Cognitive impairment in non-neuropsychiatric systemic lupus erythematosus

IntroductionSystemic lupus erythematosus (SLE) is a chronic autoimmune disease which can cause prominent central nervous system (CNS) involvement. Cognitive dysfunction is one of the major neuropsychiatric syndromes of SLE.Aim of the workTo evaluate cognitive functions in SLE patients without evident neuropsychiatric manifestations and to find out if it is correlated with disease activity and with treatment.Patients & methodsThirty SLE patients without evident neuropsychiatric manifestations were evaluated. The evaluation included full clinical examination, assessment of SLE disease activity index-2k (SLEDAI-2k), routine laboratory investigations, autoantibodies assessment and cognitive function assessment using Montréal cognitive assessment (MoCA) scale and trail making test (TMT) (part A and part B). Twenty apparently healthy individuals were taken as control.ResultsCognitive dysfunction is present in all SLE patients included in our study. During assessment of cognitive functions, a highly statistically significant difference was observed between patients and control subjects, even with equal levels of education. While patients with higher educational levels were as impaired as those with lower levels of education. Cognitive dysfunction was not correlated with disease activity or with the doses of drugs used for treatment. But a statistically significant positive correlation was noted between deterioration of cognitive functions and the disease duration.ConclusionCognitive dysfunction is a prominent feature in SLE patients without symptoms of CNS involvement. Psychological evaluation should be performed for each SLE patient to detect cognitive dysfunctions. Psychological intervention is recommended to prevent further deterioration. Correlation with disease duration should pay attention to the chronicity of disease.