title: Cognitive and neurologic status in patients with systemic lupus erythematosus without major neuropsychiatric syndromes.
abstract: OBJECTIVE
  To examine neuropsychological and neurologic functioning in systemic lupus erythematosus (SLE) patients without histories of overt neuropsychiatric disorders (non-NPSLE patients).
  
  
  METHODS
  Sixty-seven non-NPSLE patients and 29 healthy controls were administered a standardized neurologic examination and measures of cognition, depression, and self-reported cognitive functioning.
  
  
  RESULTS
  Non-NPSLE patients scored lower than controls on the total score of the neurologic examination (P < 0.0001). Item analysis indicated that the physician's description of mentation and mood was the only item that differed significantly between patients with SLE and controls (P = 0.004). Compared with controls, non-NPSLE patients had significantly higher rates of impairment on logical reasoning (P = 0.012) and verbal memory (P = 0.03), and trends toward greater impairment on visual attention (P = 0.06) and working memory (P = 0.098). There were no significant differences between non-NPSLE patients and controls on a cognitive impairment index (CII): 20.9% of non-NPSLE patients and 13.8% of controls were impaired. Patients with SLE scored higher on depressive symptoms (P < 0.0001) and perceived cognitive difficulties (P = 0.001) compared with controls.
  
  
  CONCLUSIONS
  The utility of a standardized neurologic examination in SLE for excluding overt neurologic dysfunction and assuring a non-NPSLE group selection was demonstrated. In contrast to our earlier study, we did not find differences between non-NPSLE patients and controls on the CII. Slightly lower CII scores in non-NPSLE patients and higher CII scores in controls may have reduced cognitive differences between these groups. Non-NPSLE patients demonstrate specific decline in the areas of attention, memory, and reasoning; continued studies of associated brain regions are warranted.
authors.affiliation: National Jewish Medical and Research Center and University of Colorado Denver Health Sciences Center, Denver, Colorado 80206, USA. Kozorae@njc.org
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Kozora
authors.forename: David B
authors.initials: DB
authors.lastname: Arciniegas
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Filley
authors.forename: Sterling G
authors.initials: SG
authors.lastname: West
authors.forename: Mark
authors.initials: M
authors.lastname: Brown
authors.forename: David
authors.initials: D
authors.lastname: Miller
authors.forename: Alex
authors.initials: A
authors.lastname: Grimm
authors.forename: Maria D
authors.initials: MD
authors.lastname: Devore
authors.forename: Christy
authors.initials: C
authors.lastname: Wingrove
authors.forename: Lening
authors.initials: L
authors.lastname: Zhang
mesh_terms: D000328:Adult; D001288:Attention / Q000502:physiology; D001921:Brain / Q000503:physiopathology; D016022:Case-Control Studies; D003071:Cognition / Q000502:physiology*; D003072:Cognition Disorders / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology / Q000523:psychology; D003863:Depression / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008180:Lupus Erythematosus, Systemic / Q000503:physiopathology* / Q000523:psychology*; D008297:Male; D008568:Memory / Q000502:physiology; D008875:Middle Aged; D009422:Nervous System Diseases / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology / Q000523:psychology; D009460:Neurologic Examination; D009483:Neuropsychological Tests