White matter lesions and brain atrophy in systemic lupus erythematosus patients: correlation to cognitive dysfunction in a cohort of systemic lupus erythematosus patients using different definition models for neuropsychiatric systemic lupus erythematosus

Abstract

Aim The aim of this study was to evaluate the extent of white matter lesions, atrophy of the hippocampus and corpus callosum, and their correlation with cognitive dysfunction (CD), in patients diagnosed with systemic lupus erythematosus (SLE). Methods Seventy SLE patients and 25 healthy individuals (HIs) were included in the study. To evaluate the different SLE and neuropsychiatric SLE (NPSLE) definition schemes, patients were grouped both according to the American College of Rheumatology (ACR) definition, as well as the more stringent ACR-Systemic Lupus International Collaborating Clinics definition. Patients and HIs underwent a 3 Tesla brain MRI and a standardized neuropsychological test. MRI data were evaluated for number and volume of white matter lesions and atrophy of the hippocampus and corpus callosum. Differences between groups and subgroups were evaluated for significance. Number and volume of white matter lesions and atrophy of the hippocampus and corpus callosum were correlated to cognitive dysfunction. Results The total volume of white matter lesions was significantly larger in SLE patients compared to HIs ( p = 0.004). However, no significant differences were seen between the different SLE subgroups. Atrophy of the bilateral hippocampus was significantly more pronounced in patients with NPSLE compared to those with non-NPSLE (right: p = 0.010; left p = 0.023). Significant negative correlations between cognitive test scores on verbal memory and number and volume of white matter lesions were present. Conclusion SLE patients have a significantly larger volume of white matter lesions on MRI compared to HIs and the degree of white matter lesion volume correlates to cognitive dysfunction, specifically to verbal memory. No significant differences in the number or volume of white matter lesions were identified between subgroups of SLE patients regardless of the definition model used.

Metabolic and microstructural alterations in the SLE brain correlate with cognitive impairment

“…Hippocampal abnormalities have been well described in SLE patients and animal models. In human SLE, hippocampal atrophy, presumably reflective of neuronal loss, has been correlated with cognitive deficits (38,(44)(45)(46)(47)(48) as well as specific autoantibodies, including DNRAb (44,49). Our findings of reproducible hippocampal hypermetabolism with functional correlates extend these previous reports, suggesting an SLE-mediated attack on the hippocampus.…”

“…Additional longitudinal studies are needed to verify this prediction. While several studies have reported WM alterations in NPSLE compared with HC subjects in segments of the CC, the forceps, anterior corona radiata, thalamus, and parietal and frontal lobes (33-36) and overall diminished volume of the CC (34, 37), our results support the growing body of literature demonstrating significant WM abnormalities in SLE subjects without acute neuropsychiatric manifestations (38)(39)(40)(41)(42). Most of these studies in SLE subjects without neuropsychiatric manifestations failed to demonstrate significant correlations between diminished WM integrity and cognition.…”

Functional connectivity changes in core resting state networks are associated with cognitive performance in systemic lupus erythematosus

“…In a previous study, we concluded that there was bilateral hippocampal atrophy in lupus patients when compared to healthy controls, but there was no correlation between level of atrophy and cognitive performance. In the same study, a correlation between frequency and volume of white matter lesions in lupus patients and decreased verbal memory test score could be identified (Cannerfelt et al, ).…”

Intracranial Infection and Inflammation

“…The MR imaging protocol shall include T1-weighted images pre-and post-contrast, FLAIR/T2-weighted, DWI, and, for the evaluation of microbleeds, SWI or T2 * -w, MRA-3D TOF, and, if possible, vessel wall imaging (VWI) [9][10][11]. If MRI is inconclusive, digital subtraction angiography can be added to the radiological work-up.…”