Cognitive dysfunction in the Czech population of patients with systemic lupus erythematosus


Authors: R. Svobodová ;  M. Pošmurová ;  V. Peterová 1;  P. Kozelek 2;  I. Půtová ;  M. Fojtíková ;  C. Dostál ;  M. Olejárová
Authors‘ workplace: Revmatologický ústav Praha, 1Neurologická klinika 1. LF UK a VFN Praha, 2Psychiatrická klinika 1. LF UK a VFN Praha
Published in: Čes. Revmatol., 18, 2010, No. 2, p. 0.
Category: Original Papers

Overview

Background:
Involvement of the nervous system occurs in as much as 80% of patients with systemic lupus erythematosus (SLE). Diagnosis of neuropsychiatric involvement (NPSLE) is very difficult due to a variability of clinical presentation. Cognitive dysfunction (CD) is one of the most common manifestations of NPSLE. Its cause has not yet been entirely elucidated.

Objective:
The aim of this study was to assess the prevalence of NPSLE in patients with SLE, and the prevalence of CD in the Czech population of patients with SLE, and to determine an association of CD with other types of NPSLE, brain MRI findings of blood-brain barrier disorders, positivity for certain autoantibodies, and disease activity.

Methods:
A group of 100 patients diagnosed with SLE according to ACR criteria was examined. Disease activity was evaluated using the SLEDAI index. All patients underwent a clinical neurological, psychiatric, and psychological examination, and based on the results of all three examinations, diagnosis and the type of NPSLE was established according to the ACR criteria. Autoantibody activity was examined in all patients.

Results:
Based on a neurological examination alone, diagnosis of NPSLE was established in 31% of patients. Following completion of a psychiatric and psychological examination, the occurrence of NPSLE increased to 73%. A various degrees of cognitive deficit were found in most of our patients (91%). A mild degree of cognitive deficit was found in 35% of patients, and cognitive dysfunction (i.e. a moderate to severe degree of cognitive deficit) was diagnosed in 57% of patients. In the group of patients with CD, occurrence of involvement of the nervous system was four times higher than in the group without cognitive dysfunction; furthermore, occurrence of cardiac involvement (22.8 % vs. 14.0 %; p < 0.05) and antiphospholipid syndrome (28.1% vs. 20.9%; p< 0.05) was also higher in patients with CD. In the group of patients with CD, occurrence of positivity for antiphospholipid antibodies was two times higher than in the group without dysfunction.

Conclusion:
Cognitive dysfunction is a very frequent clinical manifestation of SLE; most of the patients (57% in our group) suffer from a moderate to severe degree of cognitive deficit. Cognitive dysfunction can evade diagnosis, when only routine, standard neurological and psychiatric examinations are performed. A targeted psychological examination can increase the chance of diagnosis of CD up to 10 times. Since cognitive dysfunction can significantly decrease mental performance of a patient with SLE, his or her role in the society and at work, we recommend performing psychological evaluations in all patients with SLE on regular basis.

Key words:
systemic lupus erythematosus, neuropsychiatric lupus, cognitive dysfunction


Sources

1. Brey RL, Holliday SL, Saklad AR, et al. Neuropsychiatric syndromes in lupus. Prevalence using standardized definitions. Neurology 2002; 58(8): 1214-20.

2. Ainiala H, Hietaharju A, Loukkola J, et al. Validity of the new American College of Rheumatology criteria for neuropsychiatric lupus syndromes: a population-based evaluation. Arthirits rheum 2001; 45: 419-23.

3. Glanz BI, Schur PH, Lew RA, Khoshbin S. Lateralized cognitive dysfunction in patients with systemic lupus erythematosus. Lupus 2005;14(11):896-902.

4. ACR ad hoc committee on neuropsychiatric lupus nomenclature „The American College og Rheumatology nomenclature and case definitions for neuropsychiatric lupus syndromes“. Arthritis Rheum 1999;42:599-608.

5. Marshal F. Folstein, MD and Susan E. Folstein, MD; User‘s Manual by Marshal F. Folstein, MD, Susan E. Folstein, MD, Travis White, PhD, and Melissa A. Messer, MHS Mini-Mental® State Examination, 2nd Edition™ (MMSE®-2™)

6. Denburg SD, Carbotte RM, Denburg JA. Psychological aspects of systemic lupus erythematosus: cognitive function, mood, and self-report. J Rheumatol 1997;24:998-1003.

7. Kozora E, Laudenslager M, Lemieux A, et al. Inflammatory and hormonal measures predict neuropsychological functioning in systemic lupus erythematosus and rheumatoid arthritis patients. J Int Neuropsychol soc 2001;7:745-54.

8. Fisk J, eastwood B, Sherwood G, et al. Patterns of cognitive impairment in patients with systemic lupus erythematosus. Br J Rheumatol 1993;33(Suppl):S103.

