title: Neurocognitive dysfunction in systemic lupus erythematosus: association with antiphospholipid antibodies, disease activity and chronic damage.
abstract: BACKGROUND
  Systemic lupus erythematosus (SLE) is characterized by frequent neuropsychiatric involvement, which includes cognitive impairment (CI). We aimed at assessing CI in a cohort of Italian SLE patients by using a wide range of neurocognitive tests specifically designed to evaluate the fronto-subcortical dysfunction. Furthermore, we aimed at testing whether CI in SLE is associated with serum autoantibodies, disease activity and chronic damage.
  
  
  METHODS
  Fifty-eight consecutive patients were enrolled. Study protocol included data collection, evaluation of serum levels of ANA, anti-dsDNA, anti-cardiolipin, anti-β(2)-glycoprotein I, anti-P ribosomal, anti-endothelial cell, and anti-Nedd5 antibodies. SLEDAI-2000 and SLICC were used to assess disease activity and chronic damage. Patients were administered a test battery specifically designed to detect fronto-subcortical dysfunction across five domains: memory, attention, abstract reasoning, executive function and visuospatial function. For each patient, the raw scores from each test were compared with published norms, then transformed into Z scores (deviation from normal mean), and finally summed in the Global Cognitive Dysfunction score (GCDs).
  
  
  RESULTS
  Nineteen percent of patients had mild GCDs impairment (GCDs 2-3), 7% moderate (GCDs 4-5) and 5% severe (GCDs≥6). The visuospatial domain was the most compromised (MDZs = -0.89±1.23). Anti-cardiolipin IgM levels were associated with visuospatial domain impairment (r = 0.331, P = 0.005). SLEDAI correlated with GCDs, and attentional and executive domains; SLICC correlated with GCDs, and with visuospatial and attentional domains impairment.
  
  
  CONCLUSIONS
  Anti-phospholipids, disease activity, and chronic damage are associated with cognitive dysfunction in SLE. The use of a wide spectrum of tests allowed for a better selection of the relevant factors involved in SLE cognitive dysfunction, and standardized neuropsychological testing methods should be used for routine assessment of SLE patients.
authors.affiliation: Lupus Clinic, Reumatologia, Dipartimento di Medicina Interna e Specialità Mediche, Sapienza Università di Roma, Rome, Italy.
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Conti
authors.forename: Cristiano
authors.initials: C
authors.lastname: Alessandri
authors.forename: Carlo
authors.initials: C
authors.lastname: Perricone
authors.forename: Rossana
authors.initials: R
authors.lastname: Scrivo
authors.forename: Soheila
authors.initials: S
authors.lastname: Rezai
authors.forename: Fulvia
authors.initials: F
authors.lastname: Ceccarelli
authors.forename: Francesca Romana
authors.initials: FR
authors.lastname: Spinelli
authors.forename: Elena
authors.initials: E
authors.lastname: Ortona
authors.forename: Massimo
authors.initials: M
authors.lastname: Marianetti
authors.forename: Concetta
authors.initials: C
authors.lastname: Mina
authors.forename: Guido
authors.initials: G
authors.lastname: Valesini
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D017153:Antibodies, Anticardiolipin / Q000097:blood / Q000276:immunology; D000974:Antibodies, Antinuclear / Q000097:blood / Q000276:immunology; D017152:Antibodies, Antiphospholipid / Q000097:blood / Q000276:immunology; D001323:Autoantibodies / Q000097:blood / Q000276:immunology; D003072:Cognition Disorders / Q000097:blood / Q000276:immunology* / Q000503:physiopathology*; D015331:Cohort Studies; D042783:Endothelial Cells / Q000276:immunology; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood / Q000276:immunology; D016015:Logistic Models; D008180:Lupus Erythematosus, Systemic / Q000097:blood / Q000276:immunology* / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009483:Neuropsychological Tests; D058112:Septins / Q000276:immunology; D055815:Young Adult
chemical_list: D017153:Antibodies, Anticardiolipin; D000974:Antibodies, Antinuclear; D017152:Antibodies, Antiphospholipid; D001323:Autoantibodies; D007074:Immunoglobulin G; C000602252:SEPTIN2 protein, human; D058112:Septins