Metrics and definitions used in the assessment of cognitive impairment in systemic lupus erythematosus: A systematic review

Yuen, Kimberley; Green, Robin; Bingham, Kathleen; Ruttan, Lesley; Lee-Kim, Victoria; Tartaglia, Maria Carmela; Anderson, Melanie; Zandy, Moe; Choi, May Y.; Fritzler, Marvin J.; Wither, Joan E.; Beaton, Dorcas; Katz, Patricia P.; Touma, Zahi

doi:10.1016/j.semarthrit.2021.05.018

Cited by 15 publications

(14 citation statements)

References 122 publications

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“…Specifically, those initially assessed to have higher cognitive function tended to maintain higher cognitive test scores (Z score ≥ −1.5) on repeated assessments, whereas those with lower cognitive scores at baseline tended not to improve to a state of higher cognitive scores. The finding that adults with SLE tend to have relatively stable cognitive function over time replicates other previous studies with smaller sample sizes and shorter durations of follow‐up (3,15–17). Data demonstrating that cognition is a relatively stable construct in SLE inspires confidence that therapeutic programs can be developed to foster cognitive stability and potentially promote improvement.…”

Section: Discussionsupporting

confidence: 87%

“…Therefore, our findings that suggest that little transition between states of high and low cognition in participants with SLE occurs on repeated assessments reflect only cognitive domains of learning, memory, and verbal fluency. However, previous studies showed evidence of the validity of telephone‐administered screening tests in SLE when compared to a comprehensive neuropsychological battery (15,25). The HVLT‐R has shown adequate sensitivity (74%) and specificity (68%) in detecting cognitive impairment in patients with SLE compared to the modified ACR SLE battery.…”

Section: Discussionmentioning

confidence: 99%

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Intraindividual Change in Cognitive Function Among Adults With Systemic Lupus Erythematosus: A Markov Analysis Over 7 Years

Perera

Cook

Lee

et al. 2023

ACR Open Rheumatology

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Objective. Cognitive impairment is prevalent in systemic lupus erythematosus (SLE). There remain gaps in understanding cognition and SLE longitudinally. We studied intraindividual change in cognition in SLE over time.Methods. Data were from the University of California, San Francisco Lupus Outcome Study, which included 1281 adults with SLE. The Hopkins Verbal Learning Test-Revised (HVLT-R) and the Controlled Oral Word Association Test (COWAT) were administered annually over 7 years. A two-state Markov analysis was used to model transition intensities for probabilities of change in cognition. Logistic regression examined the association between clinical variables and cognitive change.Results. Minimal transition between cognitive states was observed in the Markov analysis. Using the COWAT, higher levels of self-reported depression were associated with decreased likelihood of cognitive improvement (Relative Risk [RR]: 0.98; 95% confidence interval [CI]: 0.96-0.99), and higher self-reported disease severity was associated with cognitive decline (

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Section: Discussionsupporting

confidence: 87%

Section: Discussionmentioning

confidence: 99%

Intraindividual Change in Cognitive Function Among Adults With Systemic Lupus Erythematosus: A Markov Analysis Over 7 Years

Perera

Cook

Lee

et al. 2023

ACR Open Rheumatology

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“…Paez-Venegas et al studied 44 SLE patients, of which nearly 20% were men with active disease (mean ± SD SLEDAI score of 6.5 ± 4.6) and found a high prevalence of CI of 70%. In the study of Paez-Venegas et al, CI was defined when only 1 domain was impaired, which is not the usually accepted definition of CI (29). In a recent study, Raghunath et al (37) compared the performance of the MoCA to the ACR-NB, studying 95 SLE patients.…”

Section: Discussionmentioning

confidence: 99%

“…We have recently shown in our systematic review that the assessment of CI in SLE remains heterogeneous (29). Moreover, there is no consistency between studies on the definitions of CI using the ACR‐NB, and different studies have used various CI definitions (5).…”

Section: Discussionmentioning

confidence: 99%

Assessing the Utility of the Montreal Cognitive Assessment in Screening for Cognitive Impairment in Patients With Systemic Lupus Erythematosus

