It is also important to consider the effects of cognitive dysfunction in children with SLE, Dr. Brey said. A 2010 study published in Lupus found that, retrospectively, 70.8% of 39 children tested had cognitive impairment. Prospectively, the percentage went down to 46.7%.5 However, 67.7% of the children studied had atrophy or damage to the white matter in the brain. “Connections are still being formed in these patients, and the brain is more sensitive to toxicity. Those cells are killed with subsequent dysfunction and damage,” she said. More research should be done in this area, Dr. Brey believes.
Treatment and Future Research
There is no specific treatment now for neuropsychiatric lupus, Dr. Brey said. “We don’t really understand what we need to chase with high-dose immunosuppressives and what we don’t,” she said. “Until we have better markers, we won’t have the answer.” Cognitive therapies, treating depression if it is present, and treating anything that could have an impact on cognitive dysfunction are all ways to provide at least some treatment. For mild cognitive impairment, Dr. Brey uses hydroxychloroquine and aspirin. Only if cognitive dysfunction is severe will Dr. Brey treat the patient with high-dose immunosuppressives.
One point that clinicians and researchers might want to focus on in the future is how to intervene and make symptoms of mild to moderate impairment better for patients, Dr. Brey said.
Future research should also focus on the best targeted therapies for lupus patients experiencing cognitive dysfunction and finding the most appropriate imaging techniques to monitor changes to the brain, Dr. Brey said.
Vanessa Caceres is a freelance medical writer in Bradenton, Florida.
References
- Hanly JG, Urowitz MB, Sanchez-Guerrero J, et al. Neuropsychiatric events at the time of diagnosis of systemic lupus erythematosus: An international inception cohort study. Arthritis Rheum. 2007;56:265-273.
- González LA, Pons-Estel GJ, Zhang J, et al. Time to neuropsychiatric damage occurrence in LUMINA (LXVI): A multi-ethnic lupus cohort. Lupus. 2009;18:822-830.
- Hanly JG, Omisade A, Su L, Farewell V, Fisk JD. Assessment of cognitive function in systemic lupus erythematosus, rheumatoid arthritis, and multiple sclerosis by computerized neuropsychological tests. Arthritis Rheum. 2010;62:1478-1486.
- Antonchak MA, Saoudian M, Khan AR, Brunner HI, Luggen ME. Cognitive dysfunction in patients with systemic lupus erythematosus: A controlled study. J Rheumatol. 2011; 38:1020-1025.
- Muscal E, Bloom DR, Hunter JV, Myones BL.Neurocognitive deficits and neuroimaging abnormalities are prevalent in children with lupus: Clinical and research experiences at a US pediatric institution. Lupus. 2010;19:268-2679.
