Advanced MRI finds brain abnormalities linked to cognitive dysfunction in lupus
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Key takeaways:
- Memory, attention and psychomotor speed were the most frequently affected cognitive domains linked to MRI findings.
- Disease duration and glucocorticoids were linked to regional brain abnormalities.
Advanced structural MRI can detect brain abnormalities linked with cognitive dysfunction in patients with systemic lupus erythematosus, according to a systematic review published in Lupus Science & Medicine.
The review follows previous advanced MRI investigations that found altered tissue microstructure in several regions of the brain, which correlated with greater cognitive dysfunction, regardless of diagnosis with neuropsychiatric SLE, the researchers wrote.
“Overall, the presence of these associations, even in the absence of clinical NPSLE diagnosis, suggests that brain involvement could be under-detected in SLE,” Diana Valdés Cabrera, PhD, a neuroimaging research fellow at The Hospital for Sick Children, in Toronto, and colleagues wrote. “However, existing advanced neuroimaging research in SLE has been limited in generalizability and interpretation due to small cohorts and often incomplete characterization of clinical features.”
To learn more about how MRI metrics correlate with cognitive dysfunction in SLE, Cabrera and colleagues conducted a systematic review of 18 studies. The studies used structural, T1-weighted MRI (n = 8), diffusion MRI (n = 9) or both (n = 1) and evaluated cognitive dysfunction among SLE patients, with sample sizes between 11 and 120.
Overall, the most frequently affected cognitive domains associated with MRI findings — either structural or diffusion — were memory, attention and psychomotor speed, according to the researchers. In those domains, cognitive dysfunction was correlated with abnormal MRI metrics, such as low volumes and abnormal microstructure, especially in the hippocampus, corpus callosum and frontal cortex, and regardless of clinical diagnosis of central nervous system involvement.
Factors linked to regional brain structure abnormalities included longer disease duration, fatigue and higher cumulative glucocorticoid doses, the researchers wrote.
“This systematic review indicates that despite the limitations, the existing literature shows structural and microstructural changes in brain regions and networks that are known to be involved in many aspects of cognition,” Cabrera and colleagues wrote. “The use of these advanced structural MRI metrics might enhance the knowledge of the underlying causes of [cognitive dysfunction (CD)] and other neuropsychiatric symptoms such as mood disorders in SLE, and they could help to develop more objective biomarkers for the attribution of specific NPSLE symptoms.
“Together with functional and metabolic neuroimaging tools, these structural metrics could also serve as complementary diagnostic tools of NPSLE, as well as outcome measures in clinical trials focusing on therapeutic interventions and neuroprotection and preserving cognitive function in SLE,” they added. “However, improved characterization of SLE cohorts, guidelines for neuroimaging acquisitions and analyses and more longitudinal studies are needed to further confirm the diagnostic and predictive ability of these metrics in SLE-related CD.”
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