Arthritis & Rheumatism, Volume 60,
October 2009 Abstract Supplement

The 2009 ACR/ARHP Annual Scientific Meeting
Philadelphia October 16-21, 2009.

Cardiovascular Disease, Cognitive Functioning, and Depression in SLE: A Study Using Diffusion Tensor Brain Imaging

Julian,  L. J., Katz,  P.P., Trupin,  L., Criswell,  L.A., Yelin,  E.H., Wofsy,  D., Henry,  R.


Cognitive dysfunction and depression are common in SLE; yet the causal mechanisms of these neuropsychiatric syndromes are unclear. The purpose of this study is to evaluate the associations of depression, cognitive function and white matter integrity. To study white matter abnormalities we used an improved neuroimaging technique, diffusion tensor imaging (DTI) which identifies microstructural changes in normal appearing white matter (NAWM). Additionally, the relationships among DTI, cognitive function, and depression were evaluated with a particular focus on cardiovascular (CV) disease as a potential risk factor for WM brain abnormalities.


Participants included 41 patients with diagnostically confirmed SLE and no history of other neurological syndrome who underwent a neuropsychological and psychiatric evaluation, and brain MRI. Cognitive measures included tests of learning and memory, executive functioning, and motor speed. MRI procedures were conducted on 3Tesla MRI (GE Medical Systems Milwaukee, WI). The primary DTI index in this study is fractional anisotropy (FA) of whole brain WM with lower values indicative of poorer WM structural integrity. Patients were also categorized as having high cardiovascular risk if they had >= 2 traditional CV risk factors including: history of CV event, hypertension, hypercholesterolemia, family history, current or past smoking, obesity, or diabetes. Pearson or Spearman correlation coefficients were calculated to estimate associations among variables. Group comparisons were conducted using t-tests.


Mean age of participants was 48±9 years, 70% had at least a high school education, and they were well represented across racial/ethnic groups. Average disease duration was 15.5±7.2 years. Reduced FA (reduced white matter integrity) was associated with increased CV risk (r=-.46, p<.01), and with reduced cognitive performance on measures of simple and complex sequencing, episodic memory, and working memory among patients with and without increased risk for cardiovascular disease (all p <.05). Depression was strongly associated with reduced FA among participants with increased CV risk (See Figure 1).

Figure 1. Depression and WM integrity among SLE patients stratified by CV risk


Alterations in WM structural integrity are associated with increased CV risk, depression, and poorer performance on measures of cognitive functioning. DTI can identify microstructural alterations in WM and may be a useful technique to study brain changes in SLE. The relationships with traditional CV risk factors provide some preliminary evidence in support of a vascular etiology for cognitive impairment and depression in SLE.

To cite this abstract, please use the following information:
Julian, L. J., Katz, P.P., Trupin, L., Criswell, L.A., Yelin, E.H., Wofsy, D., et al; Cardiovascular Disease, Cognitive Functioning, and Depression in SLE: A Study Using Diffusion Tensor Brain Imaging [abstract]. Arthritis Rheum 2009;60 Suppl 10 :1581
DOI: 10.1002/art.26655

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