Publications

Objectives: To estimate the prevalence of cognitive impairment (CI) in patients with SLE and to determine factors associated with its occurrence.

Methods: Patients with SLE diagnosed as per SLICC-2012 criteria attending rheumatology outpatient clinic during their routine-care visits were included between 2021 and 2022. They underwent screening for anxiety and depression using GAD7 and PHQ9, respectively. Montreal Cognitive Assessment (MoCA) Questionnaire was administered to all patients and matched healthy controls. Prevalence of CI and the factors associated with cognitive impairment were evaluated.

Results: We included 160 patients with SLE [mean age 28.1 ± 7.7 years, F:M::15:1] and healthy controls. Median disease duration of SLE was 30 (IQR 16.47) months and 33 (20.6%) had prior NPSLE events. Overall, half of SLE patients [N = 87 (54%)] had CI, as compared to healthy controls [N = 33 (20.6%)] (P = < 0.001), most commonly affected domain being delayed recall (N = 132, 82.5%). We found significant association of CI with older age (OR 1.09 (1.04, 1.16), lower socioeconomic status (SES) (OR 5.95 (2.04, 17.3), and lower education levels (OR 2.16 (1.02, 4.56). Anxiety and depression demonstrated a significant association with CI in unadjusted analysis. Disease duration, cumulative glucocorticoid dose, prior NPSLE diagnosis, and anti-phospholipid antibodies were not associated with occurrence of CI.

Conclusions: CI was detected in more than half of SLE patients. Higher age, lower SES and education, anxiety, depression and not lupus specific factors were associated with the occurrence of cognitive dysfunction. Key Points • Our study revealed a significantly higher prevalence of CI in SLE patients, compared to healthy controls, as assessed by the MoCA questionnaire. • While traditional lupus-specific factors like disease duration, glucocorticoid usage, prior NPSLE events and the presence of anti-phospholipid antibody were not independently associated with CI, our study found that older age, lower socioeconomic status and lower education level were significant risk factors. • Routine screening and comprehensive assessment of cognitive function is important in all SLE patients, regardless of NPSLE history.