FRI0627-HPR COGNITIVE DISORDERS IN SYSTEMIC LUPUS ERYTHEMATOSUS WITH JUVENILE-ONSET: ONE SINGLE CENTER EXPERIENCE
Authors: M. Kaleda, N. Stepanenko, I. Nikishina
Journal: Annals of the Rheumatic Diseases (2020)

Background: Juvenile-onset SLE (jSLE) is a more aggressive disease than in adults due to several reasons including cognitive dysfunction, significantly affected the compliance and social rehabilitation of patients (pts). Objectives: To analyze the cognitive, emotional and communicative status of pts with jSLE. Methods: The study included 31 pts (90.3% girls) with jSLE, verified in accordance to SLICC criteria 2012. All pts underwent standard examination in accordance with the diagnosis; in case of suspected neuropsychiatric disorders pts were examined by a neurologist, psychiatrist. Classifying of neuropsychiatric disorders was performed in accordance with the recommendations of the ACR,1999. SLEDAI 2К was used for disease activity assessment. All pts were examined by a clinical psychologist using the standard pathodiagnostic testing. Results: The median age at the onset was 12.0 y.o. [10.6;14.5]. The median disease duration at the time of diagnosis - 0.75 ys [0.5;2.1]. 35.5% pts had neuropsychic disorders at the onset: psychoses – 12.9%, headaches – 12.9%, cognitive disorders – 19.4%, mood disorders – 16.1%, distal polyneuropathy – 12.9%. MRI of the brain was performed in 15 pts: CNS vasculitis was diagnosed in 3 pts (2 – with psychosis, 1 – with cognitive impairment). Median disease activity by SLEDAI at the time of diagnosis was 15 scores [10;23]. At the time of examination by the clinical psychologist, the median age of pts was 15.2 ys [12.9;16.5]. The median disease duration was 1.1 ys [0.6;3.8]. Cognitive disorders were detected in 96.8% of the pts. The auditory-speech short-term memory was distributed between the medium and high levels (54.8% and 45.2%, respectively), and the high level of memorization prevailed in the long-term memory (67.7% high, 32.3% medium). A high level of indirect memory was revealed in 67.8% of pts, medium - in 25.8%, and low - in 6.4%. Distribution of the difficulties of attention were identified (64.5% - uneven distribution, 35.5% - sufficient distribution), as well as increased attrition of attention (74.2% - attrition is detected, 25.8% - no attrition). 58.1% of pts demonstrated a high level of inclusion into work, 41.9% - a low one. Concentration of attention was recognized as sufficient in 87.1% of pts, insufficient in 12.9%. The effectiveness of attention was rated as good in 87.1%, decreased – in 12.9%; stability is sufficient - in 64.5%, low - in 35.5%. In the operational side of thinking, a decrease in the level of generalization was revealed (48.4%); there were no disturbances in the motivational component, lability of thinking in the dynamic (12.9%). Various neurotic fears are characteristic for 54.8% of pts; the level of personal anxiety was increased in 41.9%, moderate - in 48.4%, low - in 9.7%. Signs of aggression were revealed in 19.4% of pts, a decrease in the level of social adaptation - in 51.6%. Communication difficulties experienced 83.9% of pts. According to the results of the clinical conversation, attention was focused on availability of conflict situations with peers in the disease onset in 38.7% of pts. Conclusion: Cognitive disorders were detected in the majority of pts with jSLE, regardless of the presence of neuropsychiatric disorders at the onset. The revealed features of the clinical and psychological status of pts with jSLE must be considered when working out an individual rehabilitation model and develop psycho-correctional programs. Disclosure of Interests: None declared