POS0714 WHITE MATTER HYPERINTENSITIES LEAD TO REDUCED PSYCHOMOTOR SPEED IN PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS AND NEUROPSYCHIATRIC SYMPTOMS
Authors: R. Monahan, F. Inglese, H. Middelkoop, M. Van Buchem, T. Huizinga, M. Kloppenburg, I. Ronen, G. M. Steup-Beekman, J. De Bresser
Journal: Annals of the Rheumatic Diseases (2021)

Background: Cognitive impairment is common in patients with systemic lupus erythematosus (SLE) and neuropsychiatric (NP) symptoms, but the exact underlying structural brain correlates are unknown. Objectives: We aimed to compare cognitive function between groups of patients with different phenotypes of (NP)SLE and assessed the association between brain volumes, white matter hyperintensity (WMH) volume and cognitive function. Methods: Patients who visited the NPSLE clinic of the Leiden University Medical Center between 2007-2015 were included in this study (n=151; 42 ± 13 years, 91% female). In a multidisciplinary consensus meeting, phenotypes were established and neuropsychiatric symptoms were attributed to SLE (NPSLE, inflammatory (n=24) or ischemic (n=12)) or to minor involvement of SLE or other causes (minor/non-NPSLE (n=115)). All patients underwent standardized cognitive assessment of the four cognitive domains: global cognitive functioning (GCF), learning and memory (LM), executive functioning and complex attention (EFCA) and psychomotor speed (PS)). Cognitive dysfunction was defined as a T-score &lt;40, with age, sex, gender and education matched individuals of the Dutch population as reference. In addition, automated volume measurements on brain MRI (white matter, grey matter, white matter hyperintensities (WMH) and total brain volume (TBV)) were performed. Patients with brain infarcts &gt;1.5 cm were excluded. Cognitive function (Z-score) was compared between different NPSLE phenotypes using multiple regression analyses corrected for age, sex and education. Associations between brain volumes, WMH and cognitive function were assessed per phenotype using multiple regression analyses corrected for age, sex and intracranial volume. Results: Global cognitive functioning was impaired in 5%, learning &amp; memory in 46%, and executive functioning &amp; complex attention in 39% and psychomotor speed in 46% of all patients. Patients with inflammatory NPSLE showed the most cognitive impairment and reduced cognitive function compared to ischemic NPSLE (all domains) and minor/non-NPSLE (EFCA) (p &lt;0.05). Lower total brain volume and grey matter volume were associated with lower cognitive functioning in all domains (β: 0.00/0.01 (0.00; 0.01)) and lower white matter volume associated with lower LM, EFCA and PS (β: 0.00/0.01 (0.00; 0.01)) in all patients. Higher WMH volume associated with lower psychomotor speed (β: -0.14 (-0.32; -0.02)), especially in patients with inflammatory NPSLE (β: -0.36 (-0.60; -0.12). Conclusion: Reduced brain volume leads to reduced cognitive function in multiple cognitive domains in all patients with SLE and neuropsychiatric symptoms. Increased WMH volume leads to reduced psychomotor speed, especially in patients with inflammatory NPSLE. Table 1. Prevalence of cognitive impairment in patients with minor/non-NPSLE, inflammatory NPSLE and ischemic NPSLE Global cognitive functioning Learning &amp; memory Executive functioning &amp; complex attention Psychomotor speed All patients (n = 151 ) 8 (5) 70 (46) 57 (39) 69 (46) Inflammatory NPSLE (n = 24 ) 3 (13) 14 (58) 12 (50) 12 (50) Ischemic NPSLE (n = 12 ) 0 (0) 6 (50) 2 (17) 2 (17) Minor/non-NPSLE (n = 115 ) 5 (4) 50 (44) 43 (38) 55 (49) NPSLE = neuropsychiatric systemic lupus erythematosus. Data represent n (%) of patients with cognitive impairment in the mentioned cognitive domain. Cognitive impairment was defined as cognitive function at least 1SD lower than the mean of an age, sex and education matched general Dutch population. The percentages were calculated from total number of patients with available scores: Global functioning: 23/24 inflammatory NPSLE and 113/115 minor/non-NPSLE; psychomotor speed 113/115 minor/non-NPSLE, executive function &amp; complex attention: also 113/115. All tests were available for ischemic NPSLE. Disclosure of Interests: None declared