Cognitive Impairment in Patients With Neuropsychiatric and Non-neuropsychiatric Systemic Lupus Erythematosus: A Systematic Review and Meta-analysis

Zabala, Arantzazu; Salgueiro, Mónika; Ballesteros, Javier; Ruiz‐Irastorza, Guillermo; Segarra, Rafael

doi:10.1017/s1355617718000073

Cited by 24 publications

(17 citation statements)

References 31 publications

(62 reference statements)

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“…Cognitive dysfunction (CD) is one of the most common clinical manifestations of NPSLE. 1 Previous research studies 2,3 suggest that CD can occur in SLE before it develops into NPSLE, and can manifest as a mild cognitive impairment to severe dementia which affects the patients’ quality of life. Due to the absence of uniform screening methods, the reported prevalence varies from 20% to 80%.…”

Section: Introductionmentioning

confidence: 99%

Prevalence, involved domains, and predictor of cognitive dysfunction in systemic lupus erythematosus

Yue

Gurung

Long

et al. 2020

Lupus

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Background Cognitive Dysfunction (CD) can occur in Systemic Lupus Erythematosus (SLE) before the occurrence of Neuropsychiatric Lupus Erythematosus (NPSLE). Given the reversibility and fluctuation of SLE-related CD, the research for possible predictors is of great significance for early detection and intervention. Objective We sought to determine the prevalence, involved domains, and possible predictors of CD in SLE patients. Methods We conducted a retrospective cross-sectional study at Nanfang Hospital from 2018 to 2019. A total of 78 SLE patients were recruited. The Montreal Cognitive Assessment (MoCA) scale was used to screen cognitive function. Demographic, clinical, and laboratory characteristics were collected. The serum anti-methyl-d-aspartate receptor (anti-NMDAR) antibody and S100β were measured by enzyme-linked immunosorbent assay (ELISA). Multivariate logistic regression analysis and ROC curve were used to assess the predictor of SLE-related CD. Results Of 78 recruited patients,53 (67.9%) had CD. It mainly involved delayed recall, abstract generalization, verbal repetition, and fluency. The disease activity index (SLEDAI) was not associated with SLE-related CD ( p > 0.05). Multivariate logistic regression showed that an increase in each year of education there was a decrease in the likelihood of CD (OR 0.261, CI 0.080-0.857, p = 0.027) whereas with each unit increase in serum anti-NMDAR antibody there was an increased likelihood of SLE-related CD (OR 1.568, CI 1.073–2.292, p = 0.020). Conclusion The prevalence of SLE-related CD was 67.9% in our study and SLE-related CD was not associated with disease activity. Serum anti-NMDAR antibody can be used as a predictor for SLE-related CD.

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Section: Introductionmentioning

confidence: 99%

Prevalence, involved domains, and predictor of cognitive dysfunction in systemic lupus erythematosus

Yue

Gurung

Long

et al. 2020

Lupus

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“…The symptoms of neuropsychiatric SLE may vary, such as mild mood disorder to psychosis or status epilepticus that accounts for up to 19% of deaths in patients with SLE [4–6]. Moreover, neuropsychological studies have found that SLE patients with nonneuropsychiatric systemic lupus erythematosus (non-NPSLE) can be affected with cognitive abnormalities [7]. The review of 22 published studies found that cognitive impairment was seen in 72% to 75% of non-NPSLE patients, which may be associated with lower health-related quality of life indices [8].…”

Section: Introductionmentioning

confidence: 99%

Altered Amplitude of Low-Frequency Fluctuations in Inactive Patients with Nonneuropsychiatric Systemic Lupus Erythematosus

