Arthritis & Rheumatism, Volume 60,
October 2009 Abstract Supplement
The 2009 ACR/ARHP Annual Scientific Meeting
Philadelphia October 16-21, 2009.
Assessment of Cognitive Function in Systemic Lupus Erythematosus, Rheumatoid Arthritis and Multiple Sclerosis Using Computerized Neuropsychological Tests
Hanly, J. G., Omisade, Antonina, Su, Li, Farewell, Vernon, Linehan, Tina, Fisk, John D.
Computerized neuropsychological testing may facilitate screening by non-experts for cognitive impairment in SLE. The Automated Neuropsychological Assessment Metrics (ANAM) is a computerized test battery that takes 45 minutes to administer. We used ANAM to evaluate the cognitive performance of SLE patients compared to patients with rheumatoid arthritis (RA), multiple sclerosis (MS) and healthy controls.
Ambulatory patients with SLE (68), RA (33), and MS (20), with mild to moderate disease activity and severity, were compared to 29 healthy controls matched to SLE and MS patients for gender, age (±5 years) and education (±3 years). ANAM measures reaction time and accuracy in Simple Reaction Time (SRT), learning and recall using code substitution subtests (CDS and CDD), working memory using the Mathematical Processing (MTH) and the Sternberg Memory Scanning (ST6) subtests, sustained attention using a Continuous Performance subtest (CPT), visual-spatial processing using the Matching Grids (MSG) subtest, and short-term visual memory using the Match to Sample subtest (MSP). Efficiency of performance on each subtest was examined by "throughput"(TP) (number of correct responses per minute) and "inverse efficiency" (IE) (response speed/proportion of correct responses). Group differences were determined using O'Brien's generalized least squares test and all results were adjusted for age and education.
Overall group differences were found for both IE (p=0.01) and TP (p<0.01). Control subjects were the most efficient while MS patients were least efficient. MS patients also demonstrated less efficient performance in comparison to both SLE (p=0.01) and RA (p<0.01) patients who did not differ from each other. To examine for differences in the frequency of overall "impairment", patients' IE scores on each subtest as well as the SRT subtest scores were converted to Z scores, based on the normal subjects' performances on each ANAM subtest. Z >=-1.5 was considered to represent "impairment" in IE on any given subtest. Sixty-one percent of RA patients and 50% of SLE patients were impaired on at least one ANAM subtest compared to 75% of MS patients. Only 9% of RA patients and 11% of SLE patients were impaired in >= 4/7 ANAM subtests, whereas 20% of MS patients were impaired to this extent. Performance on specific ANAM subtests indicated that MS patients were most often impaired on SRT, CDD and MTH subtests; SLE patients were most often impaired on SRT, CDS and CDD subtests; RA patients were most often impaired on SRT, CDS, MTH and ST6 subtests.
ANAM is sensitive to cognitive impairment in patients with neurologic disease, such as MS. Patients with SLE and RA had comparable performance on ANAM subtests. Slowing on SRT was common for all patient groups. While computerized testing may be sensitive to cognitive impairment in SLE, our results emphasize the lack of specificity of such deficits in many SLE patients and the role of chronic disease in the etiology.
To cite this abstract, please use the following information:
Hanly, J. G., Omisade, Antonina, Su, Li, Farewell, Vernon, Linehan, Tina, Fisk, John D.; Assessment of Cognitive Function in Systemic Lupus Erythematosus, Rheumatoid Arthritis and Multiple Sclerosis Using Computerized Neuropsychological Tests [abstract]. Arthritis Rheum 2009;60 Suppl 10 :1574