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

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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.

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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

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  1. Division of Cognitive and Behavioral Neurosciences, State University of New York (SUNY) at Buffalo, School of Medicine, Jacobs Neurological Institute, Buffalo General Hospital, Suite D6, 100 High Street, Buffalo, NY, 14203, USA

    R. H. B. Benedict, J. L. Shucard & D. W. Shucard

  2. Buffalo Neuroimaging Analysis Center, Department of Neurology, State University of New York (SUNY) at Buffalo, School of Medicine, Jacobs Neurological Institute, Buffalo General Hospital, Suite D6, 100 High Street, Buffalo, NY, 14203, USA

    R. Zivadinov

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Benedict, R.H.B., Shucard, J.L., Zivadinov, R. et al. Neuropsychological Impairment in Systemic Lupus Erythematosus: A Comparison with Multiple Sclerosis. Neuropsychol Rev 18, 149–166 (2008). https://doi.org/10.1007/s11065-008-9061-2

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