOI: 10.1093/rheumatology/keab256] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Factors common across many chronic diseases, such as fatigue and depression affect cognitive dysfunction (CD) but the effect of systemic lupus erythematosus (SLE) disease activity on CD remains unclear. We aimed to explore the effects of disease activity in SLE on cognitive function whilst taking into consideration other potential mediators. METHODS Two groups of SLE patients were recruited; stable/low disease activity (SLE-S, n = 36) and active disease (SLE-F, n = 26). The SLE-F group were studied during a flare; with a second visit when disease activity had reduced. In addition to demographic, clinical and psychiatric data, CD was measured using a computerised battery of tests (CANTAB®). fMRI was used to examine neuronal responses to working memory and emotional processing tasks. RESULTS No differences between the groups/visits were found using the CANTAB® battery. The fMRI results showed that the SLE-F group had a less attenuated response in the medial prefrontal cortex (a default mode network-DMN region) compared with the SLE-S group during the working memory task (p = 0.012). Exploratory correlations within the SLE-F group showed associations between neuronal responses and depression, cognitive fatigue, disease activity measures and IL-6. CONCLUSION Functional brain processes but not cognitive behavioural measures were affected by disease activity. Flaring SLE patients were less able to suppress DMN regions during a working memory task. This could reflect emotional interference during cognitive tasks and may cause cognitive fatigue. A number of factors are associated with brain function in flaring patients, which has potential implications for holistic treatments.
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Affiliation(s)
- Michelle Barraclough
- Centre for Epidemiology Versus Arthritis, Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK and NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Shane McKie
- FBMH Platform Sciences, Enabling Technologies & Infrastructure, FBMH Research & Innovation, The University of Manchester & Manchester Academic Health Science Centre, Manchester, UK
| | - Ben Parker
- Centre for Epidemiology Versus Arthritis, Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK and NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Rebecca Elliott
- Neuroscience and Psychiatry Unit, Division of Neuroscience and Experimental Psychology, The University of Manchester, Manchester, UK
| | - Ian N Bruce
- Centre for Epidemiology Versus Arthritis, Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK and NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
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14
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Valdés Hernández MDC, Smith K, Bastin ME, Nicole Amft E, Ralston SH, Wardlaw JM, Wiseman SJ. Brain network reorganisation and spatial lesion distribution in systemic lupus erythematosus. Lupus 2020; 30:285-298. [PMID: 33307988 PMCID: PMC7854491 DOI: 10.1177/0961203320979045] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Objective This work investigates network organisation of brain structural connectivity
in systemic lupus erythematosus (SLE) relative to healthy controls and its
putative association with lesion distribution and disease indicators. Methods White matter hyperintensity (WMH) segmentation and connectomics were
performed in 47 patients with SLE and 47 healthy age-matched controls from
structural and diffusion MRI data. Network nodes were divided into
hierarchical tiers based on numbers of connections. Results were compared
between patients and controls to assess for differences in brain network
organisation. Voxel-based analyses of the spatial distribution of WMH in
relation to network measures and SLE disease indicators were conducted. Results Despite inter-individual differences in brain network organization observed
across the study sample, the connectome networks of SLE patients had larger
proportion of connections in the peripheral nodes. SLE patients had
statistically larger numbers of links in their networks with generally
larger fractional anisotropy weights (i.e. a measure of white matter
integrity) and less tendency to aggregate than those of healthy controls.
The voxels exhibiting connectomic differences were coincident with WMH
clusters, particularly the left hemisphere’s intersection between the
anterior limb of the internal and external capsules. Moreover, these voxels
also associated more strongly with disease indicators. Conclusion Our results indicate network differences reflective of compensatory
reorganization of the neural circuits, reflecting adaptive or extended
neuroplasticity in SLE.
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Affiliation(s)
- Maria Del C Valdés Hernández
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK.,UK Dementia Research Institute, University of Edinburgh, Edinburgh, UK
| | - Keith Smith
- Usher Institute for Population Health Science and Informatics, University of Edinburgh, Edinburgh, UK.,Health Data Research UK, London, UK
| | - Mark E Bastin
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - E Nicole Amft
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Stuart H Ralston
- Centre for Genomic and Experimental Medicine, University of Edinburgh, Edinburgh, UK
| | - Joanna M Wardlaw
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK.,UK Dementia Research Institute, University of Edinburgh, Edinburgh, UK
| | - Stewart J Wiseman
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK.,UK Dementia Research Institute, University of Edinburgh, Edinburgh, UK
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15
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Kaplan C, Minc A, Basu N, Schrepf A. Inflammation and the Central Nervous System in Inflammatory Rheumatic Disease. Curr Rheumatol Rep 2019; 21:67. [PMID: 31807958 DOI: 10.1007/s11926-019-0870-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE OF REVIEW To review how peripheral inflammation in rheumatic disease influences the central nervous system. We consider recent studies of rheumatic disease that employ functional and structural neuroimaging in the context of inflammation, as well as recent studies considering how immunosuppressive therapy is associated with changes in brain function and structure. RECENT FINDINGS The most compelling evidence thus far comes from studies of rheumatoid arthritis and indicates that higher levels of inflammation are associated with changes in cognitive, affective, and pain-processing brain regions, some of which may be rectified by anti-inflammatory treatment. Comorbid symptoms such as widespread pain and fatigue may also be associated with these changes. Inflammation may be associated with compensatory activation of brain regions to offset structural changes. This emerging line of evidence suggests that communication between the brain and immune system are an important and underappreciated aspect of inflammatory rheumatic disease.
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Affiliation(s)
- Chelsea Kaplan
- Chronic Pain and Fatigue Research Center, Department of Anesthesiology, University of Michigan Health System, Domino's Farms, Lobby M, 24 Frank Lloyd Wright Dr., PO Box 385, Ann Arbor, MI, 48106, USA
| | | | - Neil Basu
- Institute of Infection, Immunity & Inflammation, University of Glasgow, Glasgow, UK
| | - Andrew Schrepf
- Chronic Pain and Fatigue Research Center, Department of Anesthesiology, University of Michigan Health System, Domino's Farms, Lobby M, 24 Frank Lloyd Wright Dr., PO Box 385, Ann Arbor, MI, 48106, USA.
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16
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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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17
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Cortical thickness reductions associate with abnormal resting-state functional connectivity in non-neuropsychiatric systemic lupus erythematosus. Brain Imaging Behav 2019; 12:674-684. [PMID: 28451920 DOI: 10.1007/s11682-017-9729-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
To detect the abnormal cortical thickness and disrupted brain resting-state functional connectivity (RSFC) in patients with systemic lupus erythematosus (SLE) without neuropsychiatric symptoms (non-NPSLE). Using T1-weighted 3D brain structural data, we first determined the regions with abnormal cortical thickness in a cohort of 33 adult female non-NPSLE patients. By taking brain regions with significantly reduced cortical thickness as the seeds, we calculated their RSFC based on the resting-fMRI data and detected the relationship between the RSFC and cortical thickness in the non-NPSLE patients. Compared to the controls, the non-NPSLE patients showed significantly cortical thinning in the left fusiform gyrus (FUS.L), left lingual gyrus (LING.L), right lingual gyrus (LING.R) and left superior frontal cortex (SFC.L). As for the RSFC, statistical analyses indicated that the abnormal cortical thickness in LING.L is associated with increased RSFC in the left posterior cingulate cortex (PCC.L), and cortical thinning in SFC.L associated with decreased RSFC in left cerebellum 6 (CRBL 6.L) in non-NPSLE patients. In addition, in non-NPSLE patients, the decreased cortical thickness in LING.L was correlated to the increased RSFC in PCC.L, and decreased cortical thickness in SFC.L was correlated to the decreased RSFC in CRBL 6.L. Our findings suggest that the cortical abnormalities may affect brain intrinsic connectivity in non-NPSLE patients.
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18
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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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19
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Abnormal amplitude of low frequency fluctuation and functional connectivity in non-neuropsychiatric systemic lupus erythematosus: a resting-state fMRI study. Neuroradiology 2019; 61:331-340. [PMID: 30637462 DOI: 10.1007/s00234-018-2138-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 11/13/2018] [Indexed: 02/01/2023]
Abstract
PURPOSE To explore the amplitude of low frequency fluctuation (ALFF) and functional connectivity (FC) disorders in non-neuropsychiatric systemic lupus erythematosus (non-NPSLE) patients by resting-state functional magnetic resonance imaging (rs-fMRI) and to study whether there are some clinical biomarkers that can be used to monitor the brain dysfunction. METHODS Based on the rs-fMRI data of 36 non-NPSLE patients and 30 normal controls, we first obtained the regions with abnormal ALFF signals in non-NPSLE patients. Then, by taking these areas as seed regions of interest (ROIs), we calculated the FC between ROIs and the whole brain to assess the network-level alterations. Finally, we correlated the altered values of ALFF and FC in non-NPSLE patients to some clinical data. RESULTS Compared with the controls, non-NPSLE patients showed decreased ALFF in bilateral precuneus and increased ALFF in right cuneus and right calcarine fissure surrounding cortex (CAL). At network level, non-NPSLE patients exhibited higher FC between left precuneus and left middle occipital gyrus (MOG)/left superior occipital gyrus (SOG)/right middle frontal gyrus (MFG)/right dorsolateral superior frontal gyrus (SFGdor), and higher FC between right cuneus and bilateral precuneus/left posterior cingulate gyrus (PCG). The abnormal ALFF in right CAL and abnormal FC in right cuneus-left precuneus, right cuneus-right precuneus, and right cuneus-left PCG were correlated with the patients' certain clinical data (p < 0.05). CONCLUSION Rs-fMRI is a promising tool for detecting the brain function disorders in non-NPSLE patients and to help understand the neurophysiological mechanisms. C4 and Systemic Lupus Erythematosus Disease Activity Index may be biomarkers of brain dysfunction in non-NPSLE patients.
