Date Presented 03/28/20
Over half of the participants in this sample had cognitive impairment according to an objective screener. Reduced reported functional cognition was associated with reduced participation independent of the effects of other disease-related factors, such as pain, sleep, and depressive symptoms. These findings provide rationale for further and more comprehensive investigation into cognitive impairment and its functional relevance in SLE.
Primary Author and Speaker: Moon Young Kim
Contributing Authors: Deepali Sen, Ronald Drummond, Kathryn Biesanz, Matthew Brandenburg, Carolyn M. Baum, Erin Foster
PURPOSE: (1) To identify the prevalence of cognitive impairment in Systemic Lupus Erythematosus (SLE) by objective and self-report measures, and (2) to investigate associations between cognition and other disease-related symptoms and participation in SLE
DESIGN: A cross-sectional study in a convenience sample. 55 volunteers with SLE (Age: 39.9±12.3 yrs, Female: 92.6%) were recruited at a Lupus clinic at an academic medical center
METHOD: We used the Montreal Cognitive Assessment (MoCA) to measure cognitive ability objectively, the Cognitive Symptom Inventory (CSI) and PROMIS Cognitive Function 8a (CF) to measure self-reported functional cognition, and PROMIS-43 Profile to measure self-reported seven domains: Depression, Anxiety, Physical function, Pain interference, Fatigue, Sleep disturbance, and Ability to Participate in Social Roles and Activities (Participation). We used correlations to examine bivariate relationships between cognition and participation and hierarchical regression analysis (Step 1: Depression, Anxiety, Pain interference, Fatigue, Sleep disturbance, Step 2: CF, CSI, MoCA) to determine the independent relationships between impairments and participation.
RESULTS: The average MoCA score was 25.3±3.1, with 56.4% of participants scoring in the mild to moderate cognitive impairment range (≤ 26). Group average CF (T-score = 45.0±8.5), CSI (35.8±7.9), and Participation (46.9±11.2) scores indicated slightly reduced functional cognition and participation compared to normative data. Participation correlated with both self-reported functional cognition measures (r≥0.561, p<0.01) such that poorer functional cognition was associated with poorer participation, but not with MoCA (r=0.251, p=0.064). In hierarchical linear regression analysis, CSI, Fatigue, and Pain were each significant independent predictors of Participation (R2=0.783, p<0.01).
CONCLUSION: Over half of the participants in this sample had cognitive impairment according to an objective screener. Reduced reported functional cognition was associated with reduced participation independent of the effects of other disease-related factors such as pain, sleep and depressive symptoms. These findings provide rationale for further and more comprehensive investigation into cognitive impairment and its functional relevance in SLE. A better understanding of these relationships is necessary to inform the identification, development, and testing of interventions to address cognition and daily function among people with SLE.
References
Leslie, B., & Crowe, S. F. (2018). Cognitive functioning in systemic lupus erythematosus: a meta-analysis. Lupus, 27(6), 920-929. https://doi.org/10.1177/0961203317751859
Appenzeller, S., Cendes, F., & Costallat, L. T. (2009). Cognitive impairment and employment status in systemic lupus erythematosus: a prospective longitudinal study. Arthritis Care & Research: Official Journal of the American College of Rheumatology, 61(5), 680-687. https://doi.org/10.1002/art.24346
