title: Neurocognitive impairment in corticosteroid-naive patients with active systemic lupus erythematosus: a prospective study.
abstract: OBJECTIVE
  Neurocognitive impairment (NCI) has been intensively studied in patients with systemic lupus erythematosus (SLE). However, those studies have mostly included patients who were treated with corticosteroids, which may itself induce NCI. We investigated NCI in corticosteroid-naive people with SLE who did not exhibit any overt neuropsychiatric manifestations.
  
  
  METHODS
  Forty-three inpatients with SLE who had no current or past neuropsychiatric history participated in the study. Patients and 30 healthy control subjects with similar demographic characteristics were given a 1-h battery of neuropsychological tests. NCI was defined as scores at least 2 SD below the mean of the healthy control group on at least 2 of the 7 neurocognitive domains. Results of clinical, laboratory, and neurologic tests were compared regarding the presence of NCI.
  
  
  RESULTS
  NCI was identified in 12 patients (27.9%) with SLE and in 2 control subjects (6.7%). Patients with SLE showed a significant impairment compared with controls on tasks assessing immediate recall, complex attention/executive function, and psychomotor speed. We identified psychomotor speed (Digit Symbol Substitution Test) as the factor that best differentiated the 2 groups. Further, we identified the score of the SLE Disease Activity Index 2000 as an independent risk factor for NCI in patients with SLE.
  
  
  CONCLUSIONS
  We conclude that reduced psychomotor speed is an SLE-specific pattern of NCI. Verbal-memory deficits that have been reported in patients with SLE were not evident among patients who were corticosteroid-naive. Our results indicate that impaired psychomotor speed may be added to the symptoms of early SLE.
authors.affiliation: From the Department of Psychiatry and Institute of Rheumatology, Tokyo Women's Medical University School of Medicine, Tokyo; Kanagawa Psychiatric Center, Yokohama; Department of Pharmacovigilance, Graduate School, Tokyo Medical and Dental University; Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan.K. Nishimura, MD, PhD; J. Ishigooka, MD, PhD, Department of Psychiatry, Tokyo Women's Medical University School of Medicine; M. Omori, MD, Kanagawa Psychiatric Center; Y. Katsumata, MD, PhD; E. Sato, MD; T. Gono, MD, PhD; Y. Kawaguchi, MD, PhD; H. Yamanaka, MD, PhD, Institute of Rheumatology, Tokyo Women's Medical University; M. Harigai, MD, PhD, Department of Pharmacovigilance, Graduate School, Tokyo Medical and Dental University; M. Mimura, MD, PhD, Department of Neuropsychiatry, Keio University School of Medicine. nishimura.katsuji@twmu.ac.jp.
authors.forename: Katsuji
authors.initials: K
authors.lastname: Nishimura
authors.affiliation: From the Department of Psychiatry and Institute of Rheumatology, Tokyo Women's Medical University School of Medicine, Tokyo; Kanagawa Psychiatric Center, Yokohama; Department of Pharmacovigilance, Graduate School, Tokyo Medical and Dental University; Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan.K. Nishimura, MD, PhD; J. Ishigooka, MD, PhD, Department of Psychiatry, Tokyo Women's Medical University School of Medicine; M. Omori, MD, Kanagawa Psychiatric Center; Y. Katsumata, MD, PhD; E. Sato, MD; T. Gono, MD, PhD; Y. Kawaguchi, MD, PhD; H. Yamanaka, MD, PhD, Institute of Rheumatology, Tokyo Women's Medical University; M. Harigai, MD, PhD, Department of Pharmacovigilance, Graduate School, Tokyo Medical and Dental University; M. Mimura, MD, PhD, Department of Neuropsychiatry, Keio University School of Medicine.
authors.forename: Masako
authors.initials: M
authors.lastname: Omori
authors.affiliation: From the Department of Psychiatry and Institute of Rheumatology, Tokyo Women's Medical University School of Medicine, Tokyo; Kanagawa Psychiatric Center, Yokohama; Department of Pharmacovigilance, Graduate School, Tokyo Medical and Dental University; Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan.K. Nishimura, MD, PhD; J. Ishigooka, MD, PhD, Department of Psychiatry, Tokyo Women's Medical University School of Medicine; M. Omori, MD, Kanagawa Psychiatric Center; Y. Katsumata, MD, PhD; E. Sato, MD; T. Gono, MD, PhD; Y. Kawaguchi, MD, PhD; H. Yamanaka, MD, PhD, Institute of Rheumatology, Tokyo Women's Medical University; M. Harigai, MD, PhD, Department of Pharmacovigilance, Graduate School, Tokyo Medical and Dental University; M. Mimura, MD, PhD, Department of Neuropsychiatry, Keio University School of Medicine.
