Background Systemic lupus erythematosus is an autoimmune-mediated collagen disease that results in multiorgan failure. Cognitive dysfunction, when standardly assessed using sensitive neurocognitive instruments, is the most common NPSLE manifestation.
Objectives Study aimed at assessment of the prevalence and severity of cognitive deficits in SLE patients (pts). To evaluate the volumetric brain MRI findings in a population-based sample of SLE pts and to detect a possible relationship between cerebral MRI abnormalities and specific neuropsychiatric manifestations.
Methods Depending on the clinical course, the pts with SLE (225) were divided into three groups - I group: Pts with SLE and clinically manifested lesions of the nervous system (104 pts); II group: Pts with SLE without clinically manifested lesions of the nervous system (63 pts); III group: Pts with incomplete (subclinical) SLE (58 pts). In view of the more precise differentiation of the cognitive disturbances in pts with SLE, control group (IV) from 63 healthy volunteers were used as well. Subjects with data of overlapping of SLE with other systemic diseases of the connective tissue, illiteracy, chronic alcoholism, drug abuse, were not included in the study. In addition to a clinical neurological investigation, all pts received a detailed neuropsychological assessment and an MRI and EEG study. Volumetric measures of cerebral atrophy as well as T1- and T2-weighted lesions were obtained. A cumulative lifetime dose of glucocorticoids was determined from the patientrecords.
Results Cognitive dysfunction was identified in 49,33% (111 pts) of SLE pts, 53,85% (56 pts) - in group I, 44,44% (28 pts) - in group II and 46,55% (27 pts) - in group III. Compared with controls, SLE pts had increased volumes of both T1- and T2-weighted lesions (p=0.019 and p<0.0001, respectively) and increased cerebral atrophy (p<0.001). All the measured MRI parameters were statistically significantly higher in NPSLE than in non-NPSLE pts. In SLE pts, cerebral atrophy was associated with cognitive dysfunction, epileptic seizures, and cerebrovascular disease; T1-weighted lesions were associated with epileptic seizures and T2-weighted lesions with cognitive dysfunction. All MRI parameters correlated significantly with the SLICC index. A positive correlation was found between a cumulative dose of glucocorticoids and cerebral atrophy in SLE pts. EEG changes in NPSLE are non-specific and take the form of paroxysmal disposition in the frontotemporal and parietal areas, also in pts with SLE but without clinically evident neuropsychiatric manifestations.
Conclusions MRI abnormalities, including brain atrophy and T1- and T2-weighted lesions, are significantly more common in pts with SLE and they are related to specific NP manifestations. Our findings also provide support for the organic aetiology of cognitive dysfunction in SLE. The combinative application of the instrumental methods for examination significantly increases the rate of diagnostics of neuropsychiatric manifestations and this being particularly well expressed in patients with cognitive disturbances.
Disclosure of Interest None Declared
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