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Predictors of cognitive dysfunction in patients with systemic lupus erythematosus

From the Department of Medicine, Division of Neurology, San Antonio, TX.

Address correspondence and reprint requests to Dr. Robin L. Brey, Department of Medicine, Division of Neurology, 7703 Floyd Curl Drive #7883, San Antonio, TX 78229-3900; e-mail: brey{at}uthscsa.edu

Objective: To evaluate predictors of cognitive dysfunction in patients with systemic lupus erythematosus (SLE).

Methods: The authors evaluated 123 patients enrolled in the San Antonio Lupus Study of Neuropsychiatric Disease (SALUD) who had completed at least 3 years of follow-up. Study visits occurred every 4 months and included a standard medical history, physical examination, and cognitive testing. Blood was obtained at each study visit for autoantibody testing.

Results: There were 116 (94.3%) women and 7 (5.7%) men (mean age = 41.5 [±12.0] years). Patients had the following vascular risk factors: hypercholesterolemia (17.1%), diabetes (21.1%), and hypertension (48.0%). Consistent medication use included aspirin (21.1%), prednisone (65.0%), nonsteroidal anti-inflammatories (42.3%), and hydroxychloroquine (58.5%). The numbers of patients with consistently positive autoantibody levels were as follows: antiphospholipid, 54%; anti-beta-2-glycoprotein 1, 73%; and anti-ribosomal P, 17%. Factors significantly associated with declining cognitive function were consistently positive antiphospholipid antibodies, consistent prednisone use, diabetes, higher depression scores, and less education. The association of prednisone and poorer cognitive function was seen primarily in the middle age group and could not be totally explained by SLE-associated disease activity. Consistent aspirin use was associated with improved cognitive function, primarily in the oldest age group, especially if diabetes was also present.

Conclusions: Regular aspirin use is associated with improved cognitive function in older patients with systemic lupus erythematosus (SLE) in conjunction with the presence of other vascular risk factors. Regular prednisone use is associated with decreased cognitive functioning in middle-aged patients with SLE. Although this prednisone effect was independent of measures of SLE-associated disease activity, the authors cannot exclude the possibility that consistent prednisone use is a surrogate for more severe disease.

Supported by a grant from the National Institute of Neurologic Disorders and Stroke (NS35477) and the National Center for Research Resources General Clinical Research Center Program (MO1 RR01346–19), where the study is conducted and R.L.B. is an Associate Program Director.

Received April 9, 2004. Accepted in final form October 6, 2004.

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