Systemic lupus erythematosus
A Prospective Functional MRI Study for Executive Function in Patients with Systemic Lupus Erythematosus Without Neuropsychiatric Symptoms

https://doi.org/10.1016/j.semarthrit.2011.11.010Get rights and content

Objective

To study the functional brain activation signals before and after sufficient disease control in patients with systemic lupus erythematosus (SLE) without clinical neuropsychiatric symptoms.

Methods

Blood-oxygen-level-dependent signals during event-related functional magnetic resonance imaging brain were recorded, while 14 new-onset SLE patients and 14 demographically and intelligence quotient matched healthy controls performed the computer-based Wisconsin card sorting test for assessing executive function, which probes strategic planning and goal-directed task performance during feedback evaluation (FE) and response selection (RS), respectively. Composite beta maps were constructed by a general linear model to identify regions of cortical activation. Blood-oxygen-level-dependent functional magnetic resonance imaging signals were compared between (1) new-onset SLE patients and healthy controls and (2) SLE patients before and after sufficient control of their disease activity.

Results

During RS, SLE patients demonstrated significantly higher activation than healthy controls in both caudate bodies and Brodmann area (BA) 9 to enhance event anticipation, attention, and working memory, respectively, to compensate for the reduced activation during FE in BA6, 13, 24, and 32, which serve complex motor planning and decision-making, sensory integration, error detection, and conflict processing, respectively. Despite significant reduction of SLE activity, BA32 was activated during RS to compensate for reduced activation during FE in BA6, 9, 37, and 23/32, which serve motor planning, response inhibition and attention, color processing and word recognition, error detection, and conflict evaluation, respectively.

Conclusions

Even without clinically overt neuropsychiatric symptoms, SLE patients recruited additional pathways to execute goal-directed tasks to compensate for their reduced strategic planning skill despite clinically sufficient disease control.

Section snippets

Subject Recruitment

Consecutive patients with newly diagnosed SLE based on the American College of Rheumatology classification criteria (19) were recruited between September 2007 and January 2010 from the Lupus Clinic of the National University Hospital, which is the teaching hospital of the National University of Singapore. Healthy controls who were staff working in the same university were matched with SLE patients for age (±4 years), sex, education level, and intelligence quotient (IQ) for comparison. Subjects

Demographic, Clinical, and WCST Performance Results of New Onset SLE Patients and Healthy Controls

Seventeen patients with new onset SLE were initially identified for this study between September 2007 and January 2010. However, 2 of them were not interested in participating due to work commitments. For the rest of the 15 patients, 1 presented with lupus psychosis and was not eligible for the study. Therefore, 14 SLE patients and 14 matched healthy controls (12 females in each group) were finally recruited for the study (Fig. 1). The last patient underwent a second scan in July 2010.

The SLE

Discussion

The present prospective event-related fMRI study found that new onset SLE patients demonstrated inferior planning strategy with consequential compensation on response execution while executive function was assessed, in comparison with healthy controls. Such phenomenon was demonstrated not only at first presentation of SLE but also after sufficient disease control over a period of at least 6 months.

New onset SLE patients had more inefficient strategic planning skills regarding planning of

Acknowledgments

The authors would like to thank Dr Steven Graham and Ho Yan Yin for their professional assistance with regard to data acquisition, control recruitment, teaching, as well as its initial analyses and implementation of the IQ tests, respectively.

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    This study was funded by the Tier 1 Academic Research Fund, Ministry of Education, Republic of Singapore (R-172-000-164-112).

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