Background/Purpose: : Systemic lupus erythematosus (SLE) is a multisystem autoimmune disease which can impact the central nervous system in multiple ways, including development of cognitive dysfunction. Cognitive dysfunction is commonly reported in SLE and difficult to detect. Currently used diagnostic methods including neurocognitive testing batteries are time consuming, costly and challenging to implement in clinic. This project used the Self-Administered Gerocognitive Exam (SAGE) screening test for cognitive impairment, a simple patient-completed paper test, validated for dementia, diabetes and other diseases but not SLE

Methods:

The patient population included 118 patients participating in The Ohio State University Lupus, Vasculitis and Glomerulonephritis Registry. All subjects provided informed consent, completed the SAGE instrument and supplied demographic and medical history information. Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) and Systemic Lupus International Collaborative Clinics Damage Index (SLICC-DI) were completed on all subjects. SAGE instruments, scored by a trained individual, were grouped into two categories: normal (SAGE score > 16) and abnormal (SAGE score ≤ 16). Univariate analysis was performed to assess the relationship between normal and abnormal SAGE scores and several clinical variables. Variables with p < 0.15 from the univariate analysis were initially included in multivariable logistic regression modeling. Variables with p>0.05 were subsequently removed sequentially from multivariate model using the backward selection strategy.

Results: Of the 118 subjects in this study, 97 scored in the normal range (>16) and 21 scored in the abnormal range (≤ 16). Race, ethnicity, education level and household income were significantly associated by univariate analysis with normal versus abnormal SAGE scores at the p<0.15 level were initially included in the multivariable model (Table 1). Abnormal SAGE scores were associated with higher overall SLICC DI scores but not with a neuropsychiatric-specific SLICC DI score. In multivariable analysis there was an independent association between abnormal SAGE score and higher SLICC DI score (odds ratio (OR) = 1.44, 95%CI 1.01-1.11, p-value=0.03), Hispanic ethnicity (OR=43.4, 95%CI 3.1-601, p-value=0.005) and lower household income (OR=11.9 for ≤$15,000 vs >$50,000, 95%CI 2.45-57. 8, p-value=0.002).

Conclusion:

Study results show a significant independent relationship between neurocognitive impairment as measured by SAGE score and higher lupus related damage as measured by SLICC DI scores. Abnormal SAGE scores were associated with lower household income and Hispanic ethnicity, which may suggest language barriers and a need for a Spanish version of the instrument. Finally, the SAGE was feasible to measure in the clinic setting. Further validation studies in SLE are needed.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/assessment-of-a-cognitive-impairment-measure-in-systemic-lupus-erythematosus/