Background/Purpose:  Higher stress is associated with lower cognitive functioning in many populations. We examined associations of perceived stress with cognitive symptoms among adults with systemic lupus erythematosus (SLE), a chronic, complex autoimmune disorder.

Methods:  We obtained cross-sectional data for 799 Atlanta-area SLE patients ≥18 years old on scores from the validated Perceived Stress Scale (PSS; range, 0-40 with higher scores=higher stress) and two self-reported cognitive symptoms: forgetfulness [severe/moderate vs. mild/none; from the Systemic Lupus Activity Questionnaire (SLAQ)] and difficulty concentrating (all/most vs. some/little/none of the time; from the Lupus Impact Tracker). We estimated mean PSS scores and percentages of patients with cognitive symptoms, overall and by age (18-39, 40-59, and 60+), race, sex, and high vs. low disease activity [≥ vs. <  median SLAQ score (=15), after excluding the forgetfulness item]. We used multivariable logistic regression to estimate the odds ratios (ORs) for the associations between PSS score (minimal clinically important difference=0.5*SD=4.0 points) and cognitive symptoms.

Results:  Overall, 41.6% and 29.4% of participants reported forgetfulness and difficulty concentrating. Women were twice as likely to report forgetfulness (P=0.004) and those with high vs. low disease activity were ~3- and 4-fold more likely to report forgetfulness (P<0.001) and difficulty concentrating (P<0.001), respectively (Figure). Mean PSS scores were lower in the oldest SLE patients (P=0.002) and those with low disease activity (P<0.001). With adjustment for age, race, sex, education, income, and disease activity, each 4.0-point increase in PSS score was associated with 1.3- and 2.1-fold higher prevalence of forgetfulness (OR=1.33, 95% CI 1.21-1.47) and difficulty concentrating (OR=2.12, 95% CI 1.83-2.44). No substantial differences in this association by age, race, sex, or disease activity were noted, and interaction terms were not statistically significant.

Conclusion:  SLE patients, particularly those with high disease activity, report a substantial burden of cognitive symptoms. These symptoms are associated with higher perceived stress, regardless of disease activity or other patient characteristics. This relatively young patient population may be susceptible to cognitive symptoms often linked with geriatric syndromes, for which stress may represent a modifiable risk factor.