Cognitive dysfunction in systemic lupus erythematosus: Its relationship with intracerebral volumes and antiphospholipid antibody profile. Case series.

Abstract

Introduction: The incidence of cognitive compromise in systemic lupus erythematosus is variable; it presents early and is usually asymptomatic. Our study evaluated the frequency of cognitive impairment in patients without a previous diagnosis of neuropsychiatric lupus and compared the differences in intracerebral size in subgroups with cognitive alterations and positive autoantibodies.

Methods: This is a cross-sectional study. Patients with systemic lupus erythematosus without a previous diagnosis of neuropsychiatric lupus treated between July 2018 and October 2019 were included. Neuropsychological tests and brain imaging were performed by magnetic resonance imaging (MRI) measuring brain volumes. The variables, including antiphospholipid syndrome (APS) antibodies, were compared between subgroups of patients with and without neuropsychological alterations.

Results: Six patients were included. Patients who tested positive in more than two abnormal neuropsychiatric assessments showed reduced brain volumes in the right (6.1 versus 5.31) and left (6.2 versus 5.38) frontal lobes, the right (0.66 versus 0.65) and left (0.67 versus 0.6) cingulate cortices, the right (3.63 versus 3.38) and left (3.67 versus 3.4) temporal lobes, the right (3.96 versus 3.8) and left (3.87 versus 3.7) parietal lobes, and the right (0.49 versus 0.41) and left (0.46 versus 0.42) insula. A comparison of median normalized brain volumes revealed that most patients testing positive for antiphospholipid antibodies had reduced brain volumes.

Conclusions: A relationship was observed between neurocognitive compromise, antiphospholipid antibodies and brain volumes measured by cerebral magnetic resonance. These findings occur in asymptomatic neuropsychiatric patients.