Prevalence of Cognitive Impairment in Systemic Lupus Erythematosus Assessed By a Comprehensive Neuropsychological Battery

Zahi Touma¹, Robin Green², Carmela Tartaglia³, Lesley Ruttan⁴, Sabrina Lombardi⁴, Nicole Anderson⁵, Jiandong Su⁶, Kenneth Colosimo⁶, Michelle Vitti⁶, Dennisse Bonilla⁶, Joan E. Wither⁵, Marvin J. Fritzler⁷ and Dorcas Beaton⁸, ¹Rheumatology, University of Toronto, Division of Rheumatology, Institute of Health Policy, Management and Evaluation, Toronto, ON, Canada, ²Brain and Therapeutics, Toronto Rehabilitation Institute, Toronto, ON, Canada, ³University of Toronto, Krembil Neurosciences Centre, Toronto, ON, Canada, ⁴Toronto Rehabilitation Institute, Toronto, ON, Canada, ⁵Rheumatology, University of Toronto, Toronto Western Hospital, Toronto, ON, Canada, ⁶University of Toronto, Toronto Western Hospital, Toronto, ON, Canada, ⁷Medicine, University of Calgary, Calgary, AB, Canada, ⁸Mobility Program Clinical Research Unit, St Michael's Hospital, Toronto, ON, Canada

Meeting: 2017 ACR/ARHP Annual Meeting

Date of first publication: September 18, 2017

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

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: Cognitive impairment (CI) is a common neurobehavioural manifestation of SLE. In our recent systematic review, the prevalence of CI was 38% (95% CI: 33-43%) with a wide variation (15-79%), which may be due to differences in CI definitions and selection of neuropsychological tests across studies. We aim to report the prevalence of CI in a large cohort using a comprehensive battery (CB) of tests in which we operationalized the classification of CI.

Methods: Consecutive consenting SLE patients, aged 18-65 years, who attended a single center (Jul 2016-Apr 2017) were recruited. Patients were administered a CB that evaluates the major cognitive domains: Manual motor speed and dexterity, simple attention and processing speed, visual-spatial construction, verbal fluency, learning and memory (visuospatial and memory), executive functioning (untimed and timed).

Patient scores were compared to a normative sample of age- and gender-matched healthy controls to obtain z-scores. CI was operationalized on the CB as a z-score of ≤-1.5 (as compared to controls) on ≥2 domains, z ≤-2.0 on ≥1 domain or either. Descriptive statistics were used.

Results: Of the 105 patients (91% female), the mean age at SLE diagnosis was 28.4 ± 10.2 and disease duration at enrolment was 15.0 ± 10.1 years. The prevalence of CI was 40.0% (z≤-1.5 in ≥2 domains), 44.8% (z≤-2.0 in ≥1 domains) and 55.2% for either.

Prevalence of patients with domain z-scores of ≤-1.5 and ≤-2.0 varied from 7.6-49.5% and 0-24.8% respectively (Fig 1). The most affected domain was learning and memory (visuospatial and memory) in 52 (49.5%) patients based on z≤-1.5 on ≥ 2 subtests and 26 (24.8%) patients based on z≤-2.0 in ≥ 1 subtest.

The prevalence of patients with subtest z-scores of ≤-1.5 and ≤-2.0 from 2.3-44.4% and 0.0-32.2% respectively (Table 1).

Conclusion: Prevalence of CI using our CB ranged between 40.0-44.8 % (z≤-1.5 in ≥2 domains and z≤-2.0 in ≥1 domains respectively) and 55.2% for either, which was higher than the pooled prevalence from previous reports of 38% . These differences in CI prevalence across studies could be attributed to different factors including the heterogeneity in patients’ demographics/comorbidities, sample size, the use of different metrics to determine CI, and the lack of a standardized definition of CI. Further studies are required to identify the best definition for CI and its metrics.

Table 1. Prevalence of patients with subtest z-scores of ≤-1.5 and ≤-2.0 (n=105)

Domains

Comprehensive Battery Subtest

No. (%) of Patients that scored z≤-1.5

No. (%) of Patients that scored z≤-2.0

Manual motor speed and dexterity

Finger Tapping Test

Dominant Hand

Non-Dominant Hand

40 (44.4)

33 (37.1)

29 (32.2)

22 (24.7)

Simple attention and processing speed

Trails A

Stroop colour naming

Stroop word reading

11 (10.7)

7 (6.7)

10 (9.5)

2 (1.9)

3 (2.9)

Visual-spatial construction

RCFT Copy

30 (29.1)

23 (22.3)

Verbal fluency

COWAT

ANIMALS

12 (11.4)

7 (7.2)

6 (5.7)

4 (4.1)

Learning and memory:

Visuospatial

Verbal

RCFT Delay Recall

RCFT Delay Recognition

HVLT-R Delayed Recall

HVLT-R Recognition

HVLT-R total recall

29 (28.4)

16 (15.8)

32(31.7)

34 (33.7)

41 (40.6)

17 (16.7)

10 (9.9)

23 (22.8)

24 (23.8)

18 (17.8)

Executive functioning:

Untimed

Executive timed

Stroop (interference score)

WAIS Letter-Number

Consonant Trigrams (used lower value from 18 second or 36 second)

WAIS-III Digit Symbol

Trails B

2 (2.3)

3 (2.9)

14(13.3)

5 (4.8)

20 (19.4)

0 (0.0)

9(8.6)

0 (0.0)

6 (5.8)

Number of patients with z-scores ≤-1.5 include patients with z-scores ≤-2

Disclosure: Z. Touma, None; R. Green, None; C. Tartaglia, None; L. Ruttan, None; S. Lombardi, None; N. Anderson, None; J. Su, None; K. Colosimo, None; M. Vitti, None; D. Bonilla, None; J. E. Wither, None; M. J. Fritzler, Inova Diagnostics, Inc., 5; D. Beaton, None.

To cite this abstract in AMA style:

Touma Z, Green R, Tartaglia C, Ruttan L, Lombardi S, 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 a Comprehensive Neuropsychological Battery [abstract]. Arthritis Rheumatol. 2017; 69 (suppl 10). https://acrabstracts.org/abstract/prevalence-of-cognitive-impairment-in-systemic-lupus-erythematosus-assessed-by-a-comprehensive-neuropsychological-battery/. Accessed .

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