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20
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Magro-Checa C, Steup-Beekman GM, Huizinga TW, van Buchem MA, Ronen I. Laboratory and Neuroimaging Biomarkers in Neuropsychiatric Systemic Lupus Erythematosus: Where Do We Stand, Where To Go? Front Med (Lausanne) 2018; 5:340. [PMID: 30564579 PMCID: PMC6288259 DOI: 10.3389/fmed.2018.00340] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 11/19/2018] [Indexed: 01/18/2023] Open
Abstract
Systemic lupus erythematosus (SLE) is a chronic autoimmune disease characterized by multi-systemic involvement. Nervous system involvement in SLE leads to a series of uncommon and heterogeneous neuropsychiatric (NP) manifestations. Current knowledge on the underlying pathogenic processes and their subsequent pathophysiological changes leading to NP-SLE manifestations is incomplete. Several putative laboratory biomarkers have been proposed as contributors to the genesis of SLE-related nervous system damage. Alongside the laboratory biomarkers, several neuroimaging tools have shown to reflect the nature of tissue microstructural damage associated with SLE, and thus were suggested to contribute to the understanding of the pathophysiological changes and subsequently help in clinical decision making. However, the number of useful biomarkers in NP-SLE in clinical practice is disconcertingly modest. In some cases it is not clear whether the biomarker is truly involved in pathogenesis, or the result of non-specific pathophysiological changes in the nervous system (e.g., neuroinflammation) or whether it is the consequence of a concomitant underlying abnormality related to SLE activity. In order to improve the diagnosis of NP-SLE and provide a better targeted care to these patients, there is still a need to develop and validate a range of biomarkers that reliably capture the different aspects of disease heterogeneity. This article critically reviews the current state of knowledge on laboratory and neuroimaging biomarkers in NP-SLE, discusses the factors that need to be addressed to make these biomarkers suitable for clinical application, and suggests potential future research paths to address important unmet needs in the NP-SLE field.
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Affiliation(s)
- César Magro-Checa
- Department of Rheumatology, Leiden University Medical Center, Leiden, Netherlands.,Department of Rheumatology, Zuyderland Medical Center, Heerlen, Netherlands
| | | | - Tom W Huizinga
- Department of Rheumatology, Leiden University Medical Center, Leiden, Netherlands
| | - Mark A van Buchem
- Department of Radiology, Leiden University Medical Center, Leiden, Netherlands.,Department of Radiology, C.J. Gorter Center for High Field MRI, Leiden University Medical Center, Leiden, Netherlands
| | - Itamar Ronen
- Department of Radiology, C.J. Gorter Center for High Field MRI, Leiden University Medical Center, Leiden, Netherlands
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21
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Brain white matter structural networks in patients with non-neuropsychiatric systemic lupus erythematosus. Brain Imaging Behav 2018; 12:142-155. [PMID: 28190161 DOI: 10.1007/s11682-017-9681-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Previous neuroimaging studies have revealed cognitive dysfunction in patients with systemic lupus erythematosus (SLE) and suggested that it may be related to disrupted brain white matter (WM) connectivity. However, no study has examined the topological properties of brain WM structural networks in SLE patients, especially in patients with non-neuropsychiatric SLE (non-NPSLE). In this study, we acquired DTI datasets from 28 non-NPSLE patients and 24 healthy controls, constructed their brain WM structural networks by using a deterministic fiber tracking approach, estimated the topological parameters of their structural networks, and compared their group differences. We reached the following results: 1) At the global level, the non-NPSLE patients showed significantly increased characteristic path length, normalized clustering coefficient and small-worldness, but significantly decreased global efficiency and local efficiency compared to the controls; 2) At the nodal level, the non-NPSLE patients had significantly decreased nodal efficiency in regions related to movement control, executive control, and working memory (bilateral precentral gyri, bilateral middle frontal gyri, bilateral inferior parietal lobes, left median cingulate gyrus and paracingulate gyrus, and right middle temporal gyrus). In addition, to pinpointing the injured WM fiber tracts in the non-NPSLE patients, we reconstructed the major brain WM pathways connecting the abnormal regions at the nodal level with the corticospinal tract (CST), superior longitudinal fasciculus-parietal terminations (SLFP), and superior longitudinal fasciculus-temporal terminations (SLFT). By analyzing the diffusion parameters along these WM fiber pathways, we detected abnormal diffusion parameters in the bilateral CST and right SLFT in the non-NPSLE patients. These results seem to indicate that injured brain WM connectivity exists in SLE patients even in the absence of neuropsychiatric symptoms.
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22
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Wiseman SJ, Bastin ME, Amft EN, Belch JFF, Ralston SH, Wardlaw JM. Cognitive function, disease burden and the structural connectome in systemic lupus erythematosus. Lupus 2018; 27:1329-1337. [PMID: 29722629 DOI: 10.1177/0961203318772666] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective To investigate brain structural connectivity in relation to cognitive abilities and systemic damage in systemic lupus erythematosus (SLE). Methods Structural and diffusion MRI data were acquired from 47 patients with SLE. Brains were segmented into 85 cortical and subcortical regions and combined with whole brain tractography to generate structural connectomes using graph theory. Global cognitive abilities were assessed using a composite variable g, derived from the first principal component of three common clinical screening tests of neurological function. SLE damage ( LD) was measured using a composite of a validated SLE damage score and disease duration. Relationships between network connectivity metrics, cognitive ability and systemic damage were investigated. Hub nodes were identified. Multiple linear regression, adjusting for covariates, was employed to model the outcomes g and LD as a function of network metrics. Results The network measures of density (standardised ß = 0.266, p = 0.025) and strength (standardised ß = 0.317, p = 0.022) were independently related to cognitive abilities. Strength (standardised ß = -0.330, p = 0.048), mean shortest path length (standardised ß = 0.401, p = 0.020), global efficiency (standardised ß = -0.355, p = 0.041) and clustering coefficient (standardised ß = -0.378, p = 0.030) were independently related to systemic damage. Network metrics were not related to current disease activity. Conclusion Better cognitive abilities and more SLE damage are related to brain topological network properties in this sample of SLE patients, even those without neuropsychiatric involvement and after correcting for important covariates. These data show that connectomics might be useful for understanding and monitoring cognitive function and white matter damage in SLE.
