A prospective functional MRI study for executive function in patients with systemic lupus erythematosus without neuropsychiatric symptoms.
OBJECTIVE
To study the functional brain activation signals before and after sufficient disease control in patients with systemic lupus erythematosus (SLE) without clinical neuropsychiatric symptoms.


METHODS
Blood-oxygen-level-dependent signals during event-related functional magnetic resonance imaging brain were recorded, while 14 new-onset SLE patients and 14 demographically and intelligence quotient matched healthy controls performed the computer-based Wisconsin card sorting test for assessing executive function, which probes strategic planning and goal-directed task performance during feedback evaluation (FE) and response selection (RS), respectively. Composite beta maps were constructed by a general linear model to identify regions of cortical activation. Blood-oxygen-level-dependent functional magnetic resonance imaging signals were compared between (1) new-onset SLE patients and healthy controls and (2) SLE patients before and after sufficient control of their disease activity.


RESULTS
During RS, SLE patients demonstrated significantly higher activation than healthy controls in both caudate bodies and Brodmann area (BA) 9 to enhance event anticipation, attention, and working memory, respectively, to compensate for the reduced activation during FE in BA6, 13, 24, and 32, which serve complex motor planning and decision-making, sensory integration, error detection, and conflict processing, respectively. Despite significant reduction of SLE activity, BA32 was activated during RS to compensate for reduced activation during FE in BA6, 9, 37, and 23/32, which serve motor planning, response inhibition and attention, color processing and word recognition, error detection, and conflict evaluation, respectively.


CONCLUSIONS
Even without clinically overt neuropsychiatric symptoms, SLE patients recruited additional pathways to execute goal-directed tasks to compensate for their reduced strategic planning skill despite clinically sufficient disease control.
Division of Rheumatology, Department of Medicine, University Medicine Cluster, Yong Loo Lin School of Medicine, National University of Singapore, Singapore. mdcam@nus.edu.sg
Anselm
A
Mak
Tao
T
Ren
Erin Hui-yun
EH
Fu
Alicia Ai-cia
AA
Cheak
Roger Chun-man
RC
Ho
D000328:Adult; D000368:Aged; D001288:Attention / Q000502:physiology*; D001921:Brain / Q000503:physiopathology*; D001931:Brain Mapping; D003657:Decision Making / Q000502:physiology; D056344:Executive Function / Q000502:physiology*; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008180:Lupus Erythematosus, Systemic / Q000175:diagnosis* / Q000503:physiopathology* / Q000523:psychology; D008279:Magnetic Resonance Imaging; D008297:Male; D008570:Memory, Short-Term / Q000502:physiology*; D008875:Middle Aged; D009483:Neuropsychological Tests; D011446:Prospective Studies