title: Cognitive impairment and employment status in systemic lupus erythematosus: a prospective longitudinal study.
abstract: OBJECTIVE
  To determine the relationship between cognitive impairment and employment in patients with systemic lupus erythematosus (SLE).
  
  
  METHODS
  A total of 167 consecutive patients with SLE were prospectively evaluated, and underwent standardized neuropsychological tests. Multivariate logistic regression was used to determine the likelihood of being unemployed, adjusting for sociodemographic characteristics, employment status at study entry, disease activity, disease duration, damage scores, and depression.
  
  
  RESULTS
  At study entry, 118 (70.7%) of 167 patients were employed. In the multivariate analysis, after adjusting for confounders, unemployment was predicted by the number of cognitive domains impaired (odds ratio [OR] 1.76, 95% confidence interval [95% CI] 1.58-6.72), depression (OR 1.3, 95% CI 1.1-3.1), fewer years of education (OR 0.12, 95% CI 0.02-0.34), and the presence of anticardiolipin antibodies (OR 1.43, 95% CI 1.2-6.1). Complex attention (OR 1.7, 95% CI 1.2-3.6), memory (OR 3.1, 95% CI 1.5-6.2), and executive functions (OR 2.4, 95% CI 1.9-6.1) were predictors of unemployment at study entry. After 3 years, 61 (51.7%) of 118 patients were employed (OR 2.25, 95% CI 1.38-3.68; P = 0.001). The likelihood of being unemployed after 3 years was predicted by the number of cognitive domains impaired (OR 3.8, 95% CI 2.5-7.71), depression (OR 2.31, 95% CI 1.01-5.21), fewer years of education (OR 0.09, 95% CI 0.01-0.42), and the presence of anticardiolipin antibodies (OR 2.1, 95% CI 1.2-4.9). Complex attention (OR 2.2, 95% CI 1.1-3.8), memory (OR 3.6, 95% CI 2.1-6.4), executive functions (OR 1.8, 95% CI 1.2-7.3), and reasoning/problem solving (OR 1.9, 95% CI 1.4-7.2) were associated with unemployment after 3 years.
  
  
  CONCLUSIONS
  The number of cognitive spheres, and especially attention, memory, and executive functions, are important factors associated with unemployment in patients with SLE.
authors.affiliation: Department of Medicine, Rheumatology Unit, University of Campinas-UNICAMP, Cidade Universitária, Campinas SP, Brazil, CEP 13083-970. appenzellersimone@yahoo.com
authors.forename: Simone
authors.initials: S
authors.lastname: Appenzeller
authors.forename: Fernando
authors.initials: F
authors.lastname: Cendes
authors.forename: Lilian T L
authors.initials: LT
authors.lastname: Costallat
mesh_terms: D000293:Adolescent; D000328:Adult; D017153:Antibodies, Anticardiolipin / Q000097:blood; D001288:Attention; D003072:Cognition Disorders / Q000523:psychology*; D003863:Depression / Q000523:psychology; D004651:Employment / Q000523:psychology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016015:Logistic Models; D008137:Longitudinal Studies; D008180:Lupus Erythematosus, Systemic / Q000097:blood / Q000523:psychology*; D008297:Male; D008568:Memory; D008875:Middle Aged; D015999:Multivariate Analysis; D009483:Neuropsychological Tests; D011446:Prospective Studies; D055815:Young Adult
chemical_list: D017153:Antibodies, Anticardiolipin