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Affiliation(s)
- S J Wiseman
- 1 Centre for Clinical Brain Sciences, University of Edinburgh, UK
| | - M E Bastin
- 1 Centre for Clinical Brain Sciences, University of Edinburgh, UK
| | - E N Amft
- 2 Department of Rheumatology, Western General Hospital, Edinburgh, UK
| | - J F F Belch
- 3 Division of Cardiovascular and Diabetes Medicine, University of Dundee, UK
| | - S H Ralston
- 4 Centre for Genomic and Experimental Medicine, University of Edinburgh, UK
| | - J M Wardlaw
- 1 Centre for Clinical Brain Sciences, University of Edinburgh, UK
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23
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Nystedt J, Mannfolk P, Jönsen A, Bengtsson A, Nilsson P, Sundgren PC, Strandberg TO. Functional Connectivity Changes in Systemic Lupus Erythematosus: A Resting-State Study. Brain Connect 2018; 8:220-234. [DOI: 10.1089/brain.2017.0557] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Jessika Nystedt
- Department of Clinical Sciences, Lund/Diagnostic Radiology, Lund University, Lund, Sweden
- Department of Clinical Sciences, Malmö/Neurology Malmö, Lund University, Malmö, Sweden
| | - Peter Mannfolk
- Clinical Imaging and Physiology, Skåne University Hospital, Lund, Sweden
| | - Andreas Jönsen
- Department of Clinical Sciences, Lund/Rheumatology, Lund University, Lund, Sweden
| | - Anders Bengtsson
- Department of Clinical Sciences, Lund/Rheumatology, Lund University, Lund, Sweden
| | - Petra Nilsson
- Department of Clinical Sciences, Lund/Neurology, Lund University, Lund, Sweden
| | - Pia C. Sundgren
- Department of Clinical Sciences, Lund/Diagnostic Radiology, Lund University, Lund, Sweden
- Department of Clinical Sciences/Centre for Imaging and Function, Skåne University Hospital, Lund, Sweden
| | - Tor O. Strandberg
- Department of Clinical Sciences, Lund/Memory Research Unit, Lund University, Lund, Sweden
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Wu BB, Ma Y, Xie L, Huang JZ, Sun ZB, Hou ZD, Guo RW, Lin ZR, Duan SX, Zhao SS, Yao-Xie, Sun DM, Zhu CM, Ma SH. Impaired decision-making and functional neuronal network activity in systemic lupus erythematosus. J Magn Reson Imaging 2018. [PMID: 29537670 PMCID: PMC6282848 DOI: 10.1002/jmri.26006] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Background Systemic lupus erythematosus (SLE) is associated with cognitive deficit but the exact neural mechanisms remain unclear. Purpose To explore sequential brain activities using functional magnetic resonance imaging (fMRI) during the performance of a decision‐making task, and to determine whether serum or clinical markers can reflect the involvement of the brain in SLE. Subjects Sixteen female SLE patients without overt clinical neuropsychiatric symptoms and 16 healthy controls were included. Field Strength/Sequence 1.5T, T1‐weighted anatomic images, gradient‐echo echo‐planar imaging sequence, and 3D images. Assessment The computer‐based Iowa Gambling Task (IGT) for assessing decision‐making was performed by SLE patients and 16 matched controls; brain activity was recorded via blood oxygen level‐dependent (BOLD) fMRI. The amplitudes of the average BOLD responses were calculated for each individual subject, and activation data from fMRI experiments were compared between the two groups. Statistical Tests Two‐sample t‐test; repeated‐measures analysis of variance (ANOVA); linear regression analyses. Results Imaging revealed activity in a distributed network of brain regions in both groups, including the ventromedial prefrontal cortex (vmPFC), the orbitofrontal cortex (OFC), the dorsolateral prefrontal cortex (dlPFC), the anterior cingulate cortex (ACC), the posterior cingulate cortex (PCC), and the striatum, as well as the insular, parietal, and occipital cortices. Compared to controls, SLE patients showed lower activation in a convergence zone and the limbic system, namely, the OFC, vmPFC, ACC, and PCC, but greater activation in memory, emotion, and behavior systems involving the dlPFC, the insular cortex and the striatum. Furthermore, brain activation in the vmPFC was positively correlated with IGT scores (r = 0.63, P < 0.001), but inversely related to disease activity (r = −0.57, P < 0.01). Data Conclusion The dynamics among the aforementioned neural systems (some hyperfunctioning, others hypofunctioning) may shed some light on the pathologic mechanisms underlying SLE without overt clinical neuropsychiatric symptoms. In addition, disease activity may potentially be used as an effective biomarker reflecting cerebral involvement in SLE. Level of Evidence: 1 Technical Efficacy: Stage 3 J. Magn. Reson. Imaging 2018;48:1508–1517
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Affiliation(s)
- Bei-Bei Wu
- First Affiliated Hospital of Shantou University Medical College, Shantou, China.,Guang dong Key Laboratory of Medical Molecular Imaging, Shantou, China
| | - Ye Ma
- Department of Linguistics & Languages, Michigan State University, East Lansing, Michigan, USA
| | - Lei Xie
- First Affiliated Hospital of Shantou University Medical College, Shantou, China.,Guang dong Key Laboratory of Medical Molecular Imaging, Shantou, China
| | - Jin-Zhuang Huang
- First Affiliated Hospital of Shantou University Medical College, Shantou, China.,Guang dong Key Laboratory of Medical Molecular Imaging, Shantou, China
| | - Zong-Bo Sun
- First Affiliated Hospital of Shantou University Medical College, Shantou, China.,Guang dong Key Laboratory of Medical Molecular Imaging, Shantou, China
| | - Zhi-Duo Hou
- First Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Rui-Wei Guo
- First Affiliated Hospital of Shantou University Medical College, Shantou, China.,Guang dong Key Laboratory of Medical Molecular Imaging, Shantou, China
| | - Zhi-Rong Lin
- First Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Shou-Xing Duan
- First Affiliated Hospital of Shantou University Medical College, Shantou, China.,Guang dong Key Laboratory of Medical Molecular Imaging, Shantou, China
| | - Shan-Shan Zhao
- First Affiliated Hospital of Shantou University Medical College, Shantou, China.,Guang dong Key Laboratory of Medical Molecular Imaging, Shantou, China
| | - Yao-Xie
- First Affiliated Hospital of Shantou University Medical College, Shantou, China.,Guang dong Key Laboratory of Medical Molecular Imaging, Shantou, China
| | - Dan-Miao Sun
- First Affiliated Hospital of Shantou University Medical College, Shantou, China.,Guang dong Key Laboratory of Medical Molecular Imaging, Shantou, China
| | - Chun-Min Zhu
- First Affiliated Hospital of Shantou University Medical College, Shantou, China.,Guang dong Key Laboratory of Medical Molecular Imaging, Shantou, China
| | - Shu-Hua Ma
- First Affiliated Hospital of Shantou University Medical College, Shantou, China.,Guang dong Key Laboratory of Medical Molecular Imaging, Shantou, China
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25
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Gheita TA, Abaza NM, Hammam N, Mohamed AAA, El-Gazzar II, Eissa AH. Anti-dsDNA titre in female systemic lupus erythematosus patients: relation to disease manifestations, damage and antiphospholipid antibodies. Lupus 2018; 27:1081-1087. [PMID: 29460701 DOI: 10.1177/0961203318760209] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Background Attempts are ongoing to unveil unresolved queries about anti-double-stranded deoxyribonucleic acid (anti-dsDNA), their precise pathogenic effects and to what extent blocking them would be a useful therapeutic goal. Objectives The aim of the present study was to determine the anti-dsDNA antibodies titre in systemic lupus erythematosus (SLE) patients and investigate their relation to the disease characteristics, activity, damage and antiphospholipid autoantibodies (aPL). Methods Seventy female SLE patients and 35 age- and sex-matched controls were included. The anti-dsDNA level and aPL were measured. Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) and Systemic Lupus International Collaborative Clinics/American College of Rheumatology Damage Index (SLICC/ACR-DI) were assessed. Results The mean age of the patients was 27.5 ± 5.1 years, disease duration 7.7 ± 5.4 years, and SLEDAI and SLICC/ACR-DI scores were 6.8 ± 8.04 and 1.2 ± 1.3, respectively. Anti-dsDNA was positive in 61.4% of the patients and the titre (133.2 ± 100.5 IU/ml) was significantly higher compared to controls (22.03 ± 17.2 IU/ml) ( p < 0.0001). The anti-dsDNA level was significantly increased in those with musculoskeletal manifestations ( p = 0.007) and positive anti-β2 glycoprotein (anti-β2GP) ( p = 0.037) and decreased in those with neuropsychiatric manifestations ( p = 0.004) and those receiving cyclophosphamide (CYC) ( p = 0.013). The anti-dsDNA level tended to be higher in active patients. The anti-dsDNA titre significantly correlated with the erythrocyte sedimentation rate ( p = 0.001), anticardiolipin IgG and IgA antibodies ( p = 0.008) and anti-β2GP IgG ( p = 0.03) and IgA ( p = 0.002) and inversely with the total leucocytic count ( p < 0.0001) and SLICC/ACR-DI ( p = 0.001). Conclusion Anti-dsDNA is remarkably increased in SLE patients especially those with musculoskeletal manifestations and aPL. A protective role seems likely in those with neuropsychiatric manifestations and those receiving CYC and may form a shield against disease tissue damage.
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Affiliation(s)
- T A Gheita
- 1 Rheumatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - N M Abaza
- 2 Physical Medicine, Rheumatology and Rehabilitation Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - N Hammam
- 3 Rheumatology and Rehabilitation Department, Faculty of Medicine, Assuit University, Assiut, Egypt.,4 Faculty of Rehabilitation, University of Alberta, Edmonton, Alberta, Canada
| | - A A A Mohamed
- 3 Rheumatology and Rehabilitation Department, Faculty of Medicine, Assuit University, Assiut, Egypt
| | - I I El-Gazzar
- 1 Rheumatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - A H Eissa
- 5 Clinical Pathology (Immunology) Department, Faculty of Medicine, Cairo University, Cairo, Egypt
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26
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Liu S, Cheng Y, Xie Z, Lai A, Lv Z, Zhao Y, Xu X, Luo C, Yu H, Shan B, Xu L, Xu J. A Conscious Resting State fMRI Study in SLE Patients Without Major Neuropsychiatric Manifestations. Front Psychiatry 2018; 9:677. [PMID: 30581397 PMCID: PMC6292957 DOI: 10.3389/fpsyt.2018.00677] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 11/23/2018] [Indexed: 02/02/2023] Open
Abstract
Neuropsychiatric systemic lupus erythematosus (NPSLE) is one of the main causes of death in patients with systemic lupus erythematosus (SLE). Signs and symptoms of NPSLE are heterogeneous, and it is hard to diagnose, and treat NPSLE patients in the early stage. We conducted this study to explore the possible brain activity changes using resting state functional magnetic resonance imaging (rs-fMRI) in SLE patients without major neuropsychiatric manifestations (non-NPSLE patients). We also tried to investigate the possible associations among brain activity, disease activity, depression, and anxiety. In our study, 118 non-NPSLE patients and 81 healthy controls (HC) were recruited. Rs-fMRI data were used to calculate the regional homogeneity (ReHo) in all participants. We found decreased ReHo values in the fusiform gyrus and thalamus and increased ReHo values in the parahippocampal gyrus and uncus. The disease activity was positively correlated with ReHo values of the cerebellum and negatively correlated with values in the frontal gyrus. Several brain areas showed correlations with depressive and anxiety statuses. These results suggested that abnormal brain activities might occur before NPSLE and might be the foundation of anxiety and depression symptoms. Early detection and proper treatment of brain dysfunction might prevent the progression to NPSLE. More studies are needed to understand the complicated underlying mechanisms.
