THU0275 NEW PROSPECTIVE OF COGNITIVE IMPAIRMENT IN SYSTEMIC LUPUS ERYTHEMATOSUS PATIENTS: A PRAGMATIC LANGUAGE EVALUATION
Authors: Carmelo Pirone, Fulvia Ceccarelli, Concetta Mina, Alfredo Mascolo, Carlo Perricone, Barbara Mazzotta, Laura Massaro, Francesca Spinelli, Cristiano Alessandri, Guido Valesini, Fabrizio Conti
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background:</h3> Cognitive impairment (CI) in Systemic Lupus Erythematosus (SLE) is a frequent neuropsychiatric manifestation affecting several domains, even in apparently asymptomatic patients. Current research revealed that the typical CI pattern affects frontal-subcortical circuit and thus executive functions. The impairment of non-literal language or Pragmatic Language (PL), including metaphors, idioms, inferences or irony has been well described in several conditions such as autism disorders, Parkinson's disease, brain injury and even in earlier phases of neurodegenerative processes. Even if PL neuro-anatomy remains controversial, correlation between executive dysfunctions and non-literal language involvement has been reported both in traumatic injury and mild cognitive impairment patients. Nonetheless, no specific study has been performed to evaluate PL impairment in SLE patients so far. <h3>Objectives:</h3> We aimed at assessing the PL domain in a monocentric SLE cohort in comparison to healthy controls, matched to age and education, through a specific battery, BLED [1]. Secondly, we focused attention on possible correlations between CI and clinical and laboratory SLE-related features. <h3>Methods:</h3> Forty adult patients affected by SLE, according to the ACR criteria, and thirty healthy subjects were enrolled consecutively in this cross-sectional study. The protocol included complete physical examination, extensive clinical and laboratory data collection (comprehensive of demographics, past medical history, co-morbidities, disease activity, chronic damage evaluation, previous and concomitant treatments) and cognitive assessment for five different domains: memory, attention, pragmatic language, executive and visuospatial functions. Self-reported scale for anxiety and depression were performed to exclude the influence of mood disorders on cognitive dysfunction. <h3>Results:</h3> We enrolled forty Caucasian SLE patients (M/F 3/37; mean±SD age 45.9±10.1 years, mean±SD disease duration 120.8±81.2 months) and thirty healthy subjects (M/F 9/21; mean±SD age 41.3±13 years). According to the low level of disease activity and damage (mean±SD SLEDAI-2K of 1.3±2.3, mean±SD SDI of 0.2±0.5), only 30% of patients was on glucocorticoid treatment at the study entry. PL was the most compromised domain in terms of Mean Domain Z scores (Fig. 1). As regards the Domain Cognitive Dysfunction score, a deficit of PL was observed in 45% of patients and resulted significantly more prevalent than memory, executive and visuospatial functions impairment (P=0.0002, P=0.0002 and P&lt;0.000001, respectively). According to Global Cognitive Dysfunction score 25% of patients experienced a mild impairment and 7.5% a moderate one. Anti-phospholipid antibodies positivity was significantly associated with memory impairment (P&lt;0.0005), whereas the presence of other neuropsychiatric events was associated with executive dysfunctions (P&lt;0.05); neither further significant association nor correlation were identified. <h3>Conclusion:</h3> We evaluated for the first time PL in a single center SLE cohort finding a dysfunction in almost half of patients enrolled, significantly more frequent than the other assessed domains. <h3>Reference:</h3> [1] Rinaldi C, Marangolo P, Lauriola M. "BLED Santa Lucia: Batteria sul Linguaggio dell'Emisfero Destro Santa Lucia" Giunti O.S., 2006. <h3>Disclosure of Interests:</h3> Carmelo Pirone: None declared, Fulvia Ceccarelli: None declared, Concetta Mina: None declared, Alfredo Mascolo: None declared, Carlo Perricone Speakers bureau: BMS; Lilly, Celgene, Sanofi, Barbara Mazzotta: None declared, Laura Massaro: None declared, francesca spinelli: None declared, cristiano alessandri: None declared, Guido Valesini: None declared, fabrizio conti: None declared