Neurocognitive Disorders

Consensus Needed to Address Inconsistency in Metrics and Definitions Used to Assess Cognitive Impairment in SLE

Inga Back, MPH
|
Seizures and epilepsy (≥2 unprovoked seizures) are more common in patients with APS compared with the general population.6,10 Between 3% and 10% of patients with APS have seizures/epilepsy, a prevalence that is 10 times greater than that of the general population.10 In half of these patients, epilepsy onset is after diagnosis.3 Epilepsy is more common in APS secondary to SLE vs primary APS (13.7% vs 6%; P <.05).11 Evidence of a correlation between aPL positivity and seizure is inconclusive.10 Seizures and epilepsy in patients with APS are primarily attributable to vascular disease.6 In a cohort study of 538 patients with APS, the odds ratio for epilepsy was 4.05 (95% CI, 2.05-8.00) in those with a prior central nervous system thromboembolic event.11 Epilepsy was also associated with higher rates of thrombocytopenia, livedo reticularis, and autoimmune hemolytic anemia.11 Some patients with APS with epilepsy have normal brain MRI results,3 and in vitro studies have implicated interactions between autoantibodies and neural structures.6

Seizures and epilepsy (≥2 unprovoked seizures) are more common in patients with APS compared with the general population.6,10 Between 3% and 10% of patients with APS have seizures/epilepsy, a prevalence that is 10 times greater than that of the general population.10 In half of these patients, epilepsy onset is after diagnosis.3 Epilepsy is more common in APS secondary to SLE vs primary APS (13.7% vs 6%; P <.05).11 Evidence of a correlation between aPL positivity and seizure is inconclusive.10

Seizures and epilepsy in patients with APS are primarily attributable to vascular disease.6 In a cohort study of 538 patients with APS, the odds ratio for epilepsy was 4.05 (95% CI, 2.05-8.00) in those with a prior central nervous system thromboembolic event.11 Epilepsy was also associated with higher rates of thrombocytopenia, livedo reticularis, and autoimmune hemolytic anemia.11 Some patients with APS with epilepsy have normal brain MRI results,3 and in vitro studies have implicated interactions between autoantibodies and neural structures.6

Researchers highlighted the importance of a consensus to address inconsistencies in the metrics and definitions used for cognitive impairment assessment in systemic lupus erythematosus.

The assessment and definition of cognitive impairment in patients with systemic lupus erythematosus (SLE) is inconsistent throughout literature; this suggests the need for a consensus to standardize measurement tools and terminology, according to the researchers of a systematic review published in Seminars in Arthritis & Rheumatology.

Cognitive impairment is common in patients with SLE. In 1999, the American College of Rheumatology (ACR) developed a comprehensive, 1-hour neuropsychologic battery that defines cognitive impairment using a threshold of 2 or more standard deviations below the estimated population mean in the domains of attention, memory, and psychomotor speed. The ACR neuropsychologic battery and definition of cognitive impairment have been widely adapted, leading to inconsistencies in the assessment of patients with SLE.

The systematic review was conducted to characterize the measurement tools and definitions to assess cognitive impairment in SLE.

Several databases, including Ovid Medline, Embase, and PsychINFO, were used to search for articles on cognitive impairment in adult patients with SLE. Studies that used a neuropsychologic battery were assessed for alignment with the ACR neuropsychologic battery. Researchers also evaluated the definitions of cognitive impairment and classified the various measurement tools into the following categories: neuropsychologic battery, screening, incomplete/mixed, or computerized.

The literature search yielded 8727 references, of which 118 were selected for a detailed review and 97 were included in this systematic review. Overall, the use of the ACR neuropsychologic battery was inconsistent. When used, it was supplemented with other tests. None of the 43 studies that used a neuropsychologic battery conformed to the ACR neuropsychologic battery as published. Variations were noted in the thresholds and domains used to classify cognitive impairment. Neuropsychologic battery tests were most often used to assess cognitive impairment; however, screening tests and computerized neuropsychologic batteries are increasing in their use.

Related Content

The main limitation of the study was the difficulty in delineating neuropsychologic battery and non-neuropsychologic battery tools due to the heterogeneity of the tools used.

“As cognition research in SLE continues to grow, it is imperative to develop a comprehensive and standardized methodology for defining and assessing [cognitive impairment] that is both clinically feasible and standardized within the field,” the researchers concluded. “A consensus meeting to address existing inconsistencies should be considered to harmonize the field of [cognitive impairment] in SLE.”

Reference

Yuen K, Green R, Bingham K, et al. Metrics and definitions used in the assessment of cognitive impairment in systemic lupus erythematosus: A systematic review. Seminars in Arthritis & Rheumatology. Published online June 9, 2021. doi:10.1016/j.semarthrit.2021.05.018

This article originally appeared on Rheumatology Advisor

  • Latest News Your top articles for Thursday

  • Haymarket Medical NetworkTop Picks

  • Loading...

    Continuing Medical Education (CME/CE) Courses

    Show More