Background Cognitive dysfunction (CD) is a deficit of cognitive faculties including attention, memory, language, executive function and visuospatial processing. CD is the most frequent neuropsychiatric manifestation of SLE (55–80%) 1 and this is 3 times higher in patients with Systemic Lupus Erythematosus (SLE) than in healthy subjects.2 This is not routinely evaluated because it requires a lot of time. Brief and simple questionnaires are needed to identify CD.
A study carried out by D'Amico et al. evaluated 21 SLE patients and all of them had CD.3 Pedraza et al. analyzed the MMSE score and Montreal Cognitive Assessment (MOCA) and concluded that MOCA performs much better than MMSE for cognitive impairment correct diagnosis.4
Objectives To determine the prevalence of CD in SLE patients and compare MMSE and MOCA diagnosis effectiveness.
Methods All patients with at least 18 years old that met ACR/EULAR 2012 SLE classification criteria were included. Patients with associated comorbidity, not SLE related, that could alter cognitive functions, were excluded. 55 patients that fulfilled the inclusion criteria were admitted to Hospital Docente Padre Billini's rheumatology department from March to April 2016. After obtaining written consent, the psychology department applied both tests, MMSE and MOCA. A standardized form registered demographic variables. Data was analyzed using Microsoft Excel 2013.
Results 94.5% of the patients were women, 53% were between 31–45 years old, 52.7% were mulatto ethnic, 34.5% had at least a high school degree, 27.2% were diagnosed 1 year before enrollment, 60% had a low activity score using SLEDAI (<4), hypertension was the most common comorbidity with a 38.1%, 90.9% were taking corticoids, 80% were on antimalarial drugs (6 abandoned treatment, 2 by eye involvement, 1 allergic reaction, 2 were diagnosed with SLE the interview day), the most frequent neuropsychiatric symptom ever presented was convulsion (7.2%). Using MMSE 25.4% of the patients showed CD, however after adjusting the results according to the educational level, the percentage increased to 41.8%. MOCA classified that 67.2% of the patients had CD, of which 13 patients were MMSS positive, and finally, 22 classified after the score adjustment.
Conclusions MOCA is more effective than MMSE to detect CD. Nonetheless the MMSE should be considered as an option for patients with low levels of education.
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Díaz-Cortés, D. Correa-González, N. Díaz, M. et al. Compromiso del sistema nervioso central en el lupus eritematoso sistémico. Rev colomb reumatol. 2015; 22 (1): 16–30.
D'Amico et al. Estudio multicéntrico de deterioro cognitivo en lupus eritematoso sistémico: ECLES. Rev Arg Reumatol. 2015; 26 (2): 28–32.
Pedraza L.O. Sánchez, E. Plata, S. Montalvo, C. et al. Puntuaciones del MOCA y el MMSE en pacientes con deterioro cognitivo leve y demencia en una clínica de memoria en Bogotá. Acta Neurol Colomb. (Bog) 2014.
Disclosure of Interest None declared