CHICAGO—Cognitive impairment. Memory loss. Headaches. Psychosis. These symptoms are not uncommon in patients with systemic lupus erythematosus (SLE). In fact, “over 80% of SLE patients experience some type of neurologic manifestation during their disease course,” said Robin L. Brey, MD, professor and chair of neurology at the University of Texas Health Science Center at San Antonio.
The challenge for rheumatologists and other clinicians lies in appropriately diagnosing any cognitive dysfunctions that accompany lupus and better understanding the causes and risk factors of those dysfunctions, Dr. Brey said.
“Cognitive Function in SLE” was the focus of a talk by Dr. Brey at the 2011 ACR/ARHP Annual Scientific Meeting in November. [Editor’s note: This session was recorded and is available via ACR SessionSelect at www.rheumatology.org.]
Look at the Numbers
Studies show varying percentages of SLE patients who experience cognitive dysfunction and neuropsychiatric symptoms, Dr. Brey said. “If you look at studies that try to estimate a frequency of neurologic manifestations in lupus, it’s all over the place,” she said. However, studies that use neuropsychiatric testing consistently find a higher frequency of cognitive dysfunction, she explained.
Studies conducted with sensitive testing instruments find 69% to 74% of SLE patients experiencing mood disorders and 75% to 80% experiencing cognitive dysfunction, she said.
Contrary to that, a 2007 study found only 12.4% of SLE patients had mood disorders and only 5.4% had cognitive dysfunction.1 “You might ask, ‘Who’s right?’ ” Dr. Brey said. “I’d say both. The [latter] study didn’t use sensitive instruments to look at these factors. I think the answer is somewhere in the middle.”
Research has found that neuropsychiatric damage is the most common domain involved in lupus, followed by renal and ocular domains, noted Dr. Brey. “This is one of the best arguments for paying attention to the nervous system in lupus patients,” she said.
One challenge in pinpointing cognitive dysfunction in potential SLE patients is that these symptoms can manifest in the absence of serologic activity, Dr. Brey said. “It can make it difficult to know if the neurological manifestations are due to lupus or something else. The challenge for those of us taking care of these patients is to try to determine if neurological symptoms are due to lupus or whether they are secondary to other things,” she said.
This becomes even more challenging when you consider that some of the cognitive symptoms, such as headaches, anxiety, and mild depression, are common in the general population. However, studies focusing specifically on neurological symptoms in SLE find headaches, seizures, stroke, and psychosis to be consistently more common, Dr. Brey said.