Clinical Factors Associated with Brain Volume Reduction in Systemic Lupus Erythematosus Patients without Major Neuropsychiatric Manifestations

Abstract

The aim of the study was to find structural brain changes in systemic lupus erythematosus patients without major neuropsychiatric manifestations [non-neuropsychiatric systemic lupus erythematosus (non-NPSLE)] using quantitative magnetic resonance imaging (MRI) and possible associations with clinical characteristics. 89 non-NPSLE patients with normal conventional MRI and 84 healthy controls (HCs) were recruited. The whole brain gray matter volume (GMV) and white matter volume (WMV) were calculated for each individual. We found obvious GMV and WMV reduction in the systemic lupus erythematosus (SLE) group compared with HCs. Female patients showed significant reduction of GMV and WMV compared with male patients. Patients treated with immunosuppressive agents (ISA) showed less WMV reduction than those without. Cognitive impairment was the most common subclinical neuropsychiatric manifestation and had a prevalence of 46.1%. Association between WMV reduction with cognitive impairment was found. Thus, we concluded that structural brain atrophy could happen even before occurrence of obvious neuropsychiatric signs and symptoms and was associated with subclinical symptoms such as cognitive impairment. ISA treatment might have a protective effect on the brain atrophy. Early treatment might prevent the progressive damage to the brain. More studies are needed to fully understand the complicated underlying mechanisms of brain atrophy in SLE.

Hippocampal Atrophy in Systemic Lupus Erythematosus Patients without Major Neuropsychiatric Manifestations

“…Additionally, we found that HCQ might prevent HIPV reduction. This is consistent with our previous studies which showed that ISA had protective effects on brain atrophy in SLE patients (7,8,21). In our studies, ISA included CTX and HCQ.…”

“…Bilateral HIPV of female patients were significantly less than those of male patients. It was consistent with another study of our team, in which we found that female SLE patients had significantly lower whole brain grey matter volume (GMV) and WMV than male patients (21). We hypothesized that these findings might be related to the higher estrogen levels in females.…”

The Montreal Cognitive Assessment Test

“…One caveat of our study is that we did not include neuropsychiatric SLE 7 patients for this evaluation, and did not perform functional magnetic brain resonance imaging or cerebrospinal fluid auto-antibody detection. 3 , 26 Nevertheless, we found a positive correlation between disease duration and the affected domains as evaluated by implementing the gold standard.…”

Oligodendrocyte lineage cells and depression

“…OPCs establish physical contacts with functionally relevant neuronal domains and form in parallel with neuronal synaptogenesis, including dendrites, somata, nodes of Ranvier and synaptic cleft [ 110 – 112 ]. It has been shown that elevated glutamate levels and gene expression of glutamate receptors are found in the plasma, cerebrospinal fluid (CSF) and locus coeruleus of postmortem brains from patients with depression [ 113 ]. Although the pathological mechanism is unclear, researchers found that MDD patients treated with the antidepressant venlafaxine demonstrated decreased glutamate levels in CSF, indicating a correlation between the attenuation or dysfunction of the glutamatergic system and antidepressant treatment of MDD [ 114 ].…”