Cognitive Function Trajectories in Association With the Depressive Symptoms Trajectories in Systemic Lupus Erythematosus Over Time

Abstract

Objective Cognitive function may change over time in patients with systemic lupus erythematosus (SLE), and cognitive function trajectories have not been well studied. We aimed to identify cognitive function trajectories in SLE and describe them with depressive symptoms trajectories, and we also aimed to identify baseline factors associated with class membership in the dual trajectories. Methods Longitudinal data from the University of California San Francisco Lupus Outcomes Study were analyzed. Two outcome trajectories were studied jointly, the Hopkins Verbal Learning Test–Revised and the Center for Epidemiologic Studies Depression Scale (CES‐D) (administered annually). Univariate/multivariable logistic regression analyses examined baseline factors associated with class memberships. Results A total of 755 patients were studied, and 4 latent classes were identified: 1) low CES‐D scores and low cognitive scores (no depression plus cognitive impairment; 20%), 2) lowest CES‐D scores and highest normal cognitive scores (no depression plus normal cognition; 48%), 3) highest CES‐D scores and lowest cognitive scores (depression plus cognitive impairment; 9%), and 4) high CES‐D scores and cognitive score at borderline (depression plus borderline cognition; 23%). Conclusion In all, 4 distinct classes of dual cognitive function and depressive symptoms were identified. Persistently low cognitive performance in 28% of patients (classes 1 and 3) did not significantly improve over 7 years. Cognitive impairment was associated with depression status in 9% of patients (class 3). Other factors also predicted latent class membership: ethnicity, education, disease activity, physical functioning, and bodily pain. These results highlight the importance of periodic assessment of cognitive function and of different aspects relevant for assessing and managing cognitive function over time in SLE.

Depression-, Pain-, and Health-Related Quality of Life in Patients with Systemic Lupus Erythematosus

“…On the other hand, a study by Calderon et al described a limited role for depression in cognitive impairment in SLE patients and attributed impairments in sustained attention and spatial working memory to yet-unknown disease-intrinsic factors [ 35 ]. And, while recently published longitudinal studies found patients with cognitive dysfunction to exhibit clinically significant depression, the mechanistic link between the two remains not fully elucidated [ 37 , 38 ]. Our study is one of only a few to attempt to quantitate cognitive function and correlate it with depression while suggesting that other factors such as pain and disease activity could be contributing to the relationship between the two.…”

Cognitive Dysfunction in Systemic Lupus Erythematosus: Immunopathology, Clinical Manifestations, Neuroimaging and Management

“…However, a large prospective cohort study of 655 SLE patients by Touma et al described a persistently low but stable cognitive performance in patients with CD, with or without depressive symptoms over 7 years of follow-up [23]. These variations may be accounted for by different sample sizes, follow-up periods or NP assessment tools used to detect CD, but nonetheless, progression to frank dementia remains uncommon [18,23,93]. SLE-related disease damage is associated with CD.…”

“…However, cognitive deficits may also occur in the absence of active systemic disease of SLE and other major NP events, with 30% of SLE patients having isolated impairment of attention, working memory, executive function or processing speed [11,13,14]. Other factors which have been associated with CD in SLE include depression status, longer disease duration, regular glucocorticoid use and the presence of antineuronal and anti-phospholipid antibodies (aPLs), structural brain alterations, traditional cardiovascular risk factors, physical inactivity and vitamin D deficiency [15][16][17][18][19][20][21][22][23]. The overall clinical course of CD is favourable, with longitudinal studies describing a stable, improving or fluctuating course, but rarely with progression to frank dementia [9,[23][24][25].…”

“…Other factors which have been associated with CD in SLE include depression status, longer disease duration, regular glucocorticoid use and the presence of antineuronal and anti-phospholipid antibodies (aPLs), structural brain alterations, traditional cardiovascular risk factors, physical inactivity and vitamin D deficiency [15][16][17][18][19][20][21][22][23]. The overall clinical course of CD is favourable, with longitudinal studies describing a stable, improving or fluctuating course, but rarely with progression to frank dementia [9,[23][24][25]. The radiological features potentially related to CD on conventional neuroimaging are varied and inconsistent and include periventricular hyperintensities and cerebral atrophy [26].…”

Measures of Cognition in Rheumatic Diseases

“…In a study looking at practice effects over 1 week, significant practice effects (improvement) occurred for the HVLT‐R (total and delayed recall), with an effect size of 0.78 (79). Touma et al studied cognitive trajectories of the HVLT‐R in 755 adult patients with SLE from the University of California, San Francisco, Lupus Outcomes Study and found persistently low cognitive performance in 28% of patients that did not significantly improve over 7 years, whereas 72% of the patients with normal cognitive function followed a stable trajectory (80).…”