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Katsumata
authors.affiliation: From the Department of Psychiatry and Institute of Rheumatology, Tokyo Women's Medical University School of Medicine, Tokyo; Kanagawa Psychiatric Center, Yokohama; Department of Pharmacovigilance, Graduate School, Tokyo Medical and Dental University; Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan.K. Nishimura, MD, PhD; J. Ishigooka, MD, PhD, Department of Psychiatry, Tokyo Women's Medical University School of Medicine; M. Omori, MD, Kanagawa Psychiatric Center; Y. Katsumata, MD, PhD; E. Sato, MD; T. Gono, MD, PhD; Y. Kawaguchi, MD, PhD; H. Yamanaka, MD, PhD, Institute of Rheumatology, Tokyo Women's Medical University; M. Harigai, MD, PhD, Department of Pharmacovigilance, Graduate School, Tokyo Medical and Dental University; M. Mimura, MD, PhD, Department of Neuropsychiatry, Keio University School of Medicine.
authors.forename: Eri
authors.initials: E
authors.lastname: Sato
authors.affiliation: From the Department of Psychiatry and Institute of Rheumatology, Tokyo Women's Medical University School of Medicine, Tokyo; Kanagawa Psychiatric Center, Yokohama; Department of Pharmacovigilance, Graduate School, Tokyo Medical and Dental University; Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan.K. Nishimura, MD, PhD; J. Ishigooka, MD, PhD, Department of Psychiatry, Tokyo Women's Medical University School of Medicine; M. Omori, MD, Kanagawa Psychiatric Center; Y. Katsumata, MD, PhD; E. Sato, MD; T. Gono, MD, PhD; Y. Kawaguchi, MD, PhD; H. Yamanaka, MD, PhD, Institute of Rheumatology, Tokyo Women's Medical University; M. Harigai, MD, PhD, Department of Pharmacovigilance, Graduate School, Tokyo Medical and Dental University; M. Mimura, MD, PhD, Department of Neuropsychiatry, Keio University School of Medicine.
authors.forename: Takahisa
authors.initials: T
authors.lastname: Gono
authors.affiliation: From the Department of Psychiatry and Institute of Rheumatology, Tokyo Women's Medical University School of Medicine, Tokyo; Kanagawa Psychiatric Center, Yokohama; Department of Pharmacovigilance, Graduate School, Tokyo Medical and Dental University; Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan.K. Nishimura, MD, PhD; J. Ishigooka, MD, PhD, Department of Psychiatry, Tokyo Women's Medical University School of Medicine; M. Omori, MD, Kanagawa Psychiatric Center; Y. Katsumata, MD, PhD; E. Sato, MD; T. Gono, MD, PhD; Y. Kawaguchi, MD, PhD; H. Yamanaka, MD, PhD, Institute of Rheumatology, Tokyo Women's Medical University; M. Harigai, MD, PhD, Department of Pharmacovigilance, Graduate School, Tokyo Medical and Dental University; M. Mimura, MD, PhD, Department of Neuropsychiatry, Keio University School of Medicine.
