Objective. To determine factors affecting the severity of cognitive impairment in systemic lupus erythematosus (SLE) and to analyze its anatomic location. Methods. Fifteen cognitive functions grouped into 8 domains were evaluated in 52 patients with SLE and 20 with rheumatoid arthritis. Patients were classified according to severity of impairment as normal, mild, or moderate/severe. Multivariate analysis was performed to identify the main factors affecting severity of cognitive deficits. The most likely anatomic site of damage according to neuropsychological performance was compared with the lesion's location on magnetic resonance imaging (MRI). Results. In SLE patients, a stepwise regression analysis showed that the number of impaired functions (dependent variable) was associated with antiphospholipid antibody positivity (aPL؉; P ‫؍‬ 0.04), the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SDI; P ‫؍‬ 0.001), hypertension (P ‫؍‬ 0.032), and was inversely related to educational level (P ‫؍‬ 0.021). Including MRI, the number of impaired functions was associated with severity of MRI (P < 0.001), the SDI (P ‫؍‬ 0.013), and the presence of Raynaud's phenomenon (P ‫؍‬ 0.04). The contemporary presence of aPL؉ and Raynaud's phenomenon resulted in a higher probability to develop moderate/severe cognitive deficits (P ‫؍‬ 0.015). Two logistic multiple regression analyses identified hypertension (P < 0.05), the SDI (P < 0.01), and moderate/severe MRI findings as main predictors of moderate/severe impairment (dependent variable). The damage site hypothesized through neuropsychological testing corresponded with MRI findings in 71.7% of SLE patients K ‫؍‬ 0.42, P ‫؍‬ 0.005). Conclusion. Hypertension, aPL؉, accumulated damage, and MRI lesions are the main factors affecting severity of cognitive impairment in SLE. The hypothesized sites of central nervous system involvement according to neuropsychological testing correlated with MRI findings in most patients.

Objective: To assess the agreement between presence and location of central nervous system (CNS) structural damage and neuropsychological performance. Methods: 21 unselected SLE patients underwent a 3 hours-long battery of neuropsychological tests sampling 15 cognitive functions. A neuropsychologist hypothesized for each SLE patient the most likely site of possible involvement, according to the neuropsychological performance. Patients underwent MRI scans within 6 months (3 months before or after) from neuropsychological tests and SPECT. Results: 14 of the 21 SLE patients (66,6%) were impaired in at least 1 function; among these, 7 patients (33,3%) were mildly impaired and 7 (33,3%) had more than 3 functions impaired. 10 patients (48%) had abnormal MRI scan. Negative and positive agreements between neuropsychological performance and MRI scan were detected in 15 patients (71%; χ2 with Yates’correction 6,09, p 0,007, measure K for concordance 0,44, p 0,03). All the 6 negative agreements had no records of major neurologic or psychiatric events; among the 9 positive agreements, 6 presented previous major neurologic events and 2 minor neuropsychiatric symptoms. Among the subjects with disagreement, 1 was unimpaired with positive MRI and without neuropsychiatric symptoms, 5 were mildly impaired with negative MRI. Conclusions: A detailed neuropsychological evaluation along with MRI arose as a valid method to esclude or to identify, localize and clinically interpret CNS involvement in SLE. Disagreement between MRI and neuropsychological tests was detected mainly for mild cognitive impairment that might be the expression of functional (inflammatory or ischemic) processes

L' emicrania è una sindrome frequentemente osservabile in corso di lupus eritematoso sistemico (LES), presentando una prevalenza variabile nelle diverse casistiche tra il 3-56% (1-3). Attualmente non è ancora chiaro in letteratura se essa sia

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