Background/Purpose:  Our purpose was to investigate cognitive dysfunction (CD) in a cohort of Neuropsychiatric Systemic Lupus Erythematosus (NPSLE) patients (n=16) with severe central nervous system (CNS) involvement that had been previously evaluated prospectively in our department.

Methods:  Of a 16 patient cohort with a well documented history of CNS involvement (NPSLE), 11 patients participated in the study. Eleven non-NPSLE patients and 28 healthy controls, all female, with mean age 41.2 (±11.4) years were included. Healthy controls were age, sex and education matched. Participants were administered a 1-hour neuropsychological battery as proposed by the American College of Rheumatology (ACR-SLE battery). Data on depression using the Center of Epidemiological Studies of Depression (CESD) questionnaire, cognitive failures as reported from participants using the Cognitive Failures Questionnaire (CFQ) and levels of fatigue using the Facit Fatigue (FF) questionnaire were also collected. A Visual Analogue Scale (VAS) was used for pain assessment. Patients were evaluated for the presence of anti-dsDNA, Neuromyelitis Optica (NMO)-IgG, anti-ribosomal P and anticardiolipin antibodies (aCL). Presence of concurrent Antiphospholipid Antibody Syndrome (APS) was documented. Disease activity was assessed using the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI), and permanent damage due to SLE using the SLICC/ACR Damage Index. Analysis of variance was performed in order to assess the statistical significance of the observed differences. Pairwise comparisons were made using the Tukey’s HSD test. All analyses were done using the STATISTICA 10.0 software for Windows.

Results: Analysis of variance revealed significant differences between groups in three domains of neuropsychiatric tests: Stroop color, Greek verbal learning test (GVLT) 1,2, Rey osterrieth complex figure (ROCF) copy trial, and in the FF questionnaire. When post-hoc analysis was performed those differences were weakened, however a tendency maintained for the ROCF copy trial (p=0.06). In the patients sample, aCL positive subjects had lower values in the immediate recall trial of the GVLT, (p=0.01) and in the immediate ROCF trial (p=0.02) as compared to the non aCL ones. Also, APS patients had lower digit symbol test and lower CESD results compared to the non APS patients (p=0.01 and 0.04, respectively). Finally higher SDI scores were positively correlated to CESD scores (p=0.0) and SLEDAI scores were moderately negatively correlated to Word Reading Efficiency (WRE) and Stroop color-words scores.

Conclusion:  Severe neurological involvement does not produce severe cognitive dysfunction. NPSLE patients showed a tendency to deficient visual-spatial processing. However, in the patient’s sample, those with aCL antibodies showed deficits in memory processes. APS patients showed worse psychomotor speed. Both patients with APS and patients with higher SDI scores showed more depression.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/impact-of-severe-organic-cns-involvement-in-cognitive-function-in-a-cohort-of-systemic-lupus-erythematosus-patients/