Chen

Wang

et al. 2019

Neural Plasticity

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ObjectiveThis study is aimed at investigating the characteristics of the spontaneous brain activity in inactive patients with nonneuropsychiatric systemic lupus erythematosus (non-NPSLE). Methods Thirty-one female inactive patients with non-NPSLE and twenty healthy controls were examined by resting-state functional magnetic resonance imaging (RS-fMRI). Three amplitude methods including amplitude of low-frequency fluctuations (ALFF), fractional amplitude of low-frequency fluctuations (fALFF), and percent amplitude of fluctuation (PerAF) (with and without standardization) were applied to evaluate the spontaneous brain activity. The correlation was performed between low-frequency oscillations and clinical and neuropsychological factors in inactive patients with non-NPSLE. Results Compared to healthy controls, patients with non-NPSLE showed increased standardized ALFF (mALFF) in the left inferior temporal gyrus and left putamen, decreased PerAF in the right postcentral gyrus and bilateral precentral gyrus, and increased standardized PerAF (mPerAF) in the left putamen and decreased mPerAF in the right postcentral gyrus and bilateral precentral gyrus. By standardized fALFF (mfALFF), no significant brain regions were found between the two groups. Correlation analysis revealed significantly positive correlations between glucocorticoid dose and PerAF in the right precentral gyrus and mPerAF in the left putamen, and Complement 3 (C3) and mPerAF in the right postcentral gyrus. There was a significant negative correlation between C3 and mALFF in the left putamen. Conclusion Abnormal low-frequency oscillations in multiple brain regions were found in inactive patients with non-NPSLE, indicating that the alteration of mALFF, PerAF, and mPerAF in specific brain regions might be an imaging biomarker of brain dysfunction in inactive patients with non-NPSLE.

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“…Systemic lupus erythematosus (SLE) is an autoimmune disease characterized by high levels of autoantibody and damages in multiple organs, including central nervous system [1, 2]. Neuropsychiatric lupus erythematosus (NPSLE) has been reported as a common syndrome of SLE [3, 4]. It is widely accepted that tissue damage in SLE is associated with autoantibody production and immune complex formation and deposition [5].…”

Section: Introductionmentioning

confidence: 99%

Lupus serum IgG induces microglia activation through Fc fragment dependent way and modulated by B-cell activating factor

et al. 2019

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BackgroundNeuropsychiatric manifestations are frequent in patients with systemic lupus erythematosus (SLE), yet the etiology and pathogenesis of brain damage in SLE remains unclear. Because the production of autoantibodies, formation and deposition of immunocomplexes are major serological characteristics of SLE, the elevated level of serum immunoglobulin may contribute to brain tissue injury of SLE. To testify this, in this study, we examined whether immunoglobulin G (IgG) in the serum of SLE patients affects the cellular functions in central nervous system and the potential mechanism.MethodsIn vivo intracerebral injection of SLE-serum in mouse was used to activate microglia and the production of pro-inflammatory cytokine was assessed by ELISA. Sera was divided into IgG and IgG depleted fractions, while IgG was further divided into Fc and Fab fragments to examine which part has an effect on microglia. Flow cytometry, immunofluorescence and quantitative PCR (qPCR) were used to verify the synergistic effect of B-cell activating factor (BAFF) on IgG stimulation of microglia.ResultsWe found that IgG in lupus sera can induce M1 activation of brain microglia following intraventricular injection into normal mice, and BAFF facilitates this process. In vitro, we identified that IgG bound to microglia through Fc rather than Fab fragments, and BAFF up-regulated the expression of Fc receptors (FcγR) on the surface of microglia, consequently, promote IgG binding to microglia.ConclusionOur results suggest that lupus serum IgG causes inflammatory responses of microglia by involving the Fc signaling pathway and the activity could be up-regulated by BAFF. Accordingly, disruption of the FcγR-mediated signaling pathway and blockade of microglia activation may be a therapeutic target in patients with neuropsychiatric lupus erythematosus.

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Cognitive Impairment in Patients With Neuropsychiatric and Non-neuropsychiatric Systemic Lupus Erythematosus: A Systematic Review and Meta-analysis

Cited by 24 publications

References 31 publications

Prevalence, involved domains, and predictor of cognitive dysfunction in systemic lupus erythematosus

Prevalence, involved domains, and predictor of cognitive dysfunction in systemic lupus erythematosus

Altered Amplitude of Low-Frequency Fluctuations in Inactive Patients with Nonneuropsychiatric Systemic Lupus Erythematosus

Lupus serum IgG induces microglia activation through Fc fragment dependent way and modulated by B-cell activating factor

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