Correlation of neurocognitive function and brain lesion load on magnetic resonance imaging in systemic lupus erythematosus
Neurocognitive dysfunction and brain injury on magnetic resonance imaging (MRI) are common in patients with systemic lupus erythematosus (SLE) and are associated with increased morbidity and mortality. However, brain MRI is expensive, is restricted by payers, and requires high expertise. Neurocognitive assessment is an easily available, safe, and inexpensive clinical tool that may select patients needing brain MRI. In this cross-sectional and controlled study, 76 SLE patients (69 women, age 37 ± 12 years) and 26 age and gender-matched healthy subjects (22 women, age 34 ± 11 years) underwent assessment of attention, memory, processing speed, executive function, motor function, and global neurocognitive function. All subjects underwent brain MRI with T1-weighted, fluid-attenuated inversion recovery (FLAIR), and diffusion-weighted imaging. Hemispheric and whole brain lesion load in cm3 were determined using semi-automated methods. Neurocognitive z-scores in all clinical domains were significantly lower and whole brain and right and left hemispheres brain lesion load were significantly greater in patients than in controls (all p ≤ 0.02). There was significant correlation between neurocognitive z-scores in all domains and whole brain lesion load: processing speed (r = − 0.46; p < 0.0001), attention (r = − 0.42; p < 0.001), memory (r = − 0.40; p = 0.0004), executive function (r = − 0.25; p = 0.03), motor function (r = − 0.25; p = 0.05), and global neurocognitive function (r = − 0.38; p = 0.006). Similar correlations were found for brain hemisphere lesion loads (all p ≤ 0.05). These correlations were strengthened when adjusted for glucocorticoid therapy and SLE disease activity index. Finally, global neurocognitive z-score and erythrosedimentation rate were the only independent predictors of whole brain lesion load (both p ≤ 0.007). Neurocognitive measures and brain lesion load are worse in SLE patients than in controls. In SLE patients, neurocognitive z-scores correlate negatively with and independently predict brain lesion load. Therefore, neurocognitive testing may be an effective clinical tool to select patients needing brain MRI.
KeywordsNeurocognitive function Brain injury Magnetic resonance imaging Systemic lupus erythematosus
This research was funded by the Grant RO1-HL04722-01-A6 by the National Institutes of Health/National Heart Lung and Blood Institute and in part by the National Center for Research Resources and National Center for Advancing Translational Sciences through the Grant Number 8UL1-TR00004-1.
Compliance with ethical standards
Conflict of interest
None of the authors has a conflict of interest to disclose.
- 2.Monastero R, Bettini P, Del Zotto E, Cottini E, Tincani A, Balestrieri G, Cattaneo R, Camarda R, Vignolo LA, Padovani A (2001) Prevalence and pattern of cognitive impairment in systemic lupus erythematosus patients with and without overt neuropsychiatric manifestations. J Neurol Sci 184:33–39CrossRefPubMedGoogle Scholar
- 9.Scully M, Anderson B, Lane T, Gasparovic C, Magnotta V, Sibbitt W, Roldan C, Kikinis R, Bockholt HJ (2010) An automated method for segmenting white matter lesions through multi-level morphometric feature classification with application to lupus. Front Hum Neurosci 19:4:27Google Scholar
- 11.Gladman DD, Urowitz MB, Goldsmith CH, Fortin P, Ginzler E, Gordon C, Hanly JG, Isenberg DA, Kalunian K, Nived O, Petri M, Sanchez-Guerrero J, Snaith M, Sturfelt G (1997) The reliability of the systemic lupus international collaborating clinics/American College of rheumatology damage index in patients with systemic lupus erythematosus. Arthritis Rheum 40:809–813CrossRefPubMedGoogle Scholar
- 27.Sarbu N, Alobeidi F, Toledano P, Espinosa G, Giles I, Rahman A, Yousry T, Capurro S, Jäger R, Cervera R, Bargalló N (2015) Brain abnormalities in newly diagnosed neuropsychiatric lupus: systematic MRI approach and correlation with clinical and laboratory data in a large multicenter cohort. Autoimmun Rev 14:153–159CrossRefPubMedGoogle Scholar
- 28.Cohen D, Rijnink EC, Nabuurs RJ, Steup-Beekman GM, Versluis MJ, Emmer BJ, Zandbergen M, van Buchem MA, Allaart CF, Wolterbeek R, Bruijn JA, van Duinen SG, Huizinga TW, Bajema IM (2017) Brain histopathology in patients with systemic lupus erythematosus: identification of lesions associated with clinical neuropsychiatric lupus syndromes and the role of complement. Rheumatology (Oxford) 56:77–86CrossRefGoogle Scholar
- 30.Hanly JG, Urowitz MB, Su L, Sanchez-Guerrero J, Bae SC, Gordon C, Wallace DJ, Isenberg D, Alarcón GS, Merrill JT, Clarke A, Bernatsky S, Dooley MA, Fortin PR, Gladman D, Steinsson K, Petri M, Bruce IN, Manzi S, Khamashta M, Zoma A, Font J, Van Vollenhoven R, Aranow C, Ginzler E, Nived O, Sturfelt G, Ramsey-Goldman R, Kalunian K, Douglas J, Qiufen Qi K, Thompson K, Farewell V; Systemic Lupus International Collaborating Clinics (2008) Short-term outcome of neuropsychiatric events in systemic lupus erythematosus upon enrollment into an international inception cohort study. Arthritis Rheum 59:721–729CrossRefPubMedPubMedCentralGoogle Scholar