Cognitive impairment in systemic lupus erythematosus: a follow-up study

Carlomagno, Sergio; Migliaresi, S.; Ambrosone, Luigi; Sannino, Maria; Sanges, G.; Iorio, Giuseppe Di

doi:10.1007/s004150050583

Cited by 104 publications

(88 citation statements)

References 24 publications

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“…Seizures, neuropathies, hemiparesis, organic brain syndrome, psychosis, and depression, as well as paresthesias, headaches, anxiety, and mood swings can occur in SLE (9,19). Several groups of investigators have drawn attention to cognitive deterioration as an independent expression of nervous system involvement in SLE, in addition to neurologic and psychiatric manifestations (20)(21)(22)(23)(24)(25)(26)(27). Since the whole spectrum of nervous system derangement can occur as a result of SLE, neurologic, psychiatric, and cognitive functioning was assessed in our patients with chronic NPSLE.…”

Section: Resultsmentioning

confidence: 99%

Association of global brain damage and clinical functioning in neuropsychiatric systemic lupus erythematosus

Bosma¹,

Middelkoop²,

Rood³

et al. 2002

Arthritis & Rheumatism

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Objective. To investigate the relationship between quantitative estimates of global brain damage based on magnetization transfer imaging (MTI) and cerebral functioning, as measured by neurologic, psychiatric, and cognitive assessments, as well as disease duration in patients with a history of neuropsychiatric systemic lupus erythematosus (NPSLE).Methods. In patients with systemic lupus erythematosus (SLE), neurologic, psychiatric, and psychological symptoms often occur. The frequency of nervous system involvement has been reported to range from 11% to 60% (1). Infection, drug side effects, hypertension, or metabolic derangements, as well as an intrinsic brain manifestation of SLE (i.e., neuropsychiatric SLE [NPSLE]), can cause such symptoms. The uncertain pathogenesis and the wide variety of manifestations of NPSLE complicate the development of a uniform diagnostic decision-making protocol and a uniform method of monitoring a patient with this type of SLE. Findings of routine brain imaging studies are often unremarkable in patients with NPSLE, or the studies reveal abnormalities, such as cerebral atrophy and white matter hyperintensities (on magnetic resonance imaging [MRI]), that can also be found in SLE patients without neuropsychiatric symptoms. Furthermore, no correlation has thus far been demonstrated between quantitative measures of such nonspecific abnormalities and measures of brain function (2-5).Recently, magnetization transfer ratio (MTR) histogram analysis, a quantitative MRI technique based on magnetization transfer imaging (MTI), was applied in patients with primary NPSLE but without abnormalities on MRI that could account for the clinical picture. With this technique, cerebral abnormalities were identified in these patients (6,7). Such abnormalities were found in SLE patients who had had episodes of neuropsychiatric symptoms in the past (chronic NPSLE) as well as in patients who were experiencing an active phase of neuropsychiatric symptoms (active NPSLE) (6,7). The

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Section: Resultsmentioning

confidence: 99%

Association of global brain damage and clinical functioning in neuropsychiatric systemic lupus erythematosus

Bosma¹,

Middelkoop²,

Rood³

et al. 2002

Arthritis & Rheumatism

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“…If formal neuropsychological assessment had been included in the study protocol, this would likely have increased the prevalence of cognitive impairment identified in our cohort, although the additional impairment identified would be subtle and subclinical in the majority of cases. However, several cross-sectional and longitudinal studies have indicated that such deficits do not adversely affect HRQOL (19)(20)(21) or lead to long-term, clinically significant neurologic sequelae (19,(30)(31)(32). Also, given that formal neuropsychological assessments are not part of routine followup, we believe our protocol reflects clinical practice.…”

Section: Discussionmentioning

confidence: 99%

Neuropsychiatric events at the time of diagnosis of systemic lupus erythematosus: An international inception cohort study

