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ACR Special Report: Chicago, IL 2011

Cognitive Function in Systemic Lupus Erythematosus

It has been known for years that lupus affects the central nervous system (CNS) as well as other organ systems, resulting in problems with thinking, remembering, and learning. These cognitive issues, along with other neurologic manifestations such as seizures and psychosis, affect about 80% of patients with lupus, said Robin L. Brey, MD, of the University of Texas Health Science Center in San Antonio, while about 70% of those with lupus experience mood disorders. Her comments came during a talk on cognitive issues in patients with lupus.

Neuropsychiatric lupus (NPSLE) can even occur without any other evidence of the disease, making it difficult to know if the neurological manifestation is due to lupus or some other condition, she said.

In fact, a host of other factors can influence cognitive function in normal people and in patients with autoimmune diseases, including sleep, social and cultural issues, psychiatric disorders such as depression and anxiety, preexisting or lupus-related central-nervous system (CNS) disorders, brain damage, medications, metabolic abnormalities and infection.

“The challenge for us is determining whether or not the neurological symptoms are due to the lupus, are primary central-nervous system (CNS) mediated, lupus-mediated CNS pathology, or whether they are secondary to other conditions,” she said.

It may also be that the autoimmune dysfunction itself triggers the cognitive dysfunction, with some studies finding similar levels of cognitive dysfunction in patients with rheumatoid arthritis, multiple sclerosis, and lupus.xv, xvi

“Does this mean that cognitive dysfunction in these patient groups is not related to the underlying disease?” Dr. Brey asked. “I say no, it doesn’t mean that at all.” Instead, she suggested that the underlying inflammation of all three diseases plays a role. Thus, she said, “the quest for looking for a specific cognitive dysfunction pattern in lupus that is not seen in other disease entities will stop us in our tracks in terms of progress.” Instead, what these studies show is that the result of inflammatory damage to the brain can be cognitive dysfunction. “It is a process that you can come to by several different mechanisms.”

Brain involvement in lupus may also be related to the damage that occurs in tiny blood vessels throughout the body, including those in the brain. In addition, she said, there also appears to be dysfunction in the blood-brain-barrier, which may allow autoantibodies access to the brain, leading to the production pro-inflammatory proteins further damaging the brain.

In the San Antonio Lupus Study of Neuropsychiatric Disease (SALUD) study she and her colleagues conducted, in which 65% of the patients were Hispanic, depression, disease activity, prednisone use, persistently positive antibodies, higher SLEDAI scores, were all risk factors for cognitive dysfunction, as was Hispanic ethnicity.

One reason Hispanics may have poorer cognitive function, she said, is that these patients are sicker overall and the effects of lupus in the brain are more pronounced.

More information about lupus and treatment advances can be found by visiting www.lupusresearch.org.

The Alliance for Lupus Research Special Report on the 2011 American College of Rheumatology Meeting was made possible in part by generous support from Genentech.

©2011 Alliance for Lupus Research. All Rights Reserved.

Contents herein may not be reproduced, republished or distributed without the prior written permission of the Alliance for Lupus Research. To request permission to reproduce, republish or distribute any part of this report, contact us at 212-218-2840 or email info@lupusresearch.org.

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