Neurocognitive impairment in childhood‐onset systemic lupus erythematosus: Measurement issues in diagnosis

Abstract

Objectives To assess the prevalence of neurocognitive impairment (NCI) in childhood-onset systemic lupus erythematosus (cSLE) comparing published classification criteria, and to examine associations between NCI, disease characteristics, psychosocial-well being and intelligence. Methods cSLE patients and ethnicity- and age-matched healthy controls completed a neuropsychological research battery, and results were categorized by three different NCI classification criteria with different cutoff scores (e.g., >2, 1.5, or 1 SD below mean) and number of required abnormal tests or domains. Results Forty-one cSLE subjects and 22 controls were included. Subjects were predominantly female (70%) and Hispanic (70%). Executive functioning, psychomotor and fine-motor speed were most commonly affected. Method 1 classified 34.1% of cSLE subjects with NCI, compared to Method 2 (14.6% with decline and 7.3 % with NCI) and Method 3 (63.4% with NCI). Prevalence of NCI was not significantly different between controls and patients using any of the categorization methods. NCI was not associated with SLE disease activity or characteristics, or with depression. Using Method 3, patients in the cognitive impairment group reported significantly lower quality of life estimates (69.7 vs 79.3, p=0.03). Below average intellectual functioning (IQ < 90) differentiated the number of test scores >1 and >1.5 SD, but not >2 SD below the mean. Conclusions NCI was prevalent in cSLE, but varied according to chosen categorization method. A similar proportion of cSLE patients and controls had NCI, reinforcing the importance of studying an appropriate control group. Categorical classification (i.e. impaired/nonimpaired) may oversimplify the commonly observed deficits in cSLE.

Psychopathology, Neurodiagnostic Testing, and Imaging

“…Although many patients are now recognized as having at least mild cognitive impairment even without recent overt signs of CNS disease, prevalence estimates of cognitive impairment determined via neuropsychological assessment have continued to vary from 7% to 80% of patients, 2-6,31 using the ACR case definitions. 1 Clearly, the selection of control groups for comparison and the criteria used for defining impairment remain critical issues, 31 and the need for studies of larger, longitudinal, multicenter efforts remains.…”

“…These issues are well illustrated in the study of childhood-onset SLE by Williams and colleagues. 31 For clinical decision making, an individualized approach to patient assessment that accounts for psychosocial, demographic, and clinical characteristics is necessary.…”

Pathogenesis of neurocognitive and neuropsychiatric manifestations in childhood-onset lupus: an overview

“…46,47,50,51 Another issue is heterogeneity of classification criteria for neurocognitive impairment. Recently published, was a prospective, crosssectional, case-control study of 41 childhood onset SLE subjects, by Williams et al 52 They combined three existing neurocognitive impairment (NCI) classification criteria to assess the prevalence of NCI in childhood onset SLE. Their American cohort was predominantly female, adolescent, urban, Hispanic and all English-speaking.…”

Juvenile-Onset Systemic Lupus Erythematosus: Clinical Features and Current Diagnostic Approaches

“…Так, напри-мер, депрессии за счет основного заболевания развивают-ся менее чем у 10-20% детей и подростков с нейролюпу-сом, при этом высока вероятность присоединения депрес-сии, имеющей вторичный характер на фоне тяжело проте-кающего основного заболевания [27]. Когнитивные нару-шения, возникающие более чем у трети детей и подрост-ков при СКВ, достаточно часто имеют ятрогенный генез и для грамотной интерпретации своего происхождения и коррекции требуют психологического динамического тестирования [28]. Когнитивные нарушения и спутан-ность сознания часто сопровождают психозы в рамках нейролюпуса.…”