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Affiliation(s)
- Shuang Liu
- Department of Rheumatology and Immunology, First Affiliated Hospital of Kunming Medical University, Kunming, China.,Yunnan Key Laboratory of Laboratory Medicine, Kunming, China
| | - Yuqi Cheng
- Yunnan Key Laboratory of Laboratory Medicine, Kunming, China.,Department of Psychiatry, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Zhongqi Xie
- Department of Rheumatology and Immunology, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Aiyun Lai
- Department of Rheumatology and Immunology, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Zhaoping Lv
- Department of Rheumatology and Immunology, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Yueyin Zhao
- Department of Rheumatology and Immunology, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Xiufeng Xu
- Department of Psychiatry, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Chunrong Luo
- Magnetic Resonance Imaging Center, The First Hospital of Kunming, Kunming, China
| | - Hongjun Yu
- Magnetic Resonance Imaging Center, The First Hospital of Kunming, Kunming, China
| | - Baoci Shan
- Key Laboratory of Nuclear Analysis, Institute of High Energy Physics, Chinese Academy of Sciences, Beijing, China
| | - Lin Xu
- Key Laboratory of Animal Models and Human Disease Mechanisms, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming, China
| | - Jian Xu
- Department of Rheumatology and Immunology, First Affiliated Hospital of Kunming Medical University, Kunming, China.,Yunnan Key Laboratory of Laboratory Medicine, Kunming, China
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27
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Clark KEN, Clark CN, Rahman A. A critical analysis of the tools to evaluate neuropsychiatric lupus. Lupus 2017; 26:504-509. [PMID: 28394235 DOI: 10.1177/0961203317690242] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Neuropsychiatric symptoms occur commonly in patients with systemic lupus erythematosus, but they are not always due to active disease. It is crucial to identify cases that are due to active systemic lupus erythematosus so that appropriate treatment can be instituted. There is no single serological or imaging test that distinguishes active neuropsychiatric systemic lupus erythematosus from neuropsychiatric manifestations caused by other factors such as infection. Most patients with neuropsychiatric systemic lupus erythematosus have generalised features of disease activity. Raised anti-dsDNA and low C3 complement levels are often seen, but are not an invariable guide. The presence of antiphospholipid antibodies is more suggestive of thrombotic than inflammatory causation. A number of other autoantibody tests have been proposed as biomarkers for neuropsychiatric systemic lupus erythematosus, but results in clinical studies have been inconsistent and none has so far entered routine clinical practice. Cerebrospinal fluid features and magnetic resonance imaging appearances are non-specific in neuropsychiatric systemic lupus erythematosus, but are useful in excluding other causes of neuropsychiatric symptoms. Newer magnetic resonance imaging sequences show promise for distinguishing new neuropsychiatric systemic lupus erythematosus activity from previous damage and recent research suggests these may correlate with changes in cognitive function in patients with systemic lupus erythematosus. However, formal cognitive testing is seldom carried out in the acute setting.
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Affiliation(s)
- K E N Clark
- 1 Centre for Rheumatology, Division of Medicine, University College London, London, UK
| | | | - A Rahman
- 1 Centre for Rheumatology, Division of Medicine, University College London, London, UK
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28
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Zhu CM, Ma Y, Xie L, Huang JZ, Sun ZB, Duan SX, Lin ZR, Yin JJ, Le HB, Sun DM, Xu WC, Ma SH. Spatial Working Memory Impairment in Patients with Non-neuropsychiatric Systemic Lupus Erythematosus: A Blood-oxygen-level Dependent Functional Magnetic Resonance Imaging Study. J Rheumatol 2017; 44:201-208. [PMID: 28089970 DOI: 10.3899/jrheum.160290] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/25/2016] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Using ethology and functional magnetic resonance imaging (fMRI) to explore mild cognitive dysfunction and spatial working memory (WM) impairment in patients with systemic lupus erythematosus (SLE) without overt neuropsychiatric symptoms (non-NPSLE) and to study whether any clinical biomarkers could serve as predictors of brain dysfunction in this disease. METHODS Eighteen non-NPSLE patients and 18 matched subjects were all tested using the Montreal cognitive assessment scale test and scanned using blood-oxygen-level dependent fMRI while performing the n-back task to investigate the activation intensity of some cognition-related areas. RESULTS Ethology results showed that non-NPSLE patients had mild cognitive dysfunction and memory dysfunction (p < 0.05). The fMRI scan confirmed a neural network consisting of bilateral dorsolateral prefrontal cortex (DLPFC), premotor area, parietal lobe, and supplementary motor area (SMA)/anterior cingulate cortex (ACC) that was activated during the n-back task, with right hemisphere dominance. However, only the right SMA/ACC showed a load effect in the non-NPSLE group; the activation intensity of most WM-related brain areas for the non-NPSLE group was lower than for the control group under 3 memory loads. Further, we found that the activation intensity of some cognition-related areas, including the bilateral caudate nucleus/insula and hippocampus/parahippocampal gyrus were lower than the control group under the memory loads. An inverse correlation existed between individual activation intensity and disease duration. CONCLUSION Non-NPSLE-related brain damage with right DLPFC-posterior parietal lobe and parahippocampal gyrus default network causes impairment of spatial WM and mild cognitive dysfunction. Patients with longer disease duration would be expected to exhibit increased central nervous system damage.
