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Abstract Number: 770

Cognitive Function Trajectories Are Associated with the Depressive Symptoms Trajectories in SLE over Time

Zahi Touma1, Jiandong Su1 and Patricia Katz2, 1University of Toronto, Toronto Western Hospital, Toronto, ON, Canada, 2University of California San Francisco, San Francisco, CA

Meeting: 2018 ACR/ARHP Annual Meeting

Keywords: Cognitive dysfunction, Depression and systemic lupus erythematosus (SLE)

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Session Information

Date: Sunday, October 21, 2018

Session Title: Systemic Lupus Erythematosus – Clinical Poster I: Clinical Manifestations and Comorbidity

Session Type: ACR Poster Session A

Session Time: 9:00AM-11:00AM

Background/Purpose:

We have shown that cognitive function followed particular trajectories over time in SLE, with some patients having persistently low scores and others normal scores. This study aims to: 1) describe the association between cognitive function trajectories and depressive symptoms trajectories and 2) identify baseline factors associated with trajectory membership.

 

Methods:   Data were from the University of California San Francisco Lupus Outcomes Study, in which participants are followed longitudinally via annual telephone surveys. The Hopkins Verbal Learning Test-Revised (HVLT-R; measures verbal memory) was administered in years 2-7, providing up to 6 of observation. Age- and education-stratified z-scores were derived for HVLT delayed recall. The Center of Epidemiologic Studies Depression Scale (CES-D: score range 0–60; score ≥ 24 represents depression) was administered yearly.

Combined trajectory modelling for HVLT-R and CES-D was performed. Models with up to 6 classes were assessed. The best model was determined by a combination of clinical plausibility and statistical criteria. Univariate/multivariable logistic regression analyses examined baseline (year 2) factors associated with class memberships, including sex, ethnicity, disease duration, treatments, fatigue, and self-reported disease activity.  

Results:   755 patients (mean age 35 ± 13 years at SLE diagnosis) were studied. 4 latent classes were identified: 1-low CES-D scores and low cognitive scores (no depression + cognitive impairment; 20%), 2-lowest CES-D scores and highest normal cognitive scores (no depression + normal cognition; 48%), 3-highest CES-D scores and lowest cognitive scores (depression + cognitive impairment) (9%), and 4-high CES-D scores and normal cognitive score (depression + normal cognition; 23%) (Figure 1).

Table 1 shows the association between baseline variables and membership in classes 2 and 3. Caucasian ethnicity and education were associated with normal cognitive function. SLE disease activity and duration, fatigue, and methotrexate use (reflecting disease activity) were associated with cognitive impairment.

Conclusion:  4 distinct classes of combined cognitive function and the depressive symptoms were identified. Cognitive function was associated with depression status in 32% of patients (class 2 and 3). The results also confirmed that other factors predicted the latent class membership; such as ethnicity, education, disease activity and fatigue. These results highlight different aspects relevant for assessing and managing cognitive function over time in SLE.

 

 

Table 1. Baseline factors associated with normal cognitive function and absence of depression (comparing class 2 and 3 in univariate and multivariate analysis)

 

HVLT-R delayed recall

 

 

Univariate

Multivariate

P values

Female

0.5 (0.2, 1.8)

—

 

Caucasian

1.9 (1.1, 3.3)

5.9 (2.4, 14.7)

0.0001

Disease duration, year

1.0 (0.98, 1.02)

—

 

Education

2.2 (1.8, 2.8)

2.3 (1.6, 3.1)

<0.0001

SLE activity

0.6 (0.5, 0.7)

0.7 (0.6, 0.8)

0.0004

Smoking, ever

0.8 (0.4, 1.2)

—

 

Oral glucocorticoids

0.9 (0.5, 1.5)

—

 

Methotrexate

0.6 (0.3, 1.7)

0.2 (0.06, 0.9)

0.03

Plaquenil use

0.8 (0.5, 1.3)

0.5 (0.2, 1.02)

0.06

Fatigue score

0.93 (0.91, 0.94)

0.93 (0.90, 0.95)

<0.0001

Tabled values are odds ratios (95% confidence intervals)

 


Disclosure: Z. Touma, None; J. Su, None; P. Katz, None.

To cite this abstract in AMA style:

Touma Z, Su J, Katz P. Cognitive Function Trajectories Are Associated with the Depressive Symptoms Trajectories in SLE over Time [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 9). https://acrabstracts.org/abstract/cognitive-function-trajectories-are-associated-with-the-depressive-symptoms-trajectories-in-sle-over-time/. Accessed January 27, 2023.
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