Analysis of cognitive and psychological deficits in systemic lupus erythematosus patients without overt central nervous system disease

Abstract

Objective. To examine cognitive and psychological functioning in relation to antiribosomal P protein autoantibodies in patients with systemic lupus erythematosus (SLE) who had no previous history of central nervous system disease (non-CNS SLE).Methods. Comprehensive neuropsychological and psychological tests were administered to 51 non-CNS SLE patients, 29 rheumatoid arthritis (RA) patients, and 27 healthy controls.Results. Twenty-nine percent of the non-CNS SLE patients, 31% of the RA patients, and 11% of the control subjects were classified as cognitively impaired. Similar reductions in intelligence, attention, and fluency were detected in the non-CNS SLE and RA patients compared with controls. The non-CNS SLE patients showed a distinct deficit in learning compared with the RA and control groups. Forty-two percent of the non-CNS SLE patients demonstrated psychological distress, compared with 7% of the RA patients and 6% of the controls. In the patient groups, neither cognitive dysfunction nor psychological distress was associated with disease activity or prednisone dosage. Elevated serum levels of autoantibodies to ribosomal P protein were not associated with either psychological or cognitive abnormalities.Conclusion. These results suggest that certain cognitive deficits in non-CNS SLE patients may not be Address reprint requests to Elizabeth Kozora, PhD, National Jewish Center for Immunology and Respiratory Medicine, 1400 Jackson Street, Denver, CO 80206.Submitted for publication January 26, 1996; accepted in revised form June 28, 1996. specific to the immunopathology of SLE. In contrast, it is possible that deficits in learning, as well as psychological distress without major psychiatric pathology, may be subtle manifestations of CNS lupus.

Association of cerebrospinal fluid anti–NR2 glutamate receptor antibodies with diffuse neuropsychiatric systemic lupus erythematosus

“…Presumably, an intact blood-brain barrier prevented the transport of anti-NR2 from the systemic circulation into the brain (8). These data therefore could account for the previous observation that cognitive decline in SLE does not parallel systemic disease activity (14). In this regard, it is likely that CSF anti-NR2 antibodies, but not serum anti-NR2 antibodies, might be related to neuronal damage in NPSLE.…”

Interleukin-6 Covaries Inversely with Hippocampal Grey Matter Volume in Middle-Aged Adults

“…Low grade systemic inflammation, as defined by 2-to 3-fold increases in circulating levels of proinflammatory cytokines, increases with age (46) and is associated with a range of chronic inflammatory conditions, including atherosclerosis, type 2 diabetes, hypertension, and cardiovascular and autoimmune diseases (47)(48)(49)(50)(51). Although adults recruited for the current study were relatively healthy, their levels of plasma IL-6 (mean = 1.56; SD = 1.65, range = .…”

Validity and reliability of the proposed American College of Rheumatology neuropsychological battery for systemic lupus erythematosus: Comment on the article by Kozora et al

“…Ainiala et al interpret this finding to mean that minor central nervous system (CNS) dysfunction (measured by cognitive impairment) leads to poor specificity and a lack of distinction between the patients with SLE and controls. It is also possible that some methodologic differences (i.e., overly inclusive criteria for impairment) exist, because cognitive differences between patients with SLE and controls have been shown to exist in multiple prior studies (3)(4)(5)(6)(7)(8).…”