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Affiliation(s)
- Chun-Min Zhu
- From the Department of Radiology, First Affiliated Hospital, Medical College of Shantou University; Guangdong Key Laboratory of Medical Molecular Imaging, Shantou, Guangdong; Graduate School of Beijing Normal University, Zhuhai, China.,C.M. Zhu, MD, Department of Radiology, First Affiliated Hospital, Medical College of Shantou University, and Guangdong Key Laboratory of Medical Molecular Imaging; L. Xie, MD, Department of Radiology, First Affiliated Hospital, Medical College of Shantou University, and Guangdong Key Laboratory of Medical Molecular Imaging; J.Z. Huang, MD, Department of Radiology, First Affiliated Hospital, Medical College of Shantou University, and Guangdong Key Laboratory of Medical Molecular Imaging, and Department of Radiology, Chaonan Minsheng Hospital of Shantou; Z.B. Sun, MD, Department of Radiology, First Affiliated Hospital, Medical College of Shantou University, and Guangdong Key Laboratory of Medical Molecular Imaging, and Department of Radiology, Chaonan Minsheng Hospital of Shantou; S.X. Duan, MD, Department of Radiology, First Affiliated Hospital, Medical College of Shantou University, and Guangdong Key Laboratory of Medical Molecular Imaging; Z.R. Lin, MD, Department of Radiology, First Affiliated Hospital, Medical College of Shantou University, and Guangdong Key Laboratory of Medical Molecular Imaging; J.J. Yin, MD, Department of Radiology, First Affiliated Hospital, Medical College of Shantou University, and Guangdong Key Laboratory of Medical Molecular Imaging; H.B. Le, MD, Department of Radiology, First Affiliated Hospital, Medical College of Shantou University, and Guangdong Key Laboratory of Medical Molecular Imaging; D.M. Sun, MD, Department of Radiology, First Affiliated Hospital, Medical College of Shantou University, and Guangdong Key Laboratory of Medical Molecular Imaging; S.H. Ma, PhD, Professor, Department of Radiology, First Affiliated Hospital, Medical College of Shantou University, and Guangdong Key Laboratory of Medical Molecular Imaging, and Chaonan Minsheng Hospital of Shantou; Y. Ma, MD, Graduate School of Beijing Normal University; W.C. Xu, PhD, Department of Radiology, First Affiliated Hospital, Medical College of Shantou University
| | - Ye Ma
- From the Department of Radiology, First Affiliated Hospital, Medical College of Shantou University; Guangdong Key Laboratory of Medical Molecular Imaging, Shantou, Guangdong; Graduate School of Beijing Normal University, Zhuhai, China.,C.M. Zhu, MD, Department of Radiology, First Affiliated Hospital, Medical College of Shantou University, and Guangdong Key Laboratory of Medical Molecular Imaging; L. Xie, MD, Department of Radiology, First Affiliated Hospital, Medical College of Shantou University, and Guangdong Key Laboratory of Medical Molecular Imaging; J.Z. Huang, MD, Department of Radiology, First Affiliated Hospital, Medical College of Shantou University, and Guangdong Key Laboratory of Medical Molecular Imaging, and Department of Radiology, Chaonan Minsheng Hospital of Shantou; Z.B. Sun, MD, Department of Radiology, First Affiliated Hospital, Medical College of Shantou University, and Guangdong Key Laboratory of Medical Molecular Imaging, and Department of Radiology, Chaonan Minsheng Hospital of Shantou; S.X. Duan, MD, Department of Radiology, First Affiliated Hospital, Medical College of Shantou University, and Guangdong Key Laboratory of Medical Molecular Imaging; Z.R. Lin, MD, Department of Radiology, First Affiliated Hospital, Medical College of Shantou University, and Guangdong Key Laboratory of Medical Molecular Imaging; J.J. Yin, MD, Department of Radiology, First Affiliated Hospital, Medical College of Shantou University, and Guangdong Key Laboratory of Medical Molecular Imaging; H.B. Le, MD, Department of Radiology, First Affiliated Hospital, Medical College of Shantou University, and Guangdong Key Laboratory of Medical Molecular Imaging; D.M. Sun, MD, Department of Radiology, First Affiliated Hospital, Medical College of Shantou University, and Guangdong Key Laboratory of Medical Molecular Imaging; S.H. Ma, PhD, Professor, Department of Radiology, First Affiliated Hospital, Medical College of Shantou University, and Guangdong Key Laboratory of Medical Molecular Imaging, and Chaonan Minsheng Hospital of Shantou; Y. Ma, MD, Graduate School of Beijing Normal University; W.C. Xu, PhD, Department of Radiology, First Affiliated Hospital, Medical College of Shantou University
| | - Lei Xie
- From the Department of Radiology, First Affiliated Hospital, Medical College of Shantou University; Guangdong Key Laboratory of Medical Molecular Imaging, Shantou, Guangdong; Graduate School of Beijing Normal University, Zhuhai, China.,C.M. Zhu, MD, Department of Radiology, First Affiliated Hospital, Medical College of Shantou University, and Guangdong Key Laboratory of Medical Molecular Imaging; L. Xie, MD, Department of Radiology, First Affiliated Hospital, Medical College of Shantou University, and Guangdong Key Laboratory of Medical Molecular Imaging; J.Z. Huang, MD, Department of Radiology, First Affiliated Hospital, Medical College of Shantou University, and Guangdong Key Laboratory of Medical Molecular Imaging, and Department of Radiology, Chaonan Minsheng Hospital of Shantou; Z.B. Sun, MD, Department of Radiology, First Affiliated Hospital, Medical College of Shantou University, and Guangdong Key Laboratory of Medical Molecular Imaging, and Department of Radiology, Chaonan Minsheng Hospital of Shantou; S.X. Duan, MD, Department of Radiology, First Affiliated Hospital, Medical College of Shantou University, and Guangdong Key Laboratory of Medical Molecular Imaging; Z.R. Lin, MD, Department of Radiology, First Affiliated Hospital, Medical College of Shantou University, and Guangdong Key Laboratory of Medical Molecular Imaging; J.J. Yin, MD, Department of Radiology, First Affiliated Hospital, Medical College of Shantou University, and Guangdong Key Laboratory of Medical Molecular Imaging; H.B. Le, MD, Department of Radiology, First Affiliated Hospital, Medical College of Shantou University, and Guangdong Key Laboratory of Medical Molecular Imaging; D.M. Sun, MD, Department of Radiology, First Affiliated Hospital, Medical College of Shantou University, and Guangdong Key Laboratory of Medical Molecular Imaging; S.H. Ma, PhD, Professor, Department of Radiology, First Affiliated Hospital, Medical College of Shantou University, and Guangdong Key Laboratory of Medical Molecular Imaging, and Chaonan Minsheng Hospital of Shantou; Y. Ma, MD, Graduate School of Beijing Normal University; W.C. Xu, PhD, Department of Radiology, First Affiliated Hospital, Medical College of Shantou University
| | - Jin-Zhuang Huang
- From the Department of Radiology, First Affiliated Hospital, Medical College of Shantou University; Guangdong Key Laboratory of Medical Molecular Imaging, Shantou, Guangdong; Graduate School of Beijing Normal University, Zhuhai, China.,C.M. Zhu, MD, Department of Radiology, First Affiliated Hospital, Medical College of Shantou University, and Guangdong Key Laboratory of Medical Molecular Imaging; L. Xie, MD, Department of Radiology, First Affiliated Hospital, Medical College of Shantou University, and Guangdong Key Laboratory of Medical Molecular Imaging; J.Z. Huang, MD, Department of Radiology, First Affiliated Hospital, Medical College of Shantou University, and Guangdong Key Laboratory of Medical Molecular Imaging, and Department of Radiology, Chaonan Minsheng Hospital of Shantou; Z.B. Sun, MD, Department of Radiology, First Affiliated Hospital, Medical College of Shantou University, and Guangdong Key Laboratory of Medical Molecular Imaging, and Department of Radiology, Chaonan Minsheng Hospital of Shantou; S.X. Duan, MD, Department of Radiology, First Affiliated Hospital, Medical College of Shantou University, and Guangdong Key Laboratory of Medical Molecular Imaging; Z.R. Lin, MD, Department of Radiology, First Affiliated Hospital, Medical College of Shantou University, and Guangdong Key Laboratory of Medical Molecular Imaging; J.J. Yin, MD, Department of Radiology, First Affiliated Hospital, Medical College of Shantou University, and Guangdong Key Laboratory of Medical Molecular Imaging; H.B. Le, MD, Department of Radiology, First Affiliated Hospital, Medical College of Shantou University, and Guangdong Key Laboratory of Medical Molecular Imaging; D.M. Sun, MD, Department of Radiology, First Affiliated Hospital, Medical College of Shantou University, and Guangdong Key Laboratory of Medical Molecular Imaging; S.H. Ma, PhD, Professor, Department of Radiology, First Affiliated Hospital, Medical College of Shantou University, and Guangdong Key Laboratory of Medical Molecular Imaging, and Chaonan Minsheng Hospital of Shantou; Y. Ma, MD, Graduate School of Beijing Normal University; W.C. Xu, PhD, Department of Radiology, First Affiliated Hospital, Medical College of Shantou University
| | - Zong-Bo Sun
