Disease Activity Independently Correlates with Cognitive Impairment in SLE
Steven Bieser1, Asma Qureshi2, Komel Safdar2, Mary Carns3, Vanessa Manada De Lobos2, Emily Breach7, Thales Hein da Rosa2, Mohammad Khan2, Tyler Therron2, Katherine Puev3, Anh Chung7, Neil Pillai2, Kathleen Aren2, John Seagrist7, Jing Song4, Zachary Orban7, Cecilia Stumpf7, Jason Ross5, Harris Perlman2, Yvonne Lee2, Deborah Winter2, Borna Bonakdarpour8, Mariam Siddiqui2, Laura Arneson2, Rosalind Ramsey-Goldman2, Mary Mahieu2, Lutfiyya Muhammad4, Irene Blanco2, Eric Larson6, Elena Grebenciucova1, Carla M. Cuda2
1Neurology, 2Medicine, Rheumatology Division; Feinberg School of Medicine, 3Medicine, Pulmonology Division, 4Preventative Medicine, 5Anesthesiology; Feinberg School of Medicine, 6Physical Medicine and Rehabilitation; Feinberg School of Medicine, Northwestern University, 7Northwestern University, 8Mesulam Center for Cognitive Neurology and Alzheimer Disease
Objective:
To evaluate if NIHT can characterize CI in persons with SLE and if disease activity contributes to impaired cognition.
Background:
Mechanisms driving cognitive impairment (CI) in systemic lupus erythematosus (SLE) remain poorly understood, and prior studies conflict regarding the relationship between CI and disease activity. The NIH Toolbox for Assessment of Neurological and Behavioral Function(NIHT) is used in Alzheimer’s disease, yet its value in measuring CI in SLE and relationship between NIHT subdomains and SLE disease activity remains unexplored.
Design/Methods:
Cross-sectional data were analyzed from adults meeting ≥4 of 11 ACR 1997 SLE criteria without concurrent autoimmune or neurologic diseases, infections, GFR<60, liver enzymes>3x ULN, or sodium imbalance. Cognition was assessed with Montreal Cognitive Assessment (MoCA) and six NIHT measures, including two executive function scales, Dimensional Change Card Sort (DCCS) and Flanker Inhibitory Control of Attention (FICA). SLEDAI-2K≥6 defined moderate-high disease activity; SLEDAI-2K<6 indicated low-moderate or inactive disease. Associations between continuous and categorical variables were assessed via Wilcoxon rank sum and t-tests.
Results:
Our sample included 38 female and 1 male with SLE with a mean(SD) age of 34.16(11.25) years and mean disease duration of 9.67(8.40) years. Patients with moderate-high disease activity scored significantly lower(mean difference [MD])= -6.99, p.029) on FICA compared to those with low-moderate or inactive SLE, and lower(MD= -3.77, p.009) than general population controls within NIHT. Those with high disease activity also scored significantly lower (MD= -2.99, p.0245) on DCCS compared to general population controls. Findings were independent of race/age/education or SLEDAI subcomponent scores. MoCA did not differentiate groups.
Conclusions:
NIHT is a domain-specific, sensitive tool for detecting CI in SLE, outperforming MoCA. Higher SLEDAI correlate with executive function and memory impairments, supporting a role for generalized inflammation in SLE-related CI. We advance the field by exploring the link between SLE disease activity and CI in domains essential for daily functioning.
Generative AI Usage
No, did not use generative AI in the drafting or editing in this abstract.
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