Asymptomatic Cerebrovascular, Cognitive Dysfunctions and Mood Changes in Systemic Lupus Patients

Abstract

Neuropsychiatric involvement in SLE is characterized by a heterogenesity of clinical manifestations, a wide variability in reported frequency between studies, and uncertainty about its attribution and etiology and the global application of sophisticated brain imaging and cognitive testing frequently reveal subclinical deficits whose clinical significance is unclear. From this point we wished to describe the extent and significance of neuropsychiatric disorders in an unselected population of SLE patients so, we designed our study to estimate prevalence of neuropsychiatric disorders in patients with SLE and explore the relation between brain MRI/MRA findings in SLE patients with neuropsychiatric affection, and SLE disease activity. The study included 30 female SLE patients with age ranging from 22 years to 40 years with mean age 31.7 years. All patients underwent history taking and clinical examination. SLE disease activity was measured by the SLEDAI score and psychometric evaluations were performed to all SLE patients using Modified Mini-Mental State Examination to assess for the presence of cognitive dysfunction, Hamilton Depression Rating Scale and Hamilton Anxiety Scale to assess for the presence of depression and anxiety respectively. Laboratory investigations were done including CBC, ESR, CRP, Complete urine analysis, protein/creatinine ratio, serum creatinine, AST, ALT, INR, ANA and anti-dsDNA. Magnetic resonance imaging (MRI/MRA) of the brain was done to detect signs of cerebral affection or vascular abnormalities. Data were collected, tabulated and statistical analyzed. Results revealed higher frequency of different neuropsychiatric manifestations among our SLE patients (73.33%). We recorded a higher percentage of abnormal MRI brain findings (90.9%) among SLE patients with NPSLE than that in SLE patient without NPSLE and the majority of MRI abnormalities were in the form of discrete white matter lesions (60%), cortical atrophy (25%) and gross infarctions (15%). By evaluation of our SLE patients using MRA brain; our data revealed vascular affection of one or more large intracranial vessels in (27.27%) of our NPSLE patients. Our study also recorded higher percentage of positive aPL antibodies among patients with NPSLE (54.5%) and all of them were found to have different MRI abnormalities. We also found significant correlation between SLE disease activity measured by SLEDAI and each of neuropsychiatric manifestations, MRI and MRA brain abnormalities.