Hanly

Urowitz

Sánchez‐Guerrero

et al. 2007

Arthritis & Rheumatism

270

218

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Objective. To describe the prevalence, characteristics, attribution, and clinical significance of neuropsychiatric (NP) events in an international inception cohort of systemic lupus erythematosus (SLE) patients.Methods. The study was conducted by the Systemic Lupus International Collaborating Clinics (SLICC). Patients were enrolled within 15 months of fulfilling the American College of Rheumatology (ACR) SLE classification criteria. All NP events within a predefined enrollment window were identified using the ACR case definitions of 19 NP syndromes. Decision rules were derived to determine the proportion of NP disease attributable to SLE. Clinical significance was determined using the Short Form 36 (SF-36) Health Survey and the SLICC/ACR Damage Index (SDI).Results. A total of 572 patients (88% female) were recruited, with a mean ؎ SD age of 35 ؎ 14 years. The mean ؎ SD disease duration was 5.2 ؎ 4.2 months. Within the enrollment window, 158 of 572 patients (28%) had at least 1 NP event. In total, there were 242 NP events that encompassed 15 of 19 NP syndromes. The proportion of NP events attributed to SLE varied from 19% to 38% using alternate attribution models and occurred in 6.1-11.7% of patients. Those with NP events, regardless of attribution, had lower scores on the SF-36 and higher SDI scores compared with patients with no NP events.Conclusion. Twenty-eight percent of SLE patients experienced at least 1 NP event around the time of diagnosis of SLE, of which only a minority were attributed to SLE. Regardless of attribution, the occurrence of NP events was associated with reduced quality of life and increased organ damage.Nervous system involvement as part of systemic lupus erythematosus (SLE) is well recognized, although the prevalence is highly variable among studies (1-7). A wide range of neuropsychiatric (NP) manifestations have been described, which span common features such Dr. Hanly

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“…However, the rather large spread in results should be noted -from 12% to 87% (see Table 1) [7,9,13,15,21,28]. The significant variation in the incidence of CI depends on the gender/age composition of the groups of SLE patients studied, the methods used, the patient cohort size, and the absence of a unified approach to diagnosis, especially in the earlier studies (some of these are included in Table 1).…”

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confidence: 93%

Cognitive Impairments in Systemic Lupus Erythematosus

Пизова

2015

Neurosci Behav Physi

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Recent years have seen significant changes in our concepts of cognitive impairments (CI) and dementia. The older view was that these disorders were the inevitable fate of elderly and old people, though many studies have now been reported on the frequencies, types, and mechanisms of development of cognitive impairments at younger ages, which are usually associated with one disease or another, especially those affecting the CNS. These latter include cerebrovascular impairments (CVI). While most attention in this area used to be paid to stroke, more attention is now focused on non-stroke forms of acute CVI (aCVI). Furthermore, studies in this field have addressed autoimmune demyelinating diseases.One such autoimmune disease is systemic lupus erythematosus (SLE). This is one of the most widespread autoimmune diseases and has an incidence of 10-60 per 100,000 members of the population, with more women affected than men. Disease onset is generally at age 15-30 years, the course is chronic, and many organs and systems are affected (skin, joints, lungs, heart, etc.) [1,2]. More than two thirds of SLE patients have symptoms of nervous system lesions. The American College of Rheumatologists [40] has identified 19 syndromes of nervous system lesions. The neurological manifestations include aseptic meningitis, cerebrovascular disorders, demyelinating syndromes, headache, extrapyramidal disorders, epileptic seizures, and syndromes involving the peripheral nervous system.Changes in the mental domain consist primarily of cognitive dysfunctions. One-hour neuropsychological testing is recommended for detection of this condition, including assessment of verbal ability, attention, various types of memory, information processing speed, and psychomotor function. Ainiala et al.[3] performed a population study to detect mental disorders in SLE patients aged 16-65 years using enhanced neuropsychological testing. CI was detected in 81% of patients, which were quite severe in 38% of cases. In one recent study [32], the incidence of these impairments in SLE was 37-95%.However, the rather large spread in results should be noted -from 12% to 87% (see Table 1) [7,9,13,15,21,28]. The significant variation in the incidence of CI depends on the gender/age composition of the groups of SLE patients studied, the methods used, the patient cohort size, and the absence of a unified approach to diagnosis, especially in the earlier studies (some of these are included in Table 1).The severity of CI is very variable -from minimal dysfunction through to dementia [6,13,21,31,32,36]. Monastero et al. [34] noted significant deterioration of long-term and visual memory in 52.2% of cases and mild CI in half of all patients with SLE and CNS lesions as compared with 26.9% of SLE patients without these. Brey et al. [6] investigated 67 patients and found that 21% had no impairments, 43% had mild cognitive disorders, 30% had moderate cognitive disorders, and 6% had dementia, the most severe impairments affecting verbal and visual memory. It should be noted that mo...

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Cognitive impairment in systemic lupus erythematosus: a follow-up study

Cited by 104 publications

References 24 publications

Association of global brain damage and clinical functioning in neuropsychiatric systemic lupus erythematosus

Association of global brain damage and clinical functioning in neuropsychiatric systemic lupus erythematosus

Neuropsychiatric events at the time of diagnosis of systemic lupus erythematosus: An international inception cohort study

Cognitive Impairments in Systemic Lupus Erythematosus

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