title: Neurocognitive deficits and neuroimaging abnormalities are prevalent in children with lupus: clinical and research experiences at a US pediatric institution.
abstract: Neurocognitive impairments and neuroimaging abnormalities are frequently observed in adults with systemic lupus erythematosus. There is a paucity of similar data in childhood-onset disease. We hypothesized that neurocognitive and neuroimaging abnormalities would be prevalent in children undergoing neuropsychological evaluations. We reviewed patient neurocognitive evaluations performed at a large United States pediatric institution during the period 2001 to 2008. Records were retrieved from 24 children referred to neuropsychology due to clinical indications. Data from 15 children enrolled in a prospective structure-function association study were also analyzed. Subjects were predominantly African-American and Hispanic adolescent girls of average intelligence. aPL positivity and aspirin use was prevalent. Neurocognitive impairment was designated in 70.8% of retrospective, and 46.7% of prospective cohort patients. Deficits were seen at times of wellness, without previous neuropsychiatric lupus, and early in disease courses. Scores >1.5 standard deviations below published age-matched norms were common in tests of executive functioning, visual memory and visual-spatial planning. Features of depression were seen in 33.3% of the children in the retrospective cohort (clinical referrals). Cerebral and cerebellar volume loss was observed in a majority of blinded prospective cohort research magnetic resonance images (73.3% and 67.7% respectively). White matter hyperintensities were observed in retrospective and prospective cohort magnetic resonance images (36.6% and 46.7% respectively). Larger prospective studies that elucidate structure-function associations in children with systemic lupus erythematosus are planned.
authors.affiliation: Baylor College of Medicine and Pediatric Rheumatology Center, Texas Children's Hospital, Houston, Texas 77030, USA. emuscal@bcm.tmc.edu
authors.forename: E
authors.initials: E
authors.lastname: Muscal
authors.forename: D R
authors.initials: DR
authors.lastname: Bloom
authors.forename: J V
authors.initials: JV
authors.lastname: Hunter
authors.forename: B L
authors.initials: BL
authors.lastname: Myones
mesh_terms: D000293:Adolescent; D001741:Black or African American; D002531:Cerebellum / Q000473:pathology; D054022:Cerebrum / Q000473:pathology; D002648:Child; D003072:Cognition Disorders / Q000453:epidemiology / Q000209:etiology*; D015331:Cohort Studies; D003863:Depression / Q000453:epidemiology / Q000209:etiology*; D056344:Executive Function; D005260:Female; D006630:Hispanic or Latino; D006801:Humans; D008180:Lupus Erythematosus, Systemic / Q000150:complications*; D008279:Magnetic Resonance Imaging; D008297:Male; D009483:Neuropsychological Tests; D015995:Prevalence; D011446:Prospective Studies; D012189:Retrospective Studies; D014481:United States