- From the Department of Radiology, First Affiliated Hospital, Medical College of Shantou University; Guangdong Key Laboratory of Medical Molecular Imaging, Shantou, Guangdong; Graduate School of Beijing Normal University, Zhuhai, China.,C.M. Zhu, MD, Department of Radiology, First Affiliated Hospital, Medical College of Shantou University, and Guangdong Key Laboratory of Medical Molecular Imaging; L. Xie, MD, Department of Radiology, First Affiliated Hospital, Medical College of Shantou University, and Guangdong Key Laboratory of Medical Molecular Imaging; J.Z. Huang, MD, Department of Radiology, First Affiliated Hospital, Medical College of Shantou University, and Guangdong Key Laboratory of Medical Molecular Imaging, and Department of Radiology, Chaonan Minsheng Hospital of Shantou; Z.B. Sun, MD, Department of Radiology, First Affiliated Hospital, Medical College of Shantou University, and Guangdong Key Laboratory of Medical Molecular Imaging, and Department of Radiology, Chaonan Minsheng Hospital of Shantou; S.X. Duan, MD, Department of Radiology, First Affiliated Hospital, Medical College of Shantou University, and Guangdong Key Laboratory of Medical Molecular Imaging; Z.R. Lin, MD, Department of Radiology, First Affiliated Hospital, Medical College of Shantou University, and Guangdong Key Laboratory of Medical Molecular Imaging; J.J. Yin, MD, Department of Radiology, First Affiliated Hospital, Medical College of Shantou University, and Guangdong Key Laboratory of Medical Molecular Imaging; H.B. Le, MD, Department of Radiology, First Affiliated Hospital, Medical College of Shantou University, and Guangdong Key Laboratory of Medical Molecular Imaging; D.M. Sun, MD, Department of Radiology, First Affiliated Hospital, Medical College of Shantou University, and Guangdong Key Laboratory of Medical Molecular Imaging; S.H. Ma, PhD, Professor, Department of Radiology, First Affiliated Hospital, Medical College of Shantou University, and Guangdong Key Laboratory of Medical Molecular Imaging, and Chaonan Minsheng Hospital of Shantou; Y. Ma, MD, Graduate School of Beijing Normal University; W.C. Xu, PhD, Department of Radiology, First Affiliated Hospital, Medical College of Shantou University
| | - Shou-Xing Duan
- From the Department of Radiology, First Affiliated Hospital, Medical College of Shantou University; Guangdong Key Laboratory of Medical Molecular Imaging, Shantou, Guangdong; Graduate School of Beijing Normal University, Zhuhai, China.,C.M. Zhu, MD, Department of Radiology, First Affiliated Hospital, Medical College of Shantou University, and Guangdong Key Laboratory of Medical Molecular Imaging; L. Xie, MD, Department of Radiology, First Affiliated Hospital, Medical College of Shantou University, and Guangdong Key Laboratory of Medical Molecular Imaging; J.Z. Huang, MD, Department of Radiology, First Affiliated Hospital, Medical College of Shantou University, and Guangdong Key Laboratory of Medical Molecular Imaging, and Department of Radiology, Chaonan Minsheng Hospital of Shantou; Z.B. Sun, MD, Department of Radiology, First Affiliated Hospital, Medical College of Shantou University, and Guangdong Key Laboratory of Medical Molecular Imaging, and Department of Radiology, Chaonan Minsheng Hospital of Shantou; S.X. Duan, MD, Department of Radiology, First Affiliated Hospital, Medical College of Shantou University, and Guangdong Key Laboratory of Medical Molecular Imaging; Z.R. Lin, MD, Department of Radiology, First Affiliated Hospital, Medical College of Shantou University, and Guangdong Key Laboratory of Medical Molecular Imaging; J.J. Yin, MD, Department of Radiology, First Affiliated Hospital, Medical College of Shantou University, and Guangdong Key Laboratory of Medical Molecular Imaging; H.B. Le, MD, Department of Radiology, First Affiliated Hospital, Medical College of Shantou University, and Guangdong Key Laboratory of Medical Molecular Imaging; D.M. Sun, MD, Department of Radiology, First Affiliated Hospital, Medical College of Shantou University, and Guangdong Key Laboratory of Medical Molecular Imaging; S.H. Ma, PhD, Professor, Department of Radiology, First Affiliated Hospital, Medical College of Shantou University, and Guangdong Key Laboratory of Medical Molecular Imaging, and Chaonan Minsheng Hospital of Shantou; Y. Ma, MD, Graduate School of Beijing Normal University; W.C. Xu, PhD, Department of Radiology, First Affiliated Hospital, Medical College of Shantou University
| | - Zhi-Rong Lin
- From the Department of Radiology, First Affiliated Hospital, Medical College of Shantou University; Guangdong Key Laboratory of Medical Molecular Imaging, Shantou, Guangdong; Graduate School of Beijing Normal University, Zhuhai, China.,C.M. Zhu, MD, Department of Radiology, First Affiliated Hospital, Medical College of Shantou University, and Guangdong Key Laboratory of Medical Molecular Imaging; L. Xie, MD, Department of Radiology, First Affiliated Hospital, Medical College of Shantou University, and Guangdong Key Laboratory of Medical Molecular Imaging; J.Z. Huang, MD, Department of Radiology, First Affiliated Hospital, Medical College of Shantou University, and Guangdong Key Laboratory of Medical Molecular Imaging, and Department of Radiology, Chaonan Minsheng Hospital of Shantou; Z.B. Sun, MD, Department of Radiology, First Affiliated Hospital, Medical College of Shantou University, and Guangdong Key Laboratory of Medical Molecular Imaging, and Department of Radiology, Chaonan Minsheng Hospital of Shantou; S.X. Duan, MD, Department of Radiology, First Affiliated Hospital, Medical College of Shantou University, and Guangdong Key Laboratory of Medical Molecular Imaging; Z.R. Lin, MD, Department of Radiology, First Affiliated Hospital, Medical College of Shantou University, and Guangdong Key Laboratory of Medical Molecular Imaging; J.J. Yin, MD, Department of Radiology, First Affiliated Hospital, Medical College of Shantou University, and Guangdong Key Laboratory of Medical Molecular Imaging; H.B. Le, MD, Department of Radiology, First Affiliated Hospital, Medical College of Shantou University, and Guangdong Key Laboratory of Medical Molecular Imaging; D.M. Sun, MD, Department of Radiology, First Affiliated Hospital, Medical College of Shantou University, and Guangdong Key Laboratory of Medical Molecular Imaging; S.H. Ma, PhD, Professor, Department of Radiology, First Affiliated Hospital, Medical College of Shantou University, and Guangdong Key Laboratory of Medical Molecular Imaging, and Chaonan Minsheng Hospital of Shantou; Y. Ma, MD, Graduate School of Beijing Normal University; W.C. Xu, PhD, Department of Radiology, First Affiliated Hospital, Medical College of Shantou University
| | - Jing-Jing Yin
- From the Department of Radiology, First Affiliated Hospital, Medical College of Shantou University; Guangdong Key Laboratory of Medical Molecular Imaging, Shantou, Guangdong; Graduate School of Beijing Normal University, Zhuhai, China.,C.M. Zhu, MD, Department of Radiology, First Affiliated Hospital, Medical College of Shantou University, and Guangdong Key Laboratory of Medical Molecular Imaging; L. Xie, MD, Department of Radiology, First Affiliated Hospital, Medical College of Shantou University, and Guangdong Key Laboratory of Medical Molecular Imaging; J.Z. Huang, MD, Department of Radiology, First Affiliated Hospital, Medical College of Shantou University, and Guangdong Key Laboratory of Medical Molecular Imaging, and Department of Radiology, Chaonan Minsheng Hospital of Shantou; Z.B. Sun, MD, Department of Radiology, First Affiliated Hospital, Medical College of Shantou University, and Guangdong Key Laboratory of Medical Molecular Imaging, and Department of Radiology, Chaonan Minsheng Hospital of Shantou; S.X. Duan, MD, Department of Radiology, First Affiliated Hospital, Medical College of Shantou University, and Guangdong Key Laboratory of Medical Molecular Imaging; Z.R. Lin, MD, Department of Radiology, First Affiliated Hospital, Medical College of Shantou University, and Guangdong Key Laboratory of Medical Molecular Imaging; J.J. Yin, MD, Department of Radiology, First Affiliated Hospital, Medical College of Shantou University, and Guangdong Key Laboratory of Medical Molecular Imaging; H.B. Le, MD, Department of Radiology, First Affiliated Hospital, Medical College of Shantou University, and Guangdong Key Laboratory of Medical Molecular Imaging; D.M. Sun, MD, Department of Radiology, First Affiliated Hospital, Medical College of Shantou University, and Guangdong Key Laboratory of Medical Molecular Imaging; S.H. Ma, PhD, Professor, Department of Radiology, First Affiliated Hospital, Medical College of Shantou University, and Guangdong Key Laboratory of Medical Molecular Imaging, and Chaonan Minsheng Hospital of Shantou; Y. Ma, MD, Graduate School of Beijing Normal University; W.C. Xu, PhD, Department of Radiology, First Affiliated Hospital, Medical College of Shantou University
| | - Hong-Bo Le
- From the Department of Radiology, First Affiliated Hospital, Medical College of Shantou University; Guangdong Key Laboratory of Medical Molecular Imaging, Shantou, Guangdong; Graduate School of Beijing Normal University, Zhuhai, China.,C.M. Zhu, MD, Department of Radiology, First Affiliated Hospital, Medical College of Shantou University, and Guangdong Key Laboratory of Medical Molecular Imaging; L. Xie, MD, Department of Radiology, First Affiliated Hospital, Medical College of Shantou University, and Guangdong Key Laboratory of Medical Molecular Imaging; J.Z. Huang, MD, Department of Radiology, First Affiliated Hospital, Medical College of Shantou University, and Guangdong Key Laboratory of Medical Molecular Imaging, and Department of Radiology, Chaonan Minsheng Hospital of Shantou; Z.B. Sun, MD, Department of Radiology, First Affiliated Hospital, Medical College of Shantou University, and Guangdong Key Laboratory of Medical Molecular Imaging, and Department of Radiology, Chaonan Minsheng Hospital of Shantou; S.X. Duan, MD, Department of Radiology, First Affiliated Hospital, Medical College of Shantou University, and Guangdong Key Laboratory of Medical Molecular Imaging; Z.R. Lin, MD, Department of Radiology, First Affiliated Hospital, Medical College of Shantou University, and Guangdong Key Laboratory of Medical Molecular Imaging; J.J. Yin, MD, Department of Radiology, First Affiliated Hospital, Medical College of Shantou University, and Guangdong Key Laboratory of Medical Molecular Imaging; H.B. Le, MD, Department of Radiology, First Affiliated Hospital, Medical College of Shantou University, and Guangdong Key Laboratory of Medical Molecular Imaging; D.M. Sun, MD, Department of Radiology, First Affiliated Hospital, Medical College of Shantou University, and Guangdong Key Laboratory of Medical Molecular Imaging; S.H. Ma, PhD, Professor, Department of Radiology, First Affiliated Hospital, Medical College of Shantou University, and Guangdong Key Laboratory of Medical Molecular Imaging, and Chaonan Minsheng Hospital of Shantou; Y. Ma, MD, Graduate School of Beijing Normal University; W.C. Xu, PhD, Department of Radiology, First Affiliated Hospital, Medical College of Shantou University
