title: Executive dysfunction, obsessive-compulsive symptoms, and attention deficit and hyperactivity disorder in Systemic Lupus Erythematosus: Evidence for basal ganglia dysfunction?
abstract: BACKGROUND
  Chorea is well described in a group of patients with Systemic Lupus Erythematosus (SLE). There is less information, however, on other movement disorders as well as non-motor neuropsychiatric features such as obsessive-compulsive symptoms (OCS), executive dysfunction and attention deficit and hyperactivity disorder (ADHD) in subjects with SLE.
  
  
  METHODS
  Fifty-four subjects with SLE underwent a battery of neuropsychiatric tests that included the Mini Mental State Examination, the Montreal Cognitive Assessment, the Frontal Assessment Battery (FAB), the FAS verbal and the categorical (animals) semantic fluency tests, the Obsessive and Compulsive Inventory - Revised, the Yale-Brown Obsessive and Compulsive Scale and Beck's Anxiety and Depression Scales. ADHD was diagnosed according to DSM-IV criteria. SLE disease activity and cumulative damage were evaluated according to the modified SLE Disease Activity Index 2000 (mSLEDAI-2K) and the SLICC/ACR, respectively.
  
  
  RESULTS
  Six (11.1%) and 33 (61.1%) patients had cognitive impairment according to the MMSE and MoCA, respectively. Eleven (20.4%) had abnormal FAB scores, and 5 (9.3%) had lower semantic fluency scores than expected. The overall frequency of cognitive dysfunction was 72.2% (39 patients) and of neuropsychiatric SLE was 77.8% (42 patients). Two patients (3.7%) had movement disorders. Fifteen (27.8%) had OCS and 17 (31.5%) met diagnostic criteria for ADHD. ADHD and OCS correlated with higher disease activity, p=0.003 and 0.006, respectively. Higher cumulative damage correlated with lower FAB scores (p 0.026).
  
  
  CONCLUSIONS
  Executive dysfunction, ADHD, OCS, and movement disorders are common in SLE. Our finding suggests that there is frequent basal ganglia dysfunction in SLE.
authors.affiliation: Movement Disorders Clinic, Department of Neurology, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.
authors.forename: Ricardo Oliveira Horta
authors.initials: RO
authors.lastname: Maciel
authors.affiliation: Rheumatology Clinic, Department of Locomotor System, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.
authors.forename: Gilda Aparecida
authors.initials: GA
authors.lastname: Ferreira
authors.affiliation: Rheumatology Clinic, Department of Locomotor System, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.
authors.forename: Bárbara
authors.initials: B
authors.lastname: Akemy
authors.affiliation: Movement Disorders Clinic, Department of Neurology, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil. Electronic address: cardosofe@terra.com.br.
authors.forename: Francisco
authors.initials: F
authors.lastname: Cardoso
mesh_terms: D000328:Adult; D001007:Anxiety / Q000150:complications / Q000503:physiopathology / Q000523:psychology; D001289:Attention Deficit Disorder with Hyperactivity / Q000150:complications* / Q000503:physiopathology / Q000523:psychology; D001479:Basal Ganglia / Q000503:physiopathology; D003072:Cognition Disorders / Q000150:complications* / Q000503:physiopathology / Q000523:psychology; D003192:Compulsive Behavior / Q000150:complications* / Q000503:physiopathology / Q000523:psychology; D003863:Depression / Q000150:complications / Q000503:physiopathology / Q000523:psychology; D056344:Executive Function / Q000502:physiology*; D005260:Female; D006801:Humans; D008180:Lupus Erythematosus, Systemic / Q000150:complications* / Q000503:physiopathology / Q000523:psychology; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D009770:Obsessive Behavior / Q000150:complications* / Q000503:physiopathology / Q000523:psychology; D011569:Psychiatric Status Rating Scales
keywords: Attention deficit disorder with hyperactivity; Cognitive symptoms; Haematological disorders; Movement disorder; Neuropsychiatric Systemic Lupus Erythematosus; Obsessive–compulsive disorder