9. Dostál C. Postižení mozku. In: Dostál, Vencovský J, et al. Systémový lupus erythematosus. Praha, Medprint, 1997, strana 99

10. Bonfa E, Golombek SJ, Kaufman LD, et al. Association between lupus psychosis and anti-ribosomal P protein antibodies. N engl J Med 1987;317:265-271.

11. Teh LS, Isenberg DA. Antiribosomal P protein antibodies in systemic lupus erythematosus. A reappraisal. Arthritis Rheum 1994;37:307-315.

12. Briani C, Lucchetta M, Ghirardello A, et al. Neurolupus is associated with anti-ribosomal P protein antibodies: An inception cohort study. J Autoimmunity 2009;32:79-84.

13. Hanly JG, Walsh NM, Fisk J, et al. Cognitive impairment and autoantibodies in systemic lupus erythematosus. Br J Rheumatol 1993;32:291-6.

14. Kozora E, Thompson LL, West SG, et al. Analysis of cognitive and psychological deficits in systemic lupus erythematosus patients without overt central nervous system disease. Arthritis Rheum 1996;39:2035-45.

15. Denburg SD, Carbotte RM, Denburg JA. Cognitive impairment in systemic lupus erythematosus: a neuropsychological study of individual and group deficits. J Clin Exp Neuropsychol 1987;9:323-39.

16. Omdal R, Brokstad K, Waterloo K, et al. Neuropsychiatric disturbances in SLE are associated with antibodies against NMDA receptor. Eur J Neurol 2005;12:392-8.

17. Lapteva L, Nowak M, Yarboro CH, et al. Anti-N-methyl-D-aspartate receptor antibodies, cognitive dysfunction, and depression in systemic lupus erythematosus. Arthritis Rheum 2006;54:2505-14.

18. Arinuma Y, Yanagida T, Hirohata S. Association of cerebrospinal fluid anti-NR2 glutamate receptor antibodies with diffuse neuropsychiatric systemic lupus erythematosus. Arthritis Rheum 2008;58:1130-5.

19. Hanly JG, Robichaud J, Fisk JD. Anti-NR2 glutamate receptor antibodies and cognitive function in systemic lupus erythematosus. J Rheumatol 2006;33:1553-8.

20. Harrison MJ, Ravdin LD, Lockshin MD. Relationship between serum NR2a antibodies and cognitive dysfunction in systemic lupus erythematosus. Arthritis rheum 2006;54:2515-22.

21. Steup-Beekman G, Steens S van Buchem M, et al. Anti-NMDA receptor autoantibodies in patients with systemic lupus erythematosus and their first-degree relatives. Lupus 2007;16:329-34.

22. Denburg SD, Carbotte RM, Denburg JA. The relationship of antiphospholipid antibodies to cognitive function in patients with systemic lupus erythematosus. J Int Neuropsychol Soc 1997;3:377-86.

23. Hanly JG, Hong C, Smith S, et al. A prospective analysis of cognitive function and anticardiolipin antibodies in systemic lupus erythematosus. Arthritis Rheum 1999;42:728-34.

24. Menon S, Jameson-Shortall E, Newman SP, et al. A longitudinal study of anticardiolipin antibody levels and cognitive funcioning in systemic lupus erythematosus. Arthritis Rheum 1999;42:735-41.

25. Tan EM, Cohen AS, Fries JF, et al. The 1982 revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum 1982;25(11):1271-7.

26. Říčan P, Šebek M, Vágnerová M. WAIS-R. Wechslerův inteligenční test pro dospělé. Příručka. Psychodiagnostické a didaktické testy, Bratislava, 1983.

27. WMS-III. Wechslerova paměťová škála – třetí vydání. Technická příručka pro WAIS-III a WMS-III. Příručka pro administrování a skórování WMS-III. Experimentální verze. Překlad z angličtiny. Psychodiagnostika, Brno, 1999.

28. Reyova-Oesterriethova komplexní figura – TKF. Příručka k testu. Autoři českého manuálu Košč M, Novák J. Psychodiagnostika, Brno, 1997.

29. Test cesty. Trail Making Test. Příručka pro děti i dospělé. Preiss M, Preiss J, Panamá J. Psychodiagnostika, Brno, 1997.

30. Bombardier C, Gladman DD, Urowitz EE, et al. Derivation of SLEDAI: a disease activity index for lupus patients. Arthritis Rheum 1992;35:630-40.

31. Kang EH, Shen GQ, Morris R. Flow cytometric assessment of anti-neuronal antibodies in central nervous system involvement of systemic lupus erythematosus and other autoimmune diseases 2008;17:21-25.

Labels
Dermatology & STDs Paediatric rheumatology Rheumatology
Login
Forgotten password

Don‘t have an account?  Create new account

Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.

Login

Don‘t have an account?  Create new account