Session Information
Date: Monday, November 6, 2017
Title: Systemic Lupus Erythematosus – Clinical Aspects and Treatment Poster II: Damage and Comorbidities
Session Type: ACR Poster Session B
Session Time: 9:00AM-11:00AM
Background/Purpose: The screening and diagnosis of Cognitive Impairment (CI) in Systemic Lupus Erythematosus (SLE) patients is often delayed. CI diagnosed according to the American College of Rheumatology (ACR)-SLE battery is associated with a remarkable administrative and cost burden. The Automated Neuropsychological Assessment Metrics (ANAM) is a promising computerized battery of tests that is easy to administer. In our recent systematic review, we found a CI prevalence of 34% by ANAM (95% CI: 25-44%) and by the comprehensive batteries 38% (95% CI: 33-43%). We aimed to determine the prevalence of CI based on the ANAM (v4) GNS Battery using different definitions for CI.
Methods: Consecutive SLE patients, aged 18-65 years, who attended the University of Toronto Lupus Clinic between July 2016 and April 2017 and agreeing to participate were included. Patients were administered the ANAM (v4) GNS, which consists of 15 subtests that evaluate key neurocognitive domains (processing speed, attention, memory, visuospatial processing, and executive functioning). ANAM throughput scores were used to provide an estimate of ‘cognitive efficiency’. Patient scores were compared to a normative sample of age and gender-matched healthy controls to obtain z-scores. Cognitive impairment was operationalized on the ANAM as a z-score of ≤ -1.5 (as compared to controls) on ≥ 2 subtests, or ≤-2.0 on ≥1 subtests. The finger tapping subtest scores for both dominant and non-dominant hands were averaged to calculate a single subtest z-score. The two subtests for simple reaction times were also averaged to calculate a single summary z-score for both tests. Descriptive statistics were used.
Results: Of the 105 patients, 90.6% female, 45.6% were Caucasian, 16.7% Blacks, 5.3% Asians and 32.6% others. The mean age at SLE diagnosis was 28.0 ± 10.0 and lupus duration at enrolment was 16.3 ± 10.0 years.
Thirty-eight (35.5%) patients had CI based on z ≤-1.5 on ≥ 2 subtests and 43 (40.2%) patients based on ≤-2.0 on ≥1 subtests (Table 1). The prevalence of CI in each of the 15 subtests varied from 3.8-26.4% (z ≤-1.5) and 0.9-17.0% (z ≤-2.0) (Table 2).
Conclusion: A high prevalence of CI, varying between 35.5-40.2% (z≤-1.5 in ≥2 subtests and z≤-2.0 in ≥1 subtests respectively) was identified by the ANAM in this cohort of young SLE patients. The CI prevalence of 35.5-40.2% is similar to the reported prevalence with ANAM and the comprehensive batteries found in SLE literature. Future studies should address the validity of ANAM (v4) GNS Battery against ACR-SLE battery.
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Table 1. Frequency of SLE patients with throughput z-scores of ≤-1.5 and ≤-2.0 (N=107) |
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|
Number of Subtests |
No. (%) of Patients that scored z ≤-1.5 |
No. (%) of Patients that scored z ≤-2.0 |
|
0 |
47 (43.9%) |
64 (59.8%) |
|
≥1 |
60 (56.1%) |
43 (40.2%) |
|
≥2 |
38 (35.5%) |
20 (18.7%) |
|
≥3 |
28 (26.1%) |
12 (11.2%) |
|
≥4 |
23 (21.5%) |
8 (7.5%) |
|
≥5 |
17 (15.9%) |
8 (7.5%) |
|
≥6 |
12 (11.2%) |
8 (7.5%) |
|
≥7 |
7 (6.5%) |
2 (1.9%) |
|
≥8 |
6 (5.6%) |
0 (0.0%) |
|
≥9 |
5 (4.8%) |
0 (0.0%) |
|
≥12 |
2 (1.9%) |
0 (0.0%) |
|
Number of patients with z-scores ≤-1.5 overlap with patients with z-scores ≤-2 |
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Table 2. Prevalence of patients with throughput z-scores of ≤-1.5 and ≤-2.0 (N=107) |
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|
Performance Test |
No. (%) of Patients that scored z ≤-1.5 |
No. (%) of Patients that scored z ≤-2.0 |
|
Simple Reaction Time |
23 (21.5%) |
16 (15.0%) |
|
Code Substitution – Learning |
9 (8.4%) |
2 (1.9%) |
|
Procedural Reaction Time |
18 (16.8%) |
8 (7.5%) |
|
Mathematical Processing |
14 (13.2%) |
5 (4.7%) |
|
Matching to Sample |
20 (18.7%) |
7 (6.5%) |
|
Code Substitution – Delayed |
20 (18.7%) |
4 (3.7%) |
|
Simple Reaction Time (R) |
28 (26.4%) |
18 (17.0%) |
|
Go/No-Go |
4 (3.8%) |
1 (0.9%) |
|
Logical Relations |
21 (19.8%) |
10 (9.4%) |
|
Spatial Processing |
16 (15.1%) |
8 (7.5%) |
|
Tower Puzzle |
7 (6.7%) |
3 (2.9%) |
|
Tapping – Right Hand |
8 (7.9%) |
5 (5.0%) |
|
Tapping – Left Hand |
8 (8.1%) |
3 (3.0%) |
|
2-Choice Reaction Time |
20 (19.0%) |
10 (9.5%) |
|
Running Memory CPT |
19 (18.1%) |
12 (11.4%) |
|
Number of patients with z-scores ≤-1.5 include patients with z-scores ≤-2 |
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To cite this abstract in AMA style:
Touma Z, Green R, Ruttan L, Lombardi S, Tartaglia C, Anderson N, Su J, Colosimo K, Vitti M, Bonilla D, Wither JE, Fritzler MJ, Beaton D. Prevalence of Cognitive Impairment in Systemic Lupus Erythematosus Assessed By the Automated Neuropsychological Assessment Metrics [abstract]. Arthritis Rheumatol. 2017; 69 (suppl 10). https://acrabstracts.org/abstract/prevalence-of-cognitive-impairment-in-systemic-lupus-erythematosus-assessed-by-the-automated-neuropsychological-assessment-metrics/. Accessed .« Back to 2017 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/prevalence-of-cognitive-impairment-in-systemic-lupus-erythematosus-assessed-by-the-automated-neuropsychological-assessment-metrics/