Cognitive dysfunction in the Czech population of patients with systemic lupus erythematosus
Authors:
R. Svobodová; M. Pošmurová; V. Peterová 1; P. Kozelek 2; I. Půtová; M. Fojtíková; C. Dostál; M. Olejárová
Authors‘ workplace:
Revmatologický ústav Praha, 1Neurologická klinika 1. LF UK a VFN Praha, 2Psychiatrická klinika 1. LF UK a VFN Praha
Published in:
Čes. Revmatol., 18, 2010, No. 2, p. 85-91.
Category:
Original Papers
Overview
Background:
Involvement of the nervous system occurs in as much as 80% of patients with systemic lupus erythematosus (SLE). Diagnosis of neuropsychiatric involvement (NPSLE) is very difficult due to a variability of clinical presentation. Cognitive dysfunction (CD) is one of the most common manifestations of NPSLE. Its cause has not yet been entirely elucidated.
Objective:
The aim of this study was to assess the prevalence of NPSLE in patients with SLE, and the prevalence of CD in the Czech population of patients with SLE, and to determine an association of CD with other types of NPSLE, brain MRI findings of blood-brain barrier disorders, positivity for certain autoantibodies, and disease activity.
Methods:
A group of 100 patients diagnosed with SLE according to ACR criteria was examined. Disease activity was evaluated using the SLEDAI index. All patients underwent a clinical neurological, psychiatric, and psychological examination, and based on the results of all three examinations, diagnosis and the type of NPSLE was established according to the ACR criteria. Autoantibody activity was examined in all patients.
Results:
Based on a neurological examination alone, diagnosis of NPSLE was established in 31% of patients. Following completion of a psychiatric and psychological examination, the occurrence of NPSLE increased to 73%. A various degrees of cognitive deficit were found in most of our patients (91%). A mild degree of cognitive deficit was found in 35% of patients, and cognitive dysfunction (i.e. a moderate to severe degree of cognitive deficit) was diagnosed in 57% of patients. In the group of patients with CD, occurrence of involvement of the nervous system was four times higher than in the group without cognitive dysfunction; furthermore, occurrence of cardiac involvement (22.8 % vs. 14.0 %; p < 0.05) and antiphospholipid syndrome (28.1% vs. 20.9%; p< 0.05) was also higher in patients with CD. In the group of patients with CD, occurrence of positivity for antiphospholipid antibodies was two times higher than in the group without dysfunction.
Conclusion:
Cognitive dysfunction is a very frequent clinical manifestation of SLE; most of the patients (57% in our group) suffer from a moderate to severe degree of cognitive deficit. Cognitive dysfunction can evade diagnosis, when only routine, standard neurological and psychiatric examinations are performed. A targeted psychological examination can increase the chance of diagnosis of CD up to 10 times. Since cognitive dysfunction can significantly decrease mental performance of a patient with SLE, his or her role in the society and at work, we recommend performing psychological evaluations in all patients with SLE on regular basis.
Key words:
systemic lupus erythematosus, neuropsychiatric lupus, cognitive dysfunction
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Dermatology & STDs Paediatric rheumatology RheumatologyArticle was published in
Czech Rheumatology
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