CLINICAL COURSE OF COGNITIVE DYSFUNCTION IN SYSTEMIC LUPUS-ERYTHEMATOSUS

Objective. To prospectively evaluate changes in cognitive function in a cohort of unselected patients with systemic lupus erythematosus (SLE ) and controls over a 12 month period. Methods. Seventy female patient s with SLE, 25 patients with rheumatoid arthritis (RA) and 23 healthy subjects (age and sex matched) were evaluated using the Wechsler Adult Intelligence Scale-Revised (WAIS-R), the Wechsler Memory Scale-Revise d (WMS-R), the California Verbal Learning Test (CVLT) and the National Adult Reading Test-Revised to identify impairment in 8 areas of cogni tive function. Cumulative disease manifestations and current medicatio ns were documented, and disease activity was expressed using the SLE d isease activity index (SLEDAI). Decision rules were determined for ove rall cognitive impairment. Results. At baseline, 21% (15/70) of patien ts with SLE were impaired compared to 4% (1/25) of patients with RA an d 4% (1/23) of healthy subjects (p = 0.042). After a mean interval of 12.8 months (range: 11-17) 84% (59/70) of patients with SLE, 44% (11/2 5) of patients with RA and 80% (17/23) of healthy subjects were reasse ssed. This included all subjects who were impaired at the initial asse ssment. Using the same decision rules as at baseline, 12% (7/59) of pa tients with SLE were impaired at followup compared to none of the pati ents with RA and healthy subjects. Over the period of study cognitive impairment persisted in 3 patients with SLE, resolved in 12 and evolve d in 4 others. There was no apparent association between changes in co gnitive function and concurrent changes in generalized disease activit y, overt neuropsychiatric disease or corticosteroid medication. Conclu sion. Our results suggest that cognitive dysfunction in patients with SLE is evanescent, does not necessarily lead to irreversible neurologi c compromise and changes independently of other clinical variables.