ISSN 2415-3060 (print), ISSN 2522-4972 (online)
  • 28 of 68
УЖМБС 2021, 6(5): 199–203
Clinical Medicine

Features of Cognitive Dysfunction in Patients with Systemic Lupus Erythematosus

Makarov S. O.

The purpose of the study was to explore the structure of cognitive impairment in patients with systemic lupus erythematosus and to determine the factors associated with its development. Materials and methods. Advanced examination of 64 patients with systemic lupus erythematosus was carried out. Neurological disorders were diagnosed in 54 patients (84.38% of patients). These patients were included in the main study group (group 1). In 10 (15.62% of patients) patients, these manifestations were not found and they entered the control group (group 2). The object of the study was cognitive impairment in patients with systemic lupus erythematosus. To assess the cognitive status of patients, the Montreal Cognitive Assessment Scale was used, a widely used questionnaire that evaluates cognitive functions across multiple domains. The laboratory study included blood tests to identify the type and titer of antinuclear antibodies, lupus anticoagulant, and antiphospholipid antibodies, in particular, anti-cardiolipin antibodies. Results and discussion. It was found that the complaints that patients usually present to describe impaired cognitive functions (such as "memory deterioration", "memory impairment", "decreased attention", "difficulty concentrating", etc.) were among the most common in patients with systemic lupus erythematosus. Thus, complaints of memory impairments were expressed by 37 patients (57.81% CI 45.71-69.91), impaired attention and concentration – 41 patients (64.06% CI 52.31-75.82), and between these complaints a strong correlation was established (r = 0.83; p <0.001). The results of the examination of patients using the Montreal Cognitive Assessment Scale showed that the average indicator among all examined is 25.0 (22.0; 27.5) points in the main group – 24.0 (22.0; 26.0) points, which is statistically significantly less (p <0.001) compared with the control group – 28.0 (27.0; 29.0) points. It was found that among patients who scored less than 26 points on the Montreal Cognitive Assessment Scale, there was a statistically significant decrease in indicators in the domains of memory, attention, and speech (p <0.001). It was found that there is a correlation between the presence of anti-cardiolipin antibodies with CD (determined by the Montreal Cognitive Assessment Scale) (rs = -0.56; p <0.001), the same correlation was found in relation to lupus anticoagulant (rs = -0.56; p <0.001). Conclusion. Cognitive dysfunction is one of the most common neurological manifestations of systemic lupus erythematosus. Among the examined patients, decrease in indicators in the domains of memory, attention and speech is the most often observed. Cognitive dysfunction may be associated with the production of certain classes of autoantibodies: antiphospholipid antibodies (in particular, anti-cardiolipin antibodies) and lupus anticoagulant

Keywords: systemic lupus erythematosus, cognitive dysfunction, Montreal Cognitive Assessment Scale, autoantibodies

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  1. Fujieda Y. Diversity of neuropsychiatric manifestations in systemic lupus erythematosus. Immunol Med. 2020; 43(4): 135-141.
  2. Lynall M. Neuropsychiatric symptoms in lupus. Lupus. 2018; 27(1): 18-20.
  3. Makarov SO. Urazhennya nervovoyi systemy pry systemnomu chervonomu vovchaku: aspekty patogenezu, poshyrenict', poglyady na klasyfikaciyu klinichnykh viyaviv [Defeat of the nervous system with system red lupus: aspects of pathogenesis, spreads, views on the classification of clinical manifestations]. Ukr Nevrolog Zh. 2018; 2: 25-29. [Ukrainian]
  4. Zabala A, Salgueiro M, Sáez-Atxukarro O, Ballesteros J, Ruiz-Irastorza G, Segarra R. Cognitive impairment in patients with neuropsychiatric and non-neuropsychiatric systemic lupus erythematosus: a systematic review and meta-analysis. J Int Neuropsychol Soc. 2018; 24(6): 629-639.
  5. Liang MH, Corzillius M, Bae SCh, Lew RA, Fortin PR, Isenberg D, Alarco´n GS, et al. The American College of Rheumatology nomenclature and case definitions for neuropsychiatric lupus syndromes. Arthritis Rheum. 1999; 42(4): 599-608.<599::AID-ANR2>3.0.CO;2-F
  6. Ainiala H, Loukkola J, Peltola J, Korpela M, Hietaharju A. The prevalence of neuropsychiatric syndromes in systemic lupus erythematosus. Neurology. 2001; 57(3): 496-500.
  7. Benedict RH, Shucard JL, Zivadinov R, Shucard DW. Neuropsychological impairment in systemic lupus erythematosus: a comparison with multiple sclerosis. Neuropsychol Rev. 2008; 18(2): 149-166.
  8. Huerta PT, Gibson EL, Rey C, Huerta TS. Integrative neuroscience approach to neuropsychiatric lupus. Immunol Res. 2015; 63(1): 11-17.
  9. Kozora E, Ellison MC, West S. Reliability and validity of the proposed American College of Rheumatology neuropsychological battery for systemic lupus erythematosus. Arthritis Rheum. 2004; 51(5): 810-818.
  10. Kozora E, Arciniegas DB, Filley CM, West SG, Brown M, Miller D, et al. Cognitive and neurologic status in patients with systemic lupus erythematosus without major neuropsychiatric syndromes. Arthritis Rheum. 2008; 59(1): 1639-1646.
  11. Mikdashi JA. Proposed response criteria for neurocognitive impairment in systemic lupus erythematosus clinical trials. Lupus. 2007; 16(6): 418-425.
  12. Gerosa M, Poletti B, Pregnolato F, Castellino G, Lafronza A, Silani V, et al. Antiglutamate receptor antibodies and cognitive impairment in primary antiphospholipid syndrome and systemic lupus erythematosus. Front immunol. 2016; 7: 5.
  13. Brey RL. Neuropsychiatric Lupus. Bulletin of the NYU Hospital for Joint Diseases. 2007; 65: 3.
  14. Szmyrka M, Pokryszko-Dragan A, Słotwiński K, Gruszka E, Korman L, Podemski R, et al. Cognitive impairment, event-related potentials and immunological status in patients with systemic lupus erythematosus. Adv Clin Exp Med. 2019; 28(2): 185-192.
  15. Ünlü O, Zuily S, Erkan D. The clinical significance of antiphospholipid antibodies in systemic lupus erythematosus. Eur J Rheum. 2016; 3(2): 75.
  16. Nasreddine ZS, Phillips NA, Bédirian V, Charbonneau S, Whitehead V, Collin I, et al. The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment. J Am Geriatr Soc. 2005; 53(4): 695-99.
  17. Yue R, Gurung I, Long XX, Xian JY, Peng XB. Prevalence, involved domains, and predictor of cognitive dysfunction in systemic lupus erythematosus. Lupus. 2020; 29(13): 1743-1751.
  18. Yelnik CM, Kozora E, Appenzeller S. Non-stroke central neurologic manifestations in antiphospholipid syndrome. Curr Rheum Rep. 2016; 18(2): 11.
  19. Yelnik CM, Kozora E, Appenzeller S. Cognitive disorders and antiphospholipid antibodies. Autoimmun Rev. 2016; 15(2): 1193-1198.
  20. Ceccarelli F, Perricone C, Pirone C, Massaro L, Alessandri C, Mina C, et al. Cognitive dysfunction improves in systemic lupus erythematosus: results of a 10 years prospective study. PLoS One. 2018; 3(5): e0196103.