Abstract
IntroductionSystemic lupus erythematosus (SLE) is characterized by frequent neuropsychiatric involvement, which includes cognitive impairment (CI). We aimed at assessing CI in a cohort of Italian SLE patients by using a wide range of neurocognitive tests specifically designed to evaluate the fronto-subcortical dysfunction. Furthermore, we aimed at testing whether CI in SLE is associated with serum autoantibodies, disease activity and chronic damage.MethodsFifty-eight consecutive patients were enrolled. Study protocol included data collection, evaluation of serum levels of ANA, anti-dsDNA, anti-cardiolipin, anti-β2-glycoprotein I, anti-P ribosomal, anti-endothelial cell, and anti-Nedd5 antibodies. SLEDAI-2000 and SLICC were used to assess disease activity and chronic damage. Patients were administered a test battery specifically designed to detect fronto-subcortical dysfunction across five domains: memory, attention, abstract reasoning, executive function and visuospatial function. For each patient, the raw scores from each test were compared with published norms, then transformed into Z scores (deviation from normal mean), and finally summed in the Global Cognitive Dysfunction score (GCDs).ResultsNineteen percent of patients had mild GCDs impairment (GCDs 2–3), 7% moderate (GCDs 4–5) and 5% severe (GCDs≥6). The visuospatial domain was the most compromised (MDZs = −0.89±1.23). Anti-cardiolipin IgM levels were associated with visuospatial domain impairment (r = 0.331, P = 0.005). SLEDAI correlated with GCDs, and attentional and executive domains; SLICC correlated with GCDs, and with visuospatial and attentional domains impairment.ConclusionsAnti-phospholipids, disease activity, and chronic damage are associated with cognitive dysfunction in SLE. The use of a wide spectrum of tests allowed for a better selection of the relevant factors involved in SLE cognitive dysfunction, and standardized neuropsychological testing methods should be used for routine assessment of SLE patients.
Highlights
Systemic lupus erythematosus (SLE) is characterized by frequent neuropsychiatric involvement, which includes cognitive impairment (CI)
In 1999, the American College of Rheumatology (ACR) proposed a standard nomenclature for Neuropsychiatric SLE (NPSLE) with case definitions for nineteen neuropsychiatric syndromes associated with SLE [1]
Optical density (OD) was measured at 405 nm wavelength and anti-endothelial-cell antibodies (AECAs) were expressed as a binding index (BI), equal to 1006(S-A)/(B-A), where S is the OD of the sample tested, A is the OD of a negative control, and B that of a positive reference serum
Summary
Systemic lupus erythematosus (SLE) is characterized by frequent neuropsychiatric involvement, which includes cognitive impairment (CI). We aimed at assessing CI in a cohort of Italian SLE patients by using a wide range of neurocognitive tests designed to evaluate the fronto-subcortical dysfunction. We aimed at testing whether CI in SLE is associated with serum autoantibodies, disease activity and chronic damage. Systemic lupus erythematosus (SLE) is an autoimmune disease characterized by frequent neuropsychiatric involvement that could be found up to 80% of patients [1,2,3,4,5,6,7]. Neuropsychiatric SLE (NPSLE) includes a wide range of neurological and psychiatric manifestations as well as cognitive impairment (CI). Advances in research methodologies and the introduction of neuropsychological methods have improved clinicians’ ability to identify CI in both pediatric and adult SLE patients [9]
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