Screening for Cognitive Impairment in Systemic Lupus Erythematosus

Objective. We examined the association between responses on a screening questionnaire and objective performance on a computer-administered test of cognitive abilities in systemic lupus erythematosus (SLE). Methods. The Cognitive Symptom Inventory (CSI) and Hospital Anxiety and Depression Scales (HADS) questionnaires were compared in patients with SLE or rheumatoid arthritis (RA). The Automated Neuropsychological Assessment Metrics (ANAM) was used to evaluate cognitive performance in patients with SLE. Efficiency of performance was measured by "throughput" (number of correct responses per minute) and "inverse efficiency" (response speed/proportion of correct responses). Linear regression was applied to log-transformed CSI scores to examine their associations with ANAM scores and other factors. Results. Patients with SLE (n = 68) or RA (n = 33) were similar in age, sex, ethnicity, and education status (p > 0.05). Patients with SLE had higher total CSI scores (33.6 +/- 10.5 vs 29.4 +/- 6.8, respectively; p = 0.041) and attention/concentration subscale CSI scores (15.7 +/- 5.3 vs 13.3 +/- 3.4; p = 0.016) compared to patients with RA. In patients with SLE there was a positive association between CSI scores and neuropsychiatric (NP) events at the time of testing (p = 0.0006), HADS anxiety (p < 0.0001), and depression (p < 0.0001) scores. After adjustment for age, education, disease duration, and NP events at the time of testing, there was no significant association (p > 0.05) between ANAM and CSI scores in patients with SLE. The results were similar using either "throughput" or "inverse efficiency" or the number of impaired ANAM subscales after adjustment for simple reaction time. Conclusion. The CSI self-report questionnaire of cognitive symptoms does not reliably screen for efficiency of cognitive processing in patients with SLE. Rather, cognitive complaints reported in the CSI are influenced by the presence of anxiety and depression. (First Release June 1 2012; J Rheuinatol 2012;39:1371-7; doi:10.3899/jrheum.111504)