Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement
Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.
Cognitive Dysfunction in Systemic Lupus Erythematosus: Development of a Screening Tool.
Adhikari2, Tara, Piatti2, Andres, Luggen1, Michael
Cognitive Dysfunction (CD) is said to occur frequently is SLE and to be associated with increased unemployment rates and decreased quality of life. Yet, it is oftentimes undiagnosed because of difficulties in doing so. There are only two validated tools for detecting the CD in SLE patients. Traditional neuropsychologic testing (NPT), which consist of a variable battery of tests, administered and interpreted by a clinical psychologist, requiring 4 to 6 hours to complete, and costing oftentimes over $1000. And, the Automated Neuropsychologic Assessment Metrics (ANAM), a computerized battery of tests which assess some of the same cognitive domains as NPT, requires approximately 45 minutes, and costs approximately $400 for a software license. While more efficient and less costly, the ANAM is neither readily available nor practical for clinic administration or for screening larger populations. What is needed for both situations is a brief, sensitive, and reliable screening questionnaire.
The Montreal Cognitive Assessment Questionnaire (MoCA) has been developed and tested to identify mild cognitive impairment in the elderly. It is a brief (<10 mins), performance-based questionnaire that has been utilized in a number of other diseases with fair sensitivity (8590%) and variable specificity (5387%). The MoCA has never been utilized to screen for CD in patients with lupus.
Patients with SLE fulfilling American College of Rheumatology criteria were recruited and evaluated. Demographic, clinical, and treatment information was obtained. In addition, depression was assessed using the Beck Depression Inventory (BDI) and fatigue, pain, and overall well being scored on a 10 cm visual analogue scale. All subjects were administered the ANAM as the gold standard and the MoCA.
The total throughput score (TTS) is a standard measure of cognitive performance of the ANAM. It is the average of the total number of correct responses/time required for those responses. Abnormal was defined as any score 2 SD or more below the mean established for a comparable rheumatoid arthritis population. The scores of the MoCA were compared to the TTS and the classification of normal or abnormal by the ANAM compared to that of the MoCA using various cutoffs.
Descriptive statistics of the study population were computed. Using various cutpoints for the MoCA, the sensitivity, specificity, accuracy, predictive values, and likelihood ratios were also computed.
Fourty-four (44) patients have been recruited to date. Eleven (25%) were identified by the ANAM as being impaired in comparison to 13 (29.5%) by the MoCA. The scores of the two tests were significantly correlated (r =0.57, p <.001). Using the standard cut-off of 26, the sensitivity of MoCA was 83%, specificity 73%, accuracy 75%, with a positive predictive value of 50% and negative predictive value of 92% compared to ANAM. Other cut points were less efficient.
The MoCA appears to be a useful screening tool for the detection of CD in SLE using the standard cutoff of 26. However, improved performance might be obtained by weighting individual questions differently or by developing additional items with enhanced discrimination.
To cite this abstract, please use the following information:
Adhikari, Tara, Piatti, Andres, Luggen, Michael; Cognitive Dysfunction in Systemic Lupus Erythematosus: Development of a Screening Tool. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :1855