Background Systemic lupus erythematosus (SLE) is a disease with a broad spectrum of clinical manifestations and a typical course of remission and exacerbation.

Various neuropsychiatric manifestations have been considered to be important features of SLE and indicative of Central Nervous System (CNS) involvement, including cognitive impairment, anxiety and depression.

Objectives To determine the point prevalence of cognitive impairment in patients with SLE. To investigate associations between cognitive impairment and psychiatric disorders, corticosteroid therapy, systemic disease activity and central nervous system (CNS) involvement.

Methods A cross-sectional study of 40 patients with SLE was analysed. To assess cognitive impairment, anxiety and depression standardised psychiatric and clinical research methods were used (Minimental, logic memory tests, short and long memory tests, verbal fluency test, attention tests, BPRS, HAD CAGE and BECK’s inventory for measuring depression). Systemic disease activity was measured by SLEDAI. Statistics were performed by chi-square test and by Fisher’s exact test.

Results Cognitive impairment was observed in 75% in SLE. There was no significant relation to the duration of the illness, use of corticotherapy or systemic disease activity. There was a significant association between cognitive impairment and anxiety (p < 0.05) in SLE patients. The same was not observed with depression. CNS involvement was observed in 70% in SLE. Anxiety was observed in 40% of CNS-SLE (p < 0.05). Cognitive impairment was present in 53.6% of CNS-SLE and in 66.6% of non CNS-SLE.

Conclusion The high prevalence of cognitive disorders in our study group could be related to the high prevalence of anxiety, rather than direct involvement of the CNS by SLE. Marked cognitive impairment was present in a significant percentage of patients without CNS involvement.

Supported by FAPESP (Fundação de Amparo à Pesquisa do Estado de São Paulo).

References

1. Bluestein HG. The central nervous system in lupus erythematosus. In: Lahita RG, ed. Systemic lupus erythematosus. New york: Crurchill Livingstone, 1992: 639–55

2. West SG. Neuropsychiatric lupus. Rheum Dis Clin North Am. 1994;20:129–58

3. Bruyin GAW. Controversies in lupus: nervous system involvement. Ann Rheum Dis. 1995;54:159–67

4. Calabrese LV, Stern TA. Neuropsychiatric manifestations of systemic lupus erythematosus. Psychossomatics 1995;36:344–59

5. Wallace DJ, Metzger AL. Systemic lupus erythematosus and the nervous system. In: Wallace DJ, Hanh BH, eds. Dubois lupus erythematosus. Philadelphia: Lea & Febiger, 1993: 370–85

6. Denburg SD, Carbotte RM, Denburg JÁ. Psychological aspects of systemic lupus erythematosus: cognitive function, mood and self-report. J Rheumatol. 1997;24:998–1003