Attention, inhibitory control lower in patients with lupus vs general population
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Key takeaways:
- Fluid cognition impairment was more common among patients with systemic lupus erthematosus, particularly in attention and inhibition.
- Employment and higher physical performance were linked to lower risk for impairment.
The ability to reason and solve new problems, known as fluid cognition, is lower among patients with systemic lupus erythematosus compared with the general population, according to data published in Arthritis Care & Research.
The study found that among all domains of fluid cognition, patients with SLE scored lowest on attention and inhibitory control vs. the national average.
“In our research, there has been a recurring theme that patients with SLE often feel they are in a ‘lupus fog’ and that this fog is one of the most frustrating symptoms that they experience,” Laura C. Plantinga, PhD, of the University of California, San Francisco, told Healio. “Better understanding the underlying issues could help us better support patients who experience these symptoms.”
To assess fluid cognition among patients with lupus, Plantinga and colleagues recruited 199 adults with SLE (mean age, 46.1 years) from an ongoing population-based study in the metropolitan Atlanta area. Between October 2019 and May 2022, each participant underwent an in-person fluid cognition assessment through the NIH Toolbox, which tested episodic memory, working memory, attention and inhibitory control, processing speed and cognitive flexibility.
The primary analyses were conducted using age-corrected standard scores, with a score of 100 being the national average for a representative sample at the test taker’s age. Multivariable logistic regression evaluated links between certain characteristics and potential fluid cognition impairment, defined as a standard score 1.5 or more standard deviations below the mean.
According to the researchers, the mean age-corrected standard score for overall fluid cognition among adults with SLE was 87.2 (95% CI, 85-89.4). The domain with the lowest mean score — 82 — was attention and inhibitory control, with 28% of participants being “potentially impaired.”
Factors associated with lower risk for fluid cognition impairment were current employment (OR = 0.3; 95% CI, 0.14-0.64), higher self-reported physical function (OR = 0.46; 95% CI, 0.28-0.75) and physical performance (OR = 0.72; 95% CI, 0.59-0.87). Meanwhile, lower educational attainment was associated with higher risk (OR = 3.82; 95% CI, 1.67-8.75).
According to Plantinga, one of the unexpected results was that self-reported forgetfulness showed no link with overall fluid cognition score.
“This suggests that other factors besides cognitive function may contribute to symptoms of forgetfulness — for example, sleep quality — and/or that problems with attention and inhibitory control may be experienced as a problem with memory,” she said.
In the future, studies should compare results from the NIH Toolbox Fluid Cognition Battery with those of other tests, such as the American College of Rheumatology Neurocognitive Battery, Plantinga added. Also, individuals should be followed over time and targeted interventions should be developed and implemented.
“Few studies have examined fluid cognition specifically in SLE,” Plantinga said. “Fluid cognition is considered to be mostly independent of acquired knowledge and acculturation, which can help with comparisons across individuals and populations. Additionally, it is made up of multiple domains — episodic and working memory, attention and inhibitory control, processing speed, and cognitive flexibility — and allows the identification of problematic areas and, potentially, targeted interventions.”
Perspective
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This is an informative and interesting study that highlights the importance of recognizing and addressing cognitive dysfunction in patients with lupus.
As an infusion nurse who has taken care of patients with lupus for nearly 20 years, I often hear patients’ complaints about their “lupus fog.” Although neuropsychiatric lupus is a known manifestation of the disease, in the clinical setting it often takes a back seat to other organ and system damage, and thus is not addressed meaningfully. This study shows that using a standardized tool to identify patients with cognitive impairments can help develop interventions to help patients with SLE experiencing fluid cognition dysfunction achieve a higher quality of life.
More research is needed in this area to find simpler and easier ways to identify and treat this problem, with the capacity to reason and solve problems in novel situations.
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All of us who care for patients with systemic lupus erythematosus would agree that the complaints of lupus brain fog are real and frequent. I would suspect that some of the findings of this study, regarding the prevalence of fluid cognition impairment in our lupus patient population, were not a surprise to any of us. It is encouraging to see work being done in measuring and understanding these very real and common complaints in our patients with lupus.
The findings of this study underscore the importance of assessing and addressing cognitive function in patients with SLE, with potential implications for disease management and quality of life. Further research is definitely needed to explore interventions targeting cognitive deficits in this population to improve overall wellbeing and functional outcomes.
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