Background/Purpose

There is currently no standardized tool to assess for NPSLE, and comprehensive neuropsychological testing can be lengthy and expensive. The Automated Neuropsychological Assessment Metric (ANAM) is a computerized battery of tests which has been successfully used to test cognitive function in SLE. The Cognitive Stability Index (CSI) is a web-based tool for assessing neurocognitive function which measures similar domains to the ANAM; however, it has not been studied in patients with SLE. Furthermore, in contrast to ANAM, CSI summary scores are not solely based on response speed, and thus may have a significant advantage over ANAM. Additionally, CSI can auto-invalidate subtests performed with insufficient patient effort. We aimed to evaluate and compare the utility of ANAM and CSI to assess NPSLE in the outpatient setting.

Methods

Subjects enrolled in the Einstein Lupus Cohort were eligible to participate. Subjects completed an NPSLE screening questionnaire (Mosca et al, 2011), with the presence of NPSLE defined by a screening score of >17 (NPSLE (+)). Subjects completed the ANAM and CSI tests (each taking ~30 minutes to complete). Eight cognitive domains were assessed by the ANAM and four by the CSI. The ANAM composite score measures average performance on all domains and is reported as a z score; four individual CSI factor scores for each cognitive domain are reported as standard scores (mean 100±15). Mann Whitney U tests assessed differences between NPSLE (+) and NPSLE (-) subjects. Pearson correlations were obtained for ANAM and CSI scores. 

Results

31 subjects completed the CSI, of which 20 also completed the ANAM. Of the 31 subjects, median age was 39 years, 94% were female, 42% were Hispanic and 63% were black. 74% were treated with corticosteroids (median prednisone dose 10 mg).

The median composite ANAM z-score, adjusted for sex/age, was -1.39 [-2.59, -0.98]. Median age-adjusted CSI standard factor scores ranged from 84-98 across the four cognitive domains. The median composite ANAM score was significantly different in the NPSLE(+)  patients compared to those who were NPSLE(-) (p=0.03). Of the eight domains evaluated by ANAM, learning, attention and spatial working memory differed significantly by screening score. Of the four CSI domains, response speed and memory differed significantly between the NPSLE(+) and NPSLE(-) subjects (p=0.03 and 0.01, respectively). The composite ANAM score and CSI factor scores correlated significantly with each other. Finally, anti-dsDNA antibodies, C3, C4, SLEDAI scores, and medications were not significantly associated with NPSLE.

Conclusion

Median cognitive test scores on both ANAM and CSI fell below the standard mean for normals, independent of NPSLE status. CSI factor memory scores were significantly lower in NPSLE(+) subjects, independent of their response speed. Since this cannot be inferred from the ANAM composite score, CSI may provide a more specific assessment of cognitive functioning. Overall, NPSLE was associated with significantly lower scores on both ANAM and CSI, suggesting that these are valuable “point of care” tools that can be easily implemented in the clinical setting for the diagnosis of NPSLE.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/point-of-care-neurocognitive-testing-for-neuropsychiatric-systemic-lupus-erythematosis-npsle/