Fatigue is one of the most complex and ill understood symptoms of chronic illness often reported as the number one complaint by patients with systemic lupus erythematosus (SLE). This paper aims to provide a comprehensive review of the literature on fatigue in SLE. A pool of 55 relevant articles was retrieved via electronic searches of six databases including MEDLINE, EMBASE, CINAHL, AMED, PsychINFO and PubMed. Fatigue in the studies reviewed was assessed by a range of self-report instruments, the content of which is varied. The results displayed a consensus on the high prevalence of fatigue in SLE, which is significantly higher when compared with controls. The aetiology of fatigue appears to be multifactorial. Disease activity is not always significantly associated with fatigue, in comparison with other secondary features of SLE and psychological variables. The literature is limited by the cross-sectional nature of most of the studies, which does not permit for any firm conclusion regarding the direction of causal relationships to be made. The high prevalence of fatigue in SLE emphasizes the need for further detailed prospective research to inform the understanding of its aetiology, course and management.

With the advent of improved medical and surgical care in congenital heart disease, there has been an increase in the number of patients who survive into adulthood, giving rise to a new patient population 'Adults with congenital heart disease'. In the past, morbidity and mortality were the primary concerns for this group. However, with improvements in outcome attention has shifted to other factors such as psychosocial and cognitive functioning. This paper reviews the literature on the cognitive functioning in adult congenital heart disease patients. A total of five relevant articles were retrieved via electronic searches of six databases, including MEDLINE, EMBASE, CINAHL, AMED, PsychINFO, and PubMed. The results displayed a consensus on the presence of some cognitive difficulties in adult congenital heart disease patients. The aetiology of cognitive dysfunctions appears to be multifactorial. The literature is limited by the very small number of studies looking at adults with congenital heart disease, with the majority focusing on cognitive functioning among children with congenital heart disease. However, the presence of cognitive dysfunctions and the resulting impact on the patient's day to day lives warrant for a more detailed and prospective research to enhance the understanding of its aetiology and impact.

This is the accepted version of the paper.This version of the publication may differ from the final published version. Tel No: +44 207 040 5767, Fax No: +44 207 0408750 Email: Stanton.newman.1@city.ac.uk Word Count: 3,215(excluding title page, abstract, key questions, references, figures, tables). Permanent repository linkKey Words: Adult Congenital Heart Disease, Cognition, Neuropsychological assessment, Mood 3 ABSTRACT ObjectiveA cross-sectional study assessed cognitive function in a sample of Adult Congenital Heart Disease patients, within the Functioning in Adult Congenital Heart Disease study London. The association between cognitive functioning and disease complexity was examined. MethodsThree hundred and ten patients participated. Patients were classified into four structural complexity groups (Tetralogy of Fallot, Transposition of the Great Arteries, Single Ventricle and Simple conditions). Each participant underwent neuropsychological assessment to evaluate cognitive function (memory, executive function) and completed questionnaires to assess depression and anxiety. ResultsForty one percent of the sample showed impaired performance (>1.5 SD below the normative mean) on at least 3 tests of cognitive function compared to established normative data. This was higher than the 8% that would be expected in a normal population. The sample exhibited significant deficits in divided attention, motor function and executive functioning. There was a significant group difference in divided attention (F=5.01, p=.002) and mean total composite score (F=5.19, p=.002) between different structural complexity groups with the Simple group displaying better cognitive function. ConclusionThe results indicate that many Adult Congenital Heart Disease patients display impaired cognitive function relative to a healthy population, which differs in relation to disease complexity. These findings may have implications for clinical decision making in this group of patients during childhood. Possible mechanisms underlying these deficits and how they may be 4 reduced or prevented are discussed; however further work is needed to draw conclusive judgments.