Arthritis & Rheumatism, Volume 60,
October 2009 Abstract Supplement
The 2009 ACR/ARHP Annual Scientific Meeting
Philadelphia October 16-21, 2009.
Cognitive Dysfunction in Patients with SLE: A Prospective Study
Antonchak1, Marc A., Saoudian1, Mahnaz, Khan1, Amber, Adhikari1, Tara, Brunner2, Hermine, Luggen1, Michael E.
Cognitive dysfunction (CD) has been reported to occur frequently in SLE. It is unclear, however, it this CD is transient, persistent, or progressive. Published reports have estimated persistence or progression in anywhere from 17% to 93% of patients. These widely divergent results may be due in part to the definition of CD employed and the lack of assessment of pre-morbid cognitive function. The later can result in misclassification with both false positive (pts with low native intelligence who score low) and false negative determinations (pts with high native intelligence who now fall within the "normal" range). Chronic rheumatic diseases cause pain, fatigue, and depression which may affect cognitive function. All studies to date have employed normal healthy individuals as controls. Definitions of CD relative to this population will identify some pts whose major problems are depression, pain, or fatigue, which may improve, and some who have structural CNS disease, which may not.
A random subsample of SLE patients referred by community-based primary care physicians was examined at baseline and after 6 months. Cognitive function was assessed by the ANAM (Automated Neuropyschologic Assessment Metrics), a validated, computerized, cognitive testing battery, utilizing as the primary outcome measure the total throughput score (TTS=total number of correct responses/time). Disease activity, damage, and treatment variables were ascertained at baseline and at 6 mos. Premorbid intelligence was estimated by the Peabody Picture Vocabulary Test (PPVT) which correlates with other measures of native intelligence and is minimally affected by moderate CNS disease. Abnormality was defined as having scores 2 SD below the mean of an age and sex matched RA control population. The results were compared using paired t-tests or Wilcoxon sign rank test
Ninety-six SLE patients were randomly selected. Twenty-nine have been evaluated to date on at least two occasions. Comparisons of baseline scores with scores at 6 months showed no significant differences in 6 of the 10 ANAM subtests but statistically significant improvement in 4 subtests and in the TTS (by ~8%, P=0.0007). The median PPVT standardized score was 99.0 (IQR: 93.5, 111.0). The PPVT did not appear to be correlated with TTS at baseline or 6 mos. At baseline, 5/29 (17.2%) patients had abnormal TTS. Three of the 5 pts remained impaired at 6 mos and 2 improved.
Using RA controls, 17.2% of a community based SLE cohort had CD. Most of these had persistent deficits. However, most SLE pts had normal cognitive function which remained stable or improved over 6 mos. Adjustment for premorbid intelligence did not appear to influence results in this sample. This study suggests that, in a community based population, significant CD is uncommon.
To cite this abstract, please use the following information:
Antonchak, Marc A., Saoudian, Mahnaz, Khan, Amber, Adhikari, Tara, Brunner, Hermine, Luggen, Michael E.; Cognitive Dysfunction in Patients with SLE: A Prospective Study [abstract]. Arthritis Rheum 2009;60 Suppl 10 :1576