Cognitive dysfunction and functional magnetic resonance imaging in systemic lupus erythematosus

Abstract

Cognitive dysfunction is a common aspect of systemic lupus erythematosus (SLE) and is increasingly reported as a problem by patients. In many cases the exact cause is unclear. Limited correlations between specific autoantibodies or structural brain abnormalities and cognitive dysfunction in SLE have been reported. It may be that the most appropriate biomarkers have yet to be found. Functional magnetic resonance imaging (fMRI) is a technique used in many other conditions and provides sensitive measures of brain functionality during cognitive tasks. It is now beginning to be employed in SLE studies. These studies have shown that patients with SLE often perform similarly to healthy controls in terms of behavioural measures on cognitive tasks. However, SLE patients appear to employ compensatory brain mechanisms, such as increased response in fronto-parietal regions, to maintain adequate cognitive performance. As there have been only a few studies using fMRI in SLE to investigate cognitive dysfunction, many questions remain unanswered. Further research could, however, help to identify biomarkers for cognitive dysfunction in SLE.

Compensatory activation in fronto-parietal cortices among HIV-infected persons during a monetary decision-making task

“…In contrast, the HIV‐positive group had minimal additional increases in activation within fronto‐parietal regions, with peak activation observed on easy trials, a pattern often seen in the context of reduced neural capacity [Barulli and Stern, ]. These results mirror findings observed in healthy aging and neurological disorders, such as Huntington's disease, systemic lupus erythematosus, and Alzheimer's disease [Barraclough et al, ; Hagen et al, ; Li et al, ; Martins et al, ; Muller et al, ; Papoutsi et al, ].…”

Altered cognitive function in systemic lupus erythematosus and associations with inflammation and functional and structural brain changes

“…This may explain why our SLE group performed worse on the behavioural (CANTAB) attention task. The few studies published using fMRI in SLE have suggested that patients with SLE employ compensatory brain mechanisms to maintain cognitive function 8. Our cohort may have failed to recruit compensatory mechanisms on the challenging sustained attention task, resulting in performance deficits.…”

“…fMRI gives a proxy measure of neuronal activation during cognitive testing. To date, only a few articles have reported fMRI findings in SLE but they suggest that patients with SLE may employ compensatory mechanisms within the brain to maintain adequate cognitive performance 8. Even fewer studies9 10 have examined cognition in SLE using a combination of behavioural, functional and structural assessments, although such an approach may better help identify causes and targets for therapy.…”

Nervous System Disease in Systemic Lupus Erythematosus: Current Status and Future Directions

“…BOLD fMRI data are acquired either in task/stimulus‐based paradigms (providing statistical parametric maps linked to a specific function), or in resting‐state acquisitions (providing functional connectivity maps of brain networks such as the default mode). Preliminary studies in SLE suggest compensatory adaptation of neuronal function through recruitment of additional cortical pathways. These compensatory responses maintain cognitive function in the short term but may eventually be overcome and manifest as overt cognitive impairment .…”