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Kawaguchi
authors.affiliation: From the Department of Psychiatry and Institute of Rheumatology, Tokyo Women's Medical University School of Medicine, Tokyo; Kanagawa Psychiatric Center, Yokohama; Department of Pharmacovigilance, Graduate School, Tokyo Medical and Dental University; Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan.K. Nishimura, MD, PhD; J. Ishigooka, MD, PhD, Department of Psychiatry, Tokyo Women's Medical University School of Medicine; M. Omori, MD, Kanagawa Psychiatric Center; Y. Katsumata, MD, PhD; E. Sato, MD; T. Gono, MD, PhD; Y. Kawaguchi, MD, PhD; H. Yamanaka, MD, PhD, Institute of Rheumatology, Tokyo Women's Medical University; M. Harigai, MD, PhD, Department of Pharmacovigilance, Graduate School, Tokyo Medical and Dental University; M. Mimura, MD, PhD, Department of Neuropsychiatry, Keio University School of Medicine.
authors.forename: Masayoshi
authors.initials: M
authors.lastname: Harigai
authors.affiliation: From the Department of Psychiatry and Institute of Rheumatology, Tokyo Women's Medical University School of Medicine, Tokyo; Kanagawa Psychiatric Center, Yokohama; Department of Pharmacovigilance, Graduate School, Tokyo Medical and Dental University; Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan.K. Nishimura, MD, PhD; J. Ishigooka, MD, PhD, Department of Psychiatry, Tokyo Women's Medical University School of Medicine; M. Omori, MD, Kanagawa Psychiatric Center; Y. Katsumata, MD, PhD; E. Sato, MD; T. Gono, MD, PhD; Y. Kawaguchi, MD, PhD; H. Yamanaka, MD, PhD, Institute of Rheumatology, Tokyo Women's Medical University; M. Harigai, MD, PhD, Department of Pharmacovigilance, Graduate School, Tokyo Medical and Dental University; M. Mimura, MD, PhD, Department of Neuropsychiatry, Keio University School of Medicine.
authors.forename: Masaru
authors.initials: M
authors.lastname: Mimura
authors.affiliation: From the Department of Psychiatry and Institute of Rheumatology, Tokyo Women's Medical University School of Medicine, Tokyo; Kanagawa Psychiatric Center, Yokohama; Department of Pharmacovigilance, Graduate School, Tokyo Medical and Dental University; Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan.K. Nishimura, MD, PhD; J. Ishigooka, MD, PhD, Department of Psychiatry, Tokyo Women's Medical University School of Medicine; M. Omori, MD, Kanagawa Psychiatric Center; Y. Katsumata, MD, PhD; E. Sato, MD; T. Gono, MD, PhD; Y. Kawaguchi, MD, PhD; H. Yamanaka, MD, PhD, Institute of Rheumatology, Tokyo Women's Medical University; M. Harigai, MD, PhD, Department of Pharmacovigilance, Graduate School, Tokyo Medical and Dental University; M. Mimura, MD, PhD, Department of Neuropsychiatry, Keio University School of Medicine.
authors.forename: Hisashi
authors.initials: H
authors.lastname: Yamanaka
authors.affiliation: From the Department of Psychiatry and Institute of Rheumatology, Tokyo Women's Medical University School of Medicine, Tokyo; Kanagawa Psychiatric Center, Yokohama; Department of Pharmacovigilance, Graduate School, Tokyo Medical and Dental University; Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan.K. Nishimura, MD, PhD; J. Ishigooka, MD, PhD, Department of Psychiatry, Tokyo Women's Medical University School of Medicine; M. Omori, MD, Kanagawa Psychiatric Center; Y. Katsumata, MD, PhD; E. Sato, MD; T. Gono, MD, PhD; Y. Kawaguchi, MD, PhD; H. Yamanaka, MD, PhD, Institute of Rheumatology, Tokyo Women's Medical University; M. Harigai, MD, PhD, Department of Pharmacovigilance, Graduate School, Tokyo Medical and Dental University; M. Mimura, MD, PhD, Department of Neuropsychiatry, Keio University School of Medicine.
authors.forename: Jun
authors.initials: J
authors.lastname: Ishigooka
mesh_terms: D000328:Adult; D001288:Attention / Q000502:physiology; D003071:Cognition / Q000502:physiology*; D003072:Cognition Disorders / Q000150:complications / Q000523:psychology*; D005260:Female; D006801:Humans; D008180:Lupus Erythematosus, Systemic / Q000523:psychology*; D008297:Male; D008568:Memory / Q000502:physiology; D009483:Neuropsychological Tests; D011446:Prospective Studies; D055815:Young Adult
keywords: CORTICOSTEROIDS; NEUROCOGNITIVE IMPAIRMENT; SYSTEMIC LUPUS ERYTHEMATOSUS