Comparison of Neuropsychological Impairment and Vocational Outcomes in Systemic Lupus Erythematosus and Multiple Sclerosis Patients

Abstract

Systemic lupus erythematosus (SLE) and multiple sclerosis (MS) are chronic immunologic diseases that can cause cognitive dysfunction. MS is a central nervous system (CNS) disease characterized by demyelination and progressive brain atrophy. SLE is an autoimmune disease capable of damaging multiple organ systems, including the CNS. Cognitive disturbances are seen in both SLE and MS. The present study is concerned with understanding the similarities and differences between the cognitive profiles of SLE and MS as well as the relationship between cognitive impairment and vocational disability in these patients. We examined 47 SLE patients, 47 MS patients, and 44 healthy controls. The groups were well matched on demographics and the patient groups were also matched on disease duration and severity. Group comparisons revealed that generative verbal fluency and visual-spatial memory are more profoundly affected in MS than SLE; whereas depression, fatigue, and working memory deficits are similarly involved in both diseases. Logistic regression analysis revealed that executive function, in particular, was predictive of vocational outcomes in SLE and MS patients.

Factors Associated with Employment Status in Individuals with Multiple Sclerosis

“…10 In addition, important relationships between executive function and employment have sometimes been shown to be mediated by fatigue. 15 Depression research has also yielded inconsistent findings, with one study finding the opposite result of what has been typical, with the employed group having higher depression scores than the unemployed group. 10 Some of these inconsistencies may have been due to different operationalizations of these factors across studies.…”

“…[6][7][8][9][10][11] Other MS symptom-related factors have also been found to predict employment status, including fatigue, 10,12 depression, [6][7][8] motor difficulties, 13 and cognitive problems. 14,15 More specifically, regarding cognitive problems, scores on tests of processing speed, verbal fluency, working memory, and long-term memory are typically lower in unemployed versus employed individuals with MS. 8,16,17 With all this said, research on cognition and depression has produced inconsistent findings. Regarding cognition, although most studies have found it to be associated with employment status, some have not.…”

“…In addition, each composite score was entered individually into a logistic regression model, with unemployment status (1, 0) as the dependent variable. Given that previous literature 15 has found the relationship between cognition and employment to be mediated by fatigue, analyses that found individual composite scores that predicted employment status were conducted again with fatigue as a covariate. The Hosmer-Lemeshow test of goodness of fit was run for each logistic regression to ensure adequate fit of each model to the data.…”

Cognitive and White Matter Tract Differences in MS and Diffuse Neuropsychiatric Systemic Lupus Erythematosus

“…5,6 These neuropsychological findings included deficits in working memory and processing speed and general lower cognitive scores, even in the absence of a diagnosed neurologic or psychiatric condition. 7,8 It is possible that these cognitive disturbances may be attributed to decreased WM integrity, the presence and extent of WM lesions, or GM damage, all of which are present in patients with MS and those with SLE. 2,3,[8][9][10] Unlike in MS, the relationship between cerebral pathology and resulting neuropsychiatric disorders in SLE is not well-established.…”

“…7,8 It is possible that these cognitive disturbances may be attributed to decreased WM integrity, the presence and extent of WM lesions, or GM damage, all of which are present in patients with MS and those with SLE. 2,3,[8][9][10] Unlike in MS, the relationship between cerebral pathology and resulting neuropsychiatric disorders in SLE is not well-established. Neuropsychiatric symptoms range from transient to chronic and are heterogeneous among patients.…”