Cognitive impairment in systemic lupus erythematosus: A neuropsychological study of individual and group deficits

Objective. To investigate the relationship between quantitative estimates of global brain damage based on magnetization transfer imaging (MTI) and cerebral functioning, as measured by neurologic, psychiatric, and cognitive assessments, as well as disease duration in patients with a history of neuropsychiatric systemic lupus erythematosus (NPSLE).Methods. In patients with systemic lupus erythematosus (SLE), neurologic, psychiatric, and psychological symptoms often occur. The frequency of nervous system involvement has been reported to range from 11% to 60% (1). Infection, drug side effects, hypertension, or metabolic derangements, as well as an intrinsic brain manifestation of SLE (i.e., neuropsychiatric SLE [NPSLE]), can cause such symptoms. The uncertain pathogenesis and the wide variety of manifestations of NPSLE complicate the development of a uniform diagnostic decision-making protocol and a uniform method of monitoring a patient with this type of SLE. Findings of routine brain imaging studies are often unremarkable in patients with NPSLE, or the studies reveal abnormalities, such as cerebral atrophy and white matter hyperintensities (on magnetic resonance imaging [MRI]), that can also be found in SLE patients without neuropsychiatric symptoms. Furthermore, no correlation has thus far been demonstrated between quantitative measures of such nonspecific abnormalities and measures of brain function (2-5).Recently, magnetization transfer ratio (MTR) histogram analysis, a quantitative MRI technique based on magnetization transfer imaging (MTI), was applied in patients with primary NPSLE but without abnormalities on MRI that could account for the clinical picture. With this technique, cerebral abnormalities were identified in these patients (6,7). Such abnormalities were found in SLE patients who had had episodes of neuropsychiatric symptoms in the past (chronic NPSLE) as well as in patients who were experiencing an active phase of neuropsychiatric symptoms (active NPSLE) (6,7). The

Section: Resultsmentioning

confidence: 64%

Section: Resultsmentioning

confidence: 99%

Association of global brain damage and clinical functioning in neuropsychiatric systemic lupus erythematosus

Bosma¹,

Middelkoop²,

Rood³

et al. 2002

“…Estimates of the prevalence of neuropsychiatric SLE (NPSLE) vary between 24% and 75% (1)(2)(3)(4)(5)(6)(7). This variability is partially due to the lack of uniform diagnostic criteria for determining central nervous system (CNS) involve-ment, the inability during acute episodes to obtain tissue for pathologic study, and inherent difficulties in distinguishing primary neurologic and psychiatric abnormalities from those that are secondary to SLE or other organic causes (8)(9)(10).…”

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confidence: 99%

“…These include magnetic resonance imaging (MRI) (3,10,11), computed tomography (CT) scanning (11-13), xenon-133 measurement of regional cerebral blood flow (4,14,15), positron emission tomography (16), and/or neuropsychological assessment (1,2). However, there are several general problems which preclude the routine clinical use of these techniques to diagnose NPSLE.…”

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confidence: 99%

Quantitative electroencephalography: A new approach to the diagnosis of cerebral dysfunction in systemic lupus erythematosus

Ritchlin

Chabot

Alper

et al. 1992

Objective. Neuropsychiatric manifestations are common in patients with systemic lupus erythematosus (SLE), but accurate diagnosis is often difficult. We conducted a prospective study to determine the utility of neurometric quantitative electroencephalography (QEEG) as an indicator of cerebral dysfunction in SLE patients. Methods. Fifty-two SLE patients were divided into 4 groups based on the results of neuropsychiatric evaluations. These included patients with objective evidence of neuropsychiatric SLE (NPSLE), patients with neuropsychiatric symptoms, patients with no evidence of NPSLE, and patients with a prior history of NPSLE. All QEEG findings were compared with data in an age-regressed normative database and with findings in an independent sample of normal subjects.Results. QEEG sensitivity was 87%, and specificity was 75%. QEEG results were abnormal in 74% of the SLE patients with neuropsychiatric symptoms and in 28% of the patients with no evidence of active NPSLE. QEEG profiles varied as a function of the severity and type of neuropsychiatric manifestation present. Within this patient population, QEEG was more sensitive than magnetic resonance imaging, computed tomography scanning, or conventional EEG.Conclusion. Neurometric QEEG may be a sensitive indicator of cerebral dysfunction in patients with NPSLE and can differentiate patients with diverse neuropsychiatric manifestations. When combined with a careful clinical history and evaluation, QEEG provides information that may be useful for the early detection of NPSLE and for serial evaluation of disease activity and treatment efficacy.Neurologic and psychiatric manifestations of systemic lupus erythematosus (SLE) are common, occurring at any time during the illness, and often in the absence of generalized disease activity. Estimates of the prevalence of neuropsychiatric SLE (NPSLE) vary between 24% and 75% (1-7). This variability is partially due to the lack of uniform diagnostic criteria for determining central nervous system (CNS) involve-

“…Several crosssectional studies in SLE have found no significant negative relationship between steroid dose and cognitive functioning (20)(21)(22)(23), and most have found no relationship between steroid therapy per se and being designated as cognitively impaired (20,21,23). Moreover, a retrospective analysis of testhetest data in 33 SLE patients yielded a trend toward improved cognitive functioning associated with steroid initiation or increase, and worsened cognitive functioning with steroid withdrawal or reduction (24). Finally, a study assessing the effects of low-dose alternate-day corticosteroids on mood in mild SLE found no significant group differences, but significant individual differences, when taking and not taking medication; cognitive data were not reported (25).…”

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confidence: 99%

Corticosteroids and neuropsychological functioning in patients with systemic lupus erythematosus

Denburg

Carbotte

Denburg

1994

Self Cite

139

Objective. This study was designed to assess the effects of corticosteroids on select aspects of nervous system functioning, specifically, cognition and mood, as well as disease-related symptoms in individual patients with mild systemic lupus erythematosus (SLE) and mild neuropsychiatric ( N P ) symptoms.Methods. Ten women who had not been taking corticosteroids for at least 6 months were selected from a referral-based lupus clinic to participate in an N of 1 double-blind, controlled trial consisting of 3 randomly assigned drug/placebo pairings, with a drug dose of 0.5 mgkg of prednisone daily.Results. Analysis of variance on the group data yielded significant positive drug effects for cognition (P = 0.02), mood (P = 0.003), and SLE symptom ratings (P = 0.0002). Drug efficacy was also evaluated by an objective decision rule, which yielded evidence of overall drug benefit in 5 of the 8 patients who completed the trial, and a deleterious drug effect in 1 patient. Posttrial clinical results indicated that for the 8 women who completed the trial, "acceptable" decisions, leading to remission of SLE symptoms or appropriate withholding of steroids, were made on the basis of this rule. Conclusion. Improvement in cognition, mood, and/or SLE symptom ratings can be observed following brief exposure to relatively low doses of corticosteroids in individual women with mild SLE; these persist over repeated drug exposure. The current application of N of 1 methodology represents the first systematic study of