Cognitive performance, a key factor in lupus

A significant percentage of lupus patients suffer cognitive dysfunction without having had neurological damage associated with the disease. This is a factor to consider in the approach and follow-up.

The main neurological damage associated with systemic lupus erythematosus are strokes, seizures and psychotic outbreaks. However, between 20 and 40 percent of patients with rheumatological disease develop cognitive dysfunction once these causes are ruled out. A team of researchers from the Gregorio Marañón Hospital in Madrid has selected a group of patients to determine the impact of cognitive dysfunction on these patients without apparent neurological injuries.

The conclusions of the work have been published in the journal European  Neurology. Among the authors of this study are the head of Rheumatology Service, Luis Carreño, the rheumatologist Javier López-Longo, the neurologist Javier Olazarán, the neuropsychologist Isabel Cruz and the specialist in Nuclear Medicine  Angel  Bittini,all from the center of Madrid.

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Javier Olazarán has stated that “we selected 31 women with lupus from the hospital’s Rheumatology office who had no major brain damage associated with the disease. We performed a battery of neuropsychological tests collecting data on attention, executive functions, memory, visospatial area, language, reasoning and processing speed; from this information we established a few cut-off points for a control group of women of similar characteristics without relevant neurological disease.”

The criteria chosen to determine which women with lupus had cognitive dysfunction were to perform below the fifth percentile in at least two of the tests performed.

López-Longo points out that selected patients were under 50 years old to avoid the influence on age-linked cognitive decline.

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“To determine what cognitive dysfunction was due to, we conducted a simple correlation study with various biological markers, such as time of evolution, tissue damage, disease activity, various types of antibodies, and drugs administered; we found that it was not clearly associated with any of these variables, but women with cognitive dysfunction did have a clearly lower working situation than those who did not have the impairment,” Olazaran says.

The impact on the socioeconomic situation of cognitive dysfunction due to non-neurological causes is an element to consider in the approach to lupus: “Cognitive performance should be taken into account in the study and treatment of these patients, even if they have never had significant neurological manifestations,” concludes the neurologist.

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