The LUMINA study found cognitive impairment, cerebrovascular disease, and seizures to be the most common neurological dysfunction symptoms in lupus patients, Dr. Brey said.2
Not Alone in Their Symptoms
Interestingly, SLE patients are not alone in their experience of cognitive dysfunction, Dr. Brey said. A 2010 study published in Arthritis & Rheumatism tested 68 patients with SLE, 33 with rheumatoid arthritis (RA), and 20 with multiple sclerosis (MS), and compared them with 29 normal controls.3 Using a computerized test battery, all patient groups performed more poorly than the controls, but the MS patients performed the worst. The results were nearly identical for the SLE and RA patients. A 2011 study comparing 31 SLE patients with a matched sample of 31 RA patients also found no difference in cognitive function between patients with SLE and RA, Dr. Brey said.4
Both SLE and RA have inflammation in common, Dr. Brey said. “The quest to look for a specific cognitive function in lupus not seen in other disease entities will probably stop us in our tracks,” she said. “I think the end result of inflammatory damage to white matter can be cognitive dysfunction. We’re looking at a process you can come to by several different mechanisms.”
Clinicians should consider preexisting or SLE-related central nervous system (CNS) disorders that might make cognitive dysfunction more common, Dr. Brey said. This can include CNS disorders like strokes, head injuries, seizures, or learning disabilities; psychiatric disorders; the use of certain medications; metabolic abnormalities; infections; physiologic conditions, such as sleep deprivation or pain; and social and cultural factors.
Research done by Dr. Brey and others also seems to indicate that ethnicity can play a role in cognitive dysfunction in SLE. In those bodies of work, Hispanic patients have had higher depression scores, higher acute disease activity scores, and more signs of cognitive dysfunction. This may be due to these patients being sicker overall.
“The pathophysiology of cognitive dysfunction is heterogeneous and may be different in different populations,” she said.
Dr. Brey and colleagues are also examining whether language barriers during testing make a difference in this area.
The role of medications in cognitive dysfunction and SLE remains uncertain, Dr. Brey said. Consistent prednisone use, particularly in high doses, has been found to be a risk factor for dysfunction, she said. On the other hand, the use of immunosuppressive therapy has been found in at least one study to provide a protective effect.
