Promising Screening Tools Assessed for Cognitive Dysfunction in Systemic Lupus Erythematosus

The Montreal Cognitive Assessment (MoCA) questionnaire is an easy-to-administer, inexpensive, effective screening tool that can identify patients with systemic lupus erythematosus (SLE) who might be at risk for cognitive dysfunction (CD) and might benefit from additional neuropsychiatric assessment, according to data published in Lupus.

The investigators sought to evaluate use of the MoCA test and the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) as screening tools for CD in patients with SLE. Patients with SLE who met the American College of Rheumatology classification criteria were assessed using Automated Neuropsychiatric Assessment Metrics (ANAM) as the reference standard.

Two control populations were used in the study: (1) normal controls from the community, who were age- and gender-matched and (2) patients with rheumatoid arthritis (RA) who were age-, gender-, and race-matched. Individuals with RA were selected as additional controls to minimize the potentially confounding effect of chronic illness and inflammation on cognitive performance. Overall, 4 different definitions of CD were used.

A total of 78 patients were evaluated. The mean age was 45.9 ± 11.2 years and mean disease duration was 10.4 ± 6.9 years; 91% of patients were women. Results showed that MoCA and ANAM scores were significantly correlated (P <.001). At the optimal cutoff, the sensitivity of the MoCA was ≥90% (depending on the definition of CD that was used) vs in patients with RA and ≥83% vs in normal controls. ANAM and IQCODE scores were not significantly correlated (P =.8152). Moreover, regardless of the CD definition and cutoff used, IQCODE sensitivities were low for both patients with RA and normal controls.

The investigators concluded that the MoCA seems to be a promising, practical screening tool for the identification of patients with SLE who are at risk for CD. The questionnaire is readily available to all healthcare professionals at no cost, has a high sensitivity, and has a low negative likelihood ratio.

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Reference

Chalhoub NE, Luggen ME. Screening for cognitive dysfunction in systemic lupus erythematosus: the Montreal Cognitive Assessment Questionnaire and the Informant Questionnaire on Cognitive Decline in the Elderly [published online November 27, 2018]. Lupus. doi: 10.1177/0961203318815299