| | - Dan-Miao Sun
- From the Department of Radiology, First Affiliated Hospital, Medical College of Shantou University; Guangdong Key Laboratory of Medical Molecular Imaging, Shantou, Guangdong; Graduate School of Beijing Normal University, Zhuhai, China.,C.M. Zhu, MD, Department of Radiology, First Affiliated Hospital, Medical College of Shantou University, and Guangdong Key Laboratory of Medical Molecular Imaging; L. Xie, MD, Department of Radiology, First Affiliated Hospital, Medical College of Shantou University, and Guangdong Key Laboratory of Medical Molecular Imaging; J.Z. Huang, MD, Department of Radiology, First Affiliated Hospital, Medical College of Shantou University, and Guangdong Key Laboratory of Medical Molecular Imaging, and Department of Radiology, Chaonan Minsheng Hospital of Shantou; Z.B. Sun, MD, Department of Radiology, First Affiliated Hospital, Medical College of Shantou University, and Guangdong Key Laboratory of Medical Molecular Imaging, and Department of Radiology, Chaonan Minsheng Hospital of Shantou; S.X. Duan, MD, Department of Radiology, First Affiliated Hospital, Medical College of Shantou University, and Guangdong Key Laboratory of Medical Molecular Imaging; Z.R. Lin, MD, Department of Radiology, First Affiliated Hospital, Medical College of Shantou University, and Guangdong Key Laboratory of Medical Molecular Imaging; J.J. Yin, MD, Department of Radiology, First Affiliated Hospital, Medical College of Shantou University, and Guangdong Key Laboratory of Medical Molecular Imaging; H.B. Le, MD, Department of Radiology, First Affiliated Hospital, Medical College of Shantou University, and Guangdong Key Laboratory of Medical Molecular Imaging; D.M. Sun, MD, Department of Radiology, First Affiliated Hospital, Medical College of Shantou University, and Guangdong Key Laboratory of Medical Molecular Imaging; S.H. Ma, PhD, Professor, Department of Radiology, First Affiliated Hospital, Medical College of Shantou University, and Guangdong Key Laboratory of Medical Molecular Imaging, and Chaonan Minsheng Hospital of Shantou; Y. Ma, MD, Graduate School of Beijing Normal University; W.C. Xu, PhD, Department of Radiology, First Affiliated Hospital, Medical College of Shantou University
| | - Wen-Can Xu
- From the Department of Radiology, First Affiliated Hospital, Medical College of Shantou University; Guangdong Key Laboratory of Medical Molecular Imaging, Shantou, Guangdong; Graduate School of Beijing Normal University, Zhuhai, China.,C.M. Zhu, MD, Department of Radiology, First Affiliated Hospital, Medical College of Shantou University, and Guangdong Key Laboratory of Medical Molecular Imaging; L. Xie, MD, Department of Radiology, First Affiliated Hospital, Medical College of Shantou University, and Guangdong Key Laboratory of Medical Molecular Imaging; J.Z. Huang, MD, Department of Radiology, First Affiliated Hospital, Medical College of Shantou University, and Guangdong Key Laboratory of Medical Molecular Imaging, and Department of Radiology, Chaonan Minsheng Hospital of Shantou; Z.B. Sun, MD, Department of Radiology, First Affiliated Hospital, Medical College of Shantou University, and Guangdong Key Laboratory of Medical Molecular Imaging, and Department of Radiology, Chaonan Minsheng Hospital of Shantou; S.X. Duan, MD, Department of Radiology, First Affiliated Hospital, Medical College of Shantou University, and Guangdong Key Laboratory of Medical Molecular Imaging; Z.R. Lin, MD, Department of Radiology, First Affiliated Hospital, Medical College of Shantou University, and Guangdong Key Laboratory of Medical Molecular Imaging; J.J. Yin, MD, Department of Radiology, First Affiliated Hospital, Medical College of Shantou University, and Guangdong Key Laboratory of Medical Molecular Imaging; H.B. Le, MD, Department of Radiology, First Affiliated Hospital, Medical College of Shantou University, and Guangdong Key Laboratory of Medical Molecular Imaging; D.M. Sun, MD, Department of Radiology, First Affiliated Hospital, Medical College of Shantou University, and Guangdong Key Laboratory of Medical Molecular Imaging; S.H. Ma, PhD, Professor, Department of Radiology, First Affiliated Hospital, Medical College of Shantou University, and Guangdong Key Laboratory of Medical Molecular Imaging, and Chaonan Minsheng Hospital of Shantou; Y. Ma, MD, Graduate School of Beijing Normal University; W.C. Xu, PhD, Department of Radiology, First Affiliated Hospital, Medical College of Shantou University
| | - Shu-Hua Ma
- From the Department of Radiology, First Affiliated Hospital, Medical College of Shantou University; Guangdong Key Laboratory of Medical Molecular Imaging, Shantou, Guangdong; Graduate School of Beijing Normal University, Zhuhai, China. .,C.M. Zhu, MD, Department of Radiology, First Affiliated Hospital, Medical College of Shantou University, and Guangdong Key Laboratory of Medical Molecular Imaging; L. Xie, MD, Department of Radiology, First Affiliated Hospital, Medical College of Shantou University, and Guangdong Key Laboratory of Medical Molecular Imaging; J.Z. Huang, MD, Department of Radiology, First Affiliated Hospital, Medical College of Shantou University, and Guangdong Key Laboratory of Medical Molecular Imaging, and Department of Radiology, Chaonan Minsheng Hospital of Shantou; Z.B. Sun, MD, Department of Radiology, First Affiliated Hospital, Medical College of Shantou University, and Guangdong Key Laboratory of Medical Molecular Imaging, and Department of Radiology, Chaonan Minsheng Hospital of Shantou; S.X. Duan, MD, Department of Radiology, First Affiliated Hospital, Medical College of Shantou University, and Guangdong Key Laboratory of Medical Molecular Imaging; Z.R. Lin, MD, Department of Radiology, First Affiliated Hospital, Medical College of Shantou University, and Guangdong Key Laboratory of Medical Molecular Imaging; J.J. Yin, MD, Department of Radiology, First Affiliated Hospital, Medical College of Shantou University, and Guangdong Key Laboratory of Medical Molecular Imaging; H.B. Le, MD, Department of Radiology, First Affiliated Hospital, Medical College of Shantou University, and Guangdong Key Laboratory of Medical Molecular Imaging; D.M. Sun, MD, Department of Radiology, First Affiliated Hospital, Medical College of Shantou University, and Guangdong Key Laboratory of Medical Molecular Imaging; S.H. Ma, PhD, Professor, Department of Radiology, First Affiliated Hospital, Medical College of Shantou University, and Guangdong Key Laboratory of Medical Molecular Imaging, and Chaonan Minsheng Hospital of Shantou; Y. Ma, MD, Graduate School of Beijing Normal University; W.C. Xu, PhD, Department of Radiology, First Affiliated Hospital, Medical College of Shantou University.
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Xu M, Tan X, Zhang X, Guo Y, Mei Y, Feng Q, Xu Y, Feng Y. Alterations of white matter structural networks in patients with non-neuropsychiatric systemic lupus erythematosus identified by probabilistic tractography and connectivity-based analyses. Neuroimage Clin 2016; 13:349-360. [PMID: 28066709 PMCID: PMC5200918 DOI: 10.1016/j.nicl.2016.12.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Revised: 12/04/2016] [Accepted: 12/17/2016] [Indexed: 01/13/2023]
Abstract
PURPOSE Systemic lupus erythematosus (SLE) is a chronic inflammatory female-predominant autoimmune disease that can affect the central nervous system and exhibit neuropsychiatric symptoms. In SLE patients without neuropsychiatric symptoms (non-NPSLE), recent diffusion tensor imaging studies showed white matter abnormalities in their brains. The present study investigated the entire brain white matter structural connectivity in non-NPSLE patients by using probabilistic tractography and connectivity-based analyses. METHODS Whole-brain structural networks of 29 non-NPSLE patients and 29 healthy controls (HCs) were examined. The structural networks were constructed with interregional probabilistic connectivity. Graph theory analysis was performed to investigate the topological properties, and network-based statistic was employed to assess the alterations of the interregional connections among non-NPSLE patients and controls. RESULTS Compared with HCs, non-NPSLE patients demonstrated significantly decreased global and local network efficiencies and showed increased characteristic path length. This finding suggests that the global integration and local specialization were impaired. Moreover, the regional properties (nodal efficiency and degree) in the frontal, occipital, and cingulum regions of the non-NPSLE patients were significantly changed and negatively correlated with the disease activity index. The distribution pattern of the hubs measured by nodal degree was altered in the patient group. Finally, the non-NPSLE group exhibited decreased structural connectivity in the left median cingulate-centered component and increased connectivity in the left precuneus-centered component and right middle temporal lobe-centered component. CONCLUSION This study reveals an altered topological organization of white matter networks in non-NPSLE patients. Furthermore, this research provides new insights into the structural disruptions underlying the functional and neurocognitive deficits in non-NPSLE patients.
