Cognitive deficits compound difficulties for lupus patients

A meta-analysis has confirmed the presence of subtle but significant cognitive deficits in people with systemic lupus erythematosus (SLE) – even in those patients not diagnosed with neuropsychiatric SLE.

The research identified 10 studies that compared cognitive function in people with SLE versus controls. It found an SLE diagnosis had a small but significant effect on visual attention span, cognitive fluency, immediate memory and visual reasoning.

Researcher Mr Ben Leslie, a neuropsychologist from La Trobe University, told the limbic the effects were sufficient to translate into poorer educational and employment outcomes.

“The take away message is an accumulation of subtle deficits that do exert a significant burden on patients which is borne out by outcomes such as vocational outcomes and employment status.”

“Despite these being a range of subtle deficits, the employment outcomes for people with SLE are significantly worse and the cognitive deficits tend to be a powerful predictor of that – beyond depression or even years of education.”

The analysis found greater deficits in visuospatial and verbal reasoning in people with neuropsychiatric SLE.

“All the research seems to indicate there is a gradient of deficit but the important thing is that gradient begins well before overt neuropsychiatric symptoms manifest and there is a wealth of research support for that now.”

He said that cognitive issues were notoriously difficult to assess accurately and there was a propensity for them to be overlooked.

Strategies to help compensate for cognitive deficits included making more use of diaries and reminders, working in a quieter environment, and avoiding multi-tasking.

“Cognitive deficits are incredibly hard to treat particularly ones of this nature and many medications such as corticosteroids also can have a deleterious effect on cognition as well.”

He said it was also difficult to tease out the effects of common physical symptoms as fatigue.

Mr Leslie said clinicians could screen their patients by asking a couple of quick questions such as ‘How are you going at work?’ or ‘Have you noticed any lapses or increased burden?

He added that the findings might set the scene for and encourage more work on developing quick and accurate screening measures and compensatory strategies.

The findings also reinforce the need to provide written information to patients when dealing with a group prone to lapses in attention and difficulty recalling information.

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