Patients with systemic lupus erythematosus often report severe and distressing symptoms of cognitive dysfunction, such as confusion, inability to concentrate, and forgetfulness. These symptoms are manifestations of neurological lupus which, while difficult to diagnose clinically, can be assessed by formal neuropsychological testing. In the past, although cognitive dysfunction in lupus was attributed to diffuse brain damage induced by antibodies, new imaging tools can demonstrate that brain injury can be localized and restricted anatomically to specific brain regions. Prior ideas about the pathogenesis of brain dysfunction focused on gray-matter injury. New research, however, points to white-matter injury as an increasingly likely explanation for patient symptoms.
Leaps in Brain Science
Neuropsychologists distinguish among various domains of cognitive function: attention, learning and memory, reasoning, and visuomotor skills. These domains have specific anatomic addresses in the brain, and lupus patients display distinct patterns of abnormalities in these domains. However, neurobiologists, neuropsychologists, neurologists, and rheumatologists can speak different scientific languages. Judah Denburg, MD, professor of medicine at McMaster University in Hamilton, Ontario, in 1990 and Matthew Liang, MD, MPH, professor of medicine at Harvard Medical School in Boston, in 1998 convened conferences to facilitate communication across disciplines, calling for standardized vocabularies and definitions, but controversies regarding mechanisms and treatments remain. These controversies unfortunately can limit investigation into disease pathogenesis and the development of a coherent approach to therapy.
In the 10 years since the last conference on neurological lupus, awards for research on the nervous system have abounded. The 2000 Nobel Prize was awarded to Arvid Carlsson, ML, MD, Paul Greengard, PhD, and Eric Kandel, MD, for their studies on signal transduction in the central nervous system; the 2004 Nobel Prize was awarded to Richard Axel, MD, and Linda Buck, PhD, for studies on the organization of the olfactory system; and the 2003 Nobel Prize was awarded to Paul Lauterber, PhD, and Sir Peter Mansfield, PhD, for the science underlying magnetic resonance imaging (MRI). Together, these advances have provided new tools for the study of abnormalities in cognition, as well as other aspects of higher brain function. Indeed, cognition is now an important research focus in the fields of traumatic brain injury, progressive neurological disease (such as Alzheimer’s and Parkinson’s diseases), genetic disorders (Huntington’s disease), and miscellaneous neurological (headaches and cerebral vascular disease) and medical (post–coronary artery bypass surgery, post-anesthesia) disorders.
Table 1: Neuro Vocabulary
Cognitive efficiency: The ease or proficiency of information processing skills, such as complex attention, problem solving, and reasoning, necessary for mental operations. Tests often involve the speed at which mental tasks can be done.
