Cognitive functioning in systemic lupus erythematosus: a meta-analysis

Abstract

Cognitive deficits are common in patients with systemic lupus erythematosus (SLE) regardless of overt neuropsychiatric involvement; however, a clear neuropsychological profile of SLE has not emerged. This study undertook a literature search of the PubMed, Scopus and Ovid (PsychINFO) databases for studies investigating cognitive alterations in SLE, using standardized neuropsychological (NP) measures. The data were analysed using meta-analytical procedures. The results support the observation that relative to healthy controls, SLE (regardless of overt neuropsychiatric involvement) is associated with statistically significant, small effect-sized deficits in visual attention, cognitive fluency, immediate visual memory and visual reasoning. Moreover, the results support a gradient of cognitive disturbance in SLE with significantly greater cognitive impairment in NPSLE patients relative to non-NPSLE patients. Medium-sized deficits were observed in NPSLE patients relative to healthy controls across the domains of: complex attention, delayed verbal memory, language and verbal reasoning (with small or non-significant differences observed in non-NPSLE patients relative to healthy controls). These results are relevant to the understanding, assessment and rehabilitation of patients living with SLE, with or without overt neuropsychiatric involvement.

Bortezomib at therapeutic doses poorly passes the blood–brain barrier and does not impair cognition

“…Our analysis of cognitive performance in the TAVAB study included two patients with systemic lupus erythematodes. Systemic lupus erythematodes per se seems to be associated with albeit small but relevant cognitive dysfunction, particularly for visual attention, immediate visual memory, visual reasoning and ‘cognitive fluency’ that seem to also be present in patients without neuropsychiatric involvement of the systemic lupus erythematodes ( Leslie and Crowe, 2018 ). In our two patients with systemic lupus erythematodes, cognitive performance was measured at the lower end of the observed spectrum in five out of eight subtests but not reduced compared with age- and education-matched norm values ( z -scores).…”

Metabolic and microstructural alterations in the SLE brain correlate with cognitive impairment

“…Cognitive dysfunction (CD) is one of the most common of the 19 neuropsychiatric lupus (NPSLE) syndromes and manifests insidiously over time, as opposed to the more dramatic presentations of acute confusional state, stroke, and psychosis (1,2). CD in systemic lupus erythematosus (SLE) affects multiple cognitive domains, including attention, executive function, verbal and nonverbal learning, working memory, and psychomotor function; it is associated with significantly increased morbidity and decreased quality of life (3)(4)(5)(6). The diagnosis of CD and correct attribution to SLE-associated mechanisms rather than other potentially confounding factors, such as infection, metabolic disturbances, medication effects, mood disturbances, and toxins, have been compromised by the poor sensitivity and specificity of available diagnostic tools.…”

The Montreal Cognitive Assessment Test

“…In the 19 neuropsychiatric syndromes described by the American College of Rheumatology (ACR) in 1999, 6 , 7 one of the most frequent is cognitive impairment (present in up to 65% of SLE patients 8 ), which can be associated with alterations in simple or complex attention, memory, visual–spatial processing, language, reasoning and problem solving, psychomotor speed, and executive functions. 9 – 11 This could affect the self-concept of patients as well as their ability to communicate. 5 …”