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Affiliation(s)
- Man Xu
- Guangdong Provincial Key Laboratory of Medical Image Processing, School of Biomedical Engineering, Southern Medical University, Guangzhou, China
| | - Xiangliang Tan
- Department of Medical Imaging Center, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Xinyuan Zhang
- Guangdong Provincial Key Laboratory of Medical Image Processing, School of Biomedical Engineering, Southern Medical University, Guangzhou, China
| | - Yihao Guo
- Guangdong Provincial Key Laboratory of Medical Image Processing, School of Biomedical Engineering, Southern Medical University, Guangzhou, China
| | - Yingjie Mei
- Guangdong Provincial Key Laboratory of Medical Image Processing, School of Biomedical Engineering, Southern Medical University, Guangzhou, China
- Philips Healthcare, Guangzhou, China
| | - Qianjin Feng
- Guangdong Provincial Key Laboratory of Medical Image Processing, School of Biomedical Engineering, Southern Medical University, Guangzhou, China
| | - Yikai Xu
- Department of Medical Imaging Center, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yanqiu Feng
- Guangdong Provincial Key Laboratory of Medical Image Processing, School of Biomedical Engineering, Southern Medical University, Guangzhou, China
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Zhang XD, Jiang XL, Cheng Z, Zhou Y, Xu Q, Zhang ZQ, Qi R, Luo S, Yun YS, Chen HJ, Kong X, Lu GM, Zhang LJ. Decreased Coupling Between Functional Connectivity Density and Amplitude of Low Frequency Fluctuation in Non-Neuropsychiatric Systemic Lupus Erythematosus: a Resting-Stage Functional MRI Study. Mol Neurobiol 2016; 54:5225-5235. [PMID: 27578013 DOI: 10.1007/s12035-016-0050-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Accepted: 08/09/2016] [Indexed: 12/16/2022]
Abstract
In this study, we seek to explore alterations of coupling between functional connectivity density (FCD) and amplitude of low frequency fluctuation (ALFF) in systemic lupus erythematosus patients without overt neuropsychiatric symptoms (non-NPSLE) by using resting-state functional MR imaging. This study was approved by the institutional ethical review board, and all participants signed written informed consent prior to the study. Twenty six non-NPSLE patients and 35 matched healthy controls underwent resting-state functional MR imaging. The correlation analysis between FCD and ALFF was conducted to assess the imaging coupling. Pearson correlation analysis was performed to correlate imaging variables to clinical and neuropsychological data in non-NPSLE patients. According to the consistent alteration of FCD and ALFF, region of interests were identified including the right inferior temporal gyrus, bilateral hippocampus-parahippocampus (H-PH), left posterior cingulate cortex, superior parietal gyrus, postcentral gyrus, and bilateral precuneus. Across-voxel correlation analysis showed decreased coupling strengths in some brain regions. Correlations between FCD, ALFF, and coupling strength in H-PH and C3/C4/MoCA were found. The imaging coupling between FCD and ALFF was decreased in non-NPSLE patients, indicating brain function alteration in non-NPSLE patients, especially the abnormal coupling between FCD and ALFF of the hippocampus-parahippocampus might be an imaging biomarker of brain dysfunction in non-NPSLE patients.
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Affiliation(s)
- Xiao Dong Zhang
- Department of Medical Imaging, Jinling Hospital, Nanjing Clinical School, Southern Medical University, Nanjing, Jiangsu Province, 210002, China.,Department of Radiology, Tianjin First Central Hospital, Clinical School of Tianjin Medical University, Tianjin, 300192, China.,Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, No. 305 Zhongshan East Road, Nanjing, Jiangsu Province, 210002, China
| | - Xiao Lu Jiang
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, No. 305 Zhongshan East Road, Nanjing, Jiangsu Province, 210002, China
| | - Zhen Cheng
- National Clinical Research Center of Kidney Disease, Jinling Hospital, Nanjing University School of Medicine, Nanjing, 210002, China
| | - Yan Zhou
- National Clinical Research Center of Kidney Disease, Jinling Hospital, Nanjing University School of Medicine, Nanjing, 210002, China
| | - Qiang Xu
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, No. 305 Zhongshan East Road, Nanjing, Jiangsu Province, 210002, China
| | - Zhi Qiang Zhang
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, No. 305 Zhongshan East Road, Nanjing, Jiangsu Province, 210002, China
| | - Rongfeng Qi
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, No. 305 Zhongshan East Road, Nanjing, Jiangsu Province, 210002, China
| | - Song Luo
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, No. 305 Zhongshan East Road, Nanjing, Jiangsu Province, 210002, China
| | - Yan Su Yun
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, No. 305 Zhongshan East Road, Nanjing, Jiangsu Province, 210002, China
| | - Hui Juan Chen
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, No. 305 Zhongshan East Road, Nanjing, Jiangsu Province, 210002, China
| | - Xiang Kong
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, No. 305 Zhongshan East Road, Nanjing, Jiangsu Province, 210002, China
| | - Guang Ming Lu
- Department of Medical Imaging, Jinling Hospital, Nanjing Clinical School, Southern Medical University, Nanjing, Jiangsu Province, 210002, China. .,Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, No. 305 Zhongshan East Road, Nanjing, Jiangsu Province, 210002, China.
| | - Long Jiang Zhang
- Department of Medical Imaging, Jinling Hospital, Nanjing Clinical School, Southern Medical University, Nanjing, Jiangsu Province, 210002, China. .,Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, No. 305 Zhongshan East Road, Nanjing, Jiangsu Province, 210002, China.
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Mak A, Tay SH. Connective tissue diseases: Functional MRI in SLE-the current state. Nat Rev Rheumatol 2015; 11:686-7. [PMID: 26481435 DOI: 10.1038/nrrheum.2015.143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Anselm Mak
- Division of Rheumatology, Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, Level 10, NUHS Tower Block, Singapore 119228, Singapore
| | - Sen Hee Tay
- Division of Rheumatology, Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, Level 10, NUHS Tower Block, Singapore 119228, Singapore
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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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Barraclough M, Elliott R, McKie S, Parker B, Bruce IN. Cognitive dysfunction and functional magnetic resonance imaging in systemic lupus erythematosus. Lupus 2015; 24:1239-47. [PMID: 26124237 DOI: 10.1177/0961203315593819] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Accepted: 05/05/2015] [Indexed: 01/04/2023]
Abstract
Cognitive dysfunction is a common aspect of systemic lupus erythematosus (SLE) and is increasingly reported as a problem by patients. In many cases the exact cause is unclear. Limited correlations between specific autoantibodies or structural brain abnormalities and cognitive dysfunction in SLE have been reported. It may be that the most appropriate biomarkers have yet to be found. Functional magnetic resonance imaging (fMRI) is a technique used in many other conditions and provides sensitive measures of brain functionality during cognitive tasks. It is now beginning to be employed in SLE studies. These studies have shown that patients with SLE often perform similarly to healthy controls in terms of behavioural measures on cognitive tasks. However, SLE patients appear to employ compensatory brain mechanisms, such as increased response in fronto-parietal regions, to maintain adequate cognitive performance. As there have been only a few studies using fMRI in SLE to investigate cognitive dysfunction, many questions remain unanswered. Further research could, however, help to identify biomarkers for cognitive dysfunction in SLE.
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Affiliation(s)
- M Barraclough
- Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Institute of Inflammation and Repair, Manchester Academic Health Science Centre, The University of Manchester, UK NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospital NHS Foundation Trust and Manchester Academic Health Science Centre, Manchester, UK
| | - R Elliott
- NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospital NHS Foundation Trust and Manchester Academic Health Science Centre, Manchester, UK Neuroscience and Psychiatry Unit, Institute of Brain and Behaviour and Mental Health, The University of Manchester, UK and Manchester Academic Health Science Centre
| | - S McKie
- NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospital NHS Foundation Trust and Manchester Academic Health Science Centre, Manchester, UK Neuroscience and Psychiatry Unit, Institute of Brain and Behaviour and Mental Health, The University of Manchester, UK and Manchester Academic Health Science Centre
| | - B Parker
- Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Institute of Inflammation and Repair, Manchester Academic Health Science Centre, The University of Manchester, UK NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospital NHS Foundation Trust and Manchester Academic Health Science Centre, Manchester, UK
| | - I N Bruce
- Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Institute of Inflammation and Repair, Manchester Academic Health Science Centre, The University of Manchester, UK NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospital NHS Foundation Trust and Manchester Academic Health Science Centre, Manchester, UK
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