Tayer-Shifman

Yuen

Green

et al. 2022

Arthritis Care & Research

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Screening for cognitive impairment (CI) in systemic lupus erythematosus (SLE) relies on the American College of Rheumatology (ACR) neuropsychological battery (NB). By studying the concurrent criterion validity, our goal was to assess the Montreal Cognitive Assessment (MoCA) as a screening tool for CI compared to the ACR-NB and to evaluate the added value of the MoCA to the Automated Neuropsychological Assessment Metrics (ANAM).Methods. A total of 285 adult SLE patients were administered the ACR-NB, MoCA, and ANAM. For the ACR-NB, patients were classified as having CI if there was a Z score of ≤-1.5 in ≥2 domains. The area under the curve (AUC) and sensitivities/specificities were determined. A discriminant function analysis was applied to assess the ability of the MoCA to differentiate between CI, undetermined CI, and non-CI patients.Results. CI was not accurately identified by the MoCA compared to the ACR-NB (AUC of 0.66). Sensitivity and specificity were poor at 50% and 69%, respectively, for the cutoff of 26, and 80% and 45%, respectively, for the cutoff of 28. The MoCA had a low ability to identify CI status. The addition of the MoCA to the ANAM led to improvement on the AUC by only 2.5%.Conclusion. The MoCA does not have adequate concurrent criterion validity to accurately identify CI in patients with SLE. The low specificity of the MoCA may lead to overdiagnosis and concern among patients. Adding the MoCA to the ANAM does not substantially improve the accuracy of the ANAM. These results do not support using the MoCA as a screening tool for CI in patients with SLE.

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“…1 Virtually testing cognitive function is possible, and prior to the pandemic, there was already a shift to online assessment, especially using computerised cognitive tests. 2 CANTAB® and ANAM are two established systems that provide validated normalised computerised cognitive batteries. 3 Administration of these systems requires minimal training, and reporting is much easier as it automatically calculated.…”

Section: Introductionmentioning

confidence: 99%

In-person versus virtual administration of the American College of Rheumatology gold standard cognitive battery in systemic lupus erythematosus: Are they interchangeable?

Barraclough

Díaz-Martínez

Knight

et al. 2023

Lupus

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Objective During the COVID-19 pandemic, many research studies were adapted, including our longitudinal study examining cognitive impairment (CI) in systemic lupus erythematosus (SLE). Cognitive testing was switched from in-person to virtual. This analysis aimed to determine if the administration method (in-person vs. virtual) of the ACR-neuropsychological battery (ACR-NB) affected participant cognitive performance and classification. Methods Data from our multi-visit, SLE CI study included demographic, clinical, and psychiatric characteristics, and the modified ACR-NB. Three analyses were undertaken for cognitive performance: (1) all visits, (2) non-CI group visits only and (3) intra-individual comparisons. A retrospective preferences questionnaire was given to participants who completed the ACR-NB both in-person and virtually. Results We analysed 328 SLE participants who had 801 visits (696 in-person and 105 virtual). Demographic, clinical, and psychiatric characteristics were comparable except for ethnicity, anxiety and disease-related damage. Across all three comparisons, six tests were consistently statistically significantly different. CI classification changed in 11/71 (15%) participants. 45% of participants preferred the virtual administration method and 33% preferred in-person. Conclusions Of the 19 tests in the ACR-NB, we identified one or more problems with eight (42%) tests when moving from in-person to virtual administration. As the use of virtual cognitive testing will likely increase, these issues need to be addressed – potentially by validating a virtual version of the ACR-NB. Until then, caution must be taken when directly comparing virtual to in-person test results. If future studies use a mixed administration approach, this should be accounted for during analysis.

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Metrics and definitions used in the assessment of cognitive impairment in systemic lupus erythematosus: A systematic review

Cited by 15 publications

References 122 publications

Intraindividual Change in Cognitive Function Among Adults With Systemic Lupus Erythematosus: A Markov Analysis Over 7 Years

Intraindividual Change in Cognitive Function Among Adults With Systemic Lupus Erythematosus: A Markov Analysis Over 7 Years

Assessing the Utility of the Montreal Cognitive Assessment in Screening for Cognitive Impairment in Patients With Systemic Lupus Erythematosus

In-person versus virtual administration of the American College of Rheumatology gold standard cognitive battery in systemic lupus erythematosus: Are they interchangeable?

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