Neuropsychology Review

, Volume 18, Issue 2, pp 149–166

Neuropsychological Impairment in Systemic Lupus Erythematosus: A Comparison with Multiple Sclerosis

  • R. H. B. Benedict
  • J. L. Shucard
  • R. Zivadinov
  • D. W. Shucard
Article

DOI: 10.1007/s11065-008-9061-2

Cite this article as:
Benedict, R.H.B., Shucard, J.L., Zivadinov, R. et al. Neuropsychol Rev (2008) 18: 149. doi:10.1007/s11065-008-9061-2

Abstract

In this manuscript, we review literature describing the neuropsychological and brain imaging characteristics of systemic lupus erythematosus (SLE) patients. The findings are compared and contrasted with multiple sclerosis (MS) studies, revealing similarities and differences of interest to clinicians and researchers. While cognitive impairment is somewhat less common in SLE than MS, the diseases share a similar cognitive profile with deficits most prominent on tests emphasizing the speed of information processing, working memory, and visual/spatial learning, and memory. In early or more mildly affected patients, diffuse white matter damage, which may not be apparent on conventional brain imaging, plays a major role in clinical presentation and cognitive testing. The causes of white matter damage are very different, however, and in later stages of the disease MS and SLE appear to give rise to different forms of cerebral pathology. MS may be characterized by increasing brain atrophy affecting especially the cortical and deep gray matter, at least after conversion to secondary progressive course. There is less evidence for neurodegenerative changes in SLE, but patients are increasingly at risk for cerebrovascular disease. We conclude by offering some suggestions for future clinical and imaging research.

Keywords

Systemic lupus erythematosusMultiple sclerosisCognitionMemoryProcessing speedMRIEffect size

Abbreviations

ACR

American College of Rheumatology

APLA

antiphospholipid antibodies

APLS

antiphospholipid antibody syndrome

BVMTR

Brief Visuospatial Memory Test-Revised

COWAT

Controlled Oral Word Association Test

CND

central nervous system

CRP

C-reactive protein

CVLT2

California Verbal Learning Test, second edition

DKEFS

Delis–Kaplan Executive Function System Sorting Test

DTI

diffusion tensor imaging

DWI

diffusion weighted imaging

FLAIR

fluid attenuated inversion recovery technique

IL-6

interleukin-6

JLO

Judgment of Line Orientation Test

MACFIMS

Minimal Assessment of Cognitive Function in MS

MRI

magnetic resonance imaging

MRS

magnetic resonance spectroscopy

MS

multiple sclerosis

MTI

magnetization transfer imaging

MTR

magnetization transfer ratio

NAA

N-acetyl aspartate

NP

neuropsychiatric

PASAT

Paced Auditory Serial Addition Test

RA

rheumatoid arthritis

SDMT

Symbol Digit Modalities Test

SLE

systemic lupus erythematosus

TMT

Trail Making Test

WI

weighted imaging

WMS-III

Wechsler Memory Scale, 3rd edition

Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  • R. H. B. Benedict
    • 1
  • J. L. Shucard
    • 1
  • R. Zivadinov
    • 2
  • D. W. Shucard
    • 1
  1. 1.Division of Cognitive and Behavioral Neurosciences, State University of New York (SUNY) at Buffalo, School of Medicine, Jacobs Neurological InstituteBuffalo General HospitalBuffaloUSA
  2. 2.Buffalo Neuroimaging Analysis Center, Department of Neurology, State University of New York (SUNY) at Buffalo, School of Medicine, Jacobs Neurological InstituteBuffalo General HospitalBuffaloUSA