Cognitive Functioning in Systemic Lupus Erythematosus: A Meta-Analysis (2018)

Leslie, B., & Crowe, S. F. (2018). Cognitive functioning in systemic lupus erythematosus: A meta-analysis. Lupus, 27(6), 920-929.

This study was a meta-analysis to assess the cognitive deficits commonly associated with systemic lupus erythematosus (SLE). The authors found individuals with SLE, with or without neuropsychiatric involvement, do have statistically significant deficits with cognitive fluency, visual attention, immediate visual memory, and visual reasoning when compared to healthy controls. These results are essential to help with further development of assessment and rehabilitation treatment for people with SLE with or without neuropsychological involvement.

Systemic lupus erythematosus is an inflammatory disease where the auto-immune system attacks its own body tissues. The American College of Rheumatology (ACR) found 80% of individuals with SLE have at least one neurological symptom and cognitive dysfunction is one of the most common. However, a clear neuropsychological profile for SLE is emerging but not yet established. Few studies have investigated the commonly cited attention deficit for individuals with SLE, especially with more complex tasks. This study used a meta-analysis approach to evaluate the current research on the cognitive abilities of patients with SLE compared to healthy control groups. The authors hypothesized the individuals with SLE (would demonstrate cognitive deficits in immediate and delayed memory, processing speed, executive function, working memory, and complex attention with and without neuropsychiatric symptoms.

The authors screened 947 articles and narrowed them down to include ten studies within the quantitative meta-analysis. Individuals with SLE clearly demonstrated executive function deficits when compared to healthy control. The executive function deficits were present for individuals with SLE regardless of neuropsychological involvement. The specific domains of executive function relying on inhibition, expressive language, and cognitive flexibility were mentioned. Individuals with neuropsychic SLE also had deficits with visuospatial organization, verbal reasoning tasks, and complex attention tasks. Interestingly, processing speed and working memory were not found to be a statistically significant deficit for SLE. Overall the study demonstrated the presence of cognitive deficits for individuals with SLE and is not based on the presence of overt neuropsychiatric symptoms. However, the cognitive deficits observed for people with neuropsychiatric SLE tend to be greater, especially for tasks involving complex attention, delayed verbal memory, and verbal reasoning. Neuropsychological assessment measures are the most sensitive for determining the cognitive areas of impairment and determining if a person is with or without neuropsychiatric SLE.

Clinical Takeaways

  • Systemic lupus erythematosus is an inflammatory disease where the auto-immune system attacks its own body tissues.
  • Executive function skills, specifically those reliant upon inhibition, expressive language, and cognitive flexibility, should be assessed and treated for individuals with SLE regardless of neuropsychological symptoms involvement. 
  • Individuals with neuropsychic SLE demonstrated more deficits with visuospatial organization, verbal reasoning, and complex attention tasks compared to individuals without neuropsychic involvement.
  • The authors found that processing speed and working memory were not found to be statistically significant deficits for individuals with SLE. 
  • Neuropsychological assessment measures are the most sensitive to determine the cognitive areas affected and if a person has neuropsychiatric SLE involvement.

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