POS0731 CLINICAL ASSOCIATIONS OF COGNITIVE DYSFUNCTION IN SYSTEMIC LUPUS ERYTHEMATOSUS (SLE)
Authors: S. Raghunath, V. Golder, R. Kandane-Rathnayake, E. F. Morand, Y. Glikmann-Johnston, J. C. Stout, A. Hoi
Journal: Annals of the Rheumatic Diseases (2021)

Background: Cognitive symptoms are commonly reported by SLE patients, but the prevalence and clinical associations of cognitive dysfunction (CD) is poorly understood. Objectives: To examine the relationship between SLE disease parameters and CD. Methods: Patients with SLE were consecutively recruited from 2018-2020. Cognitive assessment was performed using the one-hour conventional neuropsychiatric test battery recommended by the American College of Rheumatology for SLE 1 . Three binary definitions of CD and seven cognitive test z-scores were included in analysis. Clinical parameters included disease activity (SLEDAI-2K) and damage (SDI). Multivariate regression analysis was performed to determine associations with cognitive endpoints using variables with p &lt;0.1 on univariate testing; likelihood ratio tests were used to select for inclusion from collinear pairs. A subgroup univariate analysis was performed to look for associations with interferon gene signature (IGS) and metabolic indices. Results: 91 SLE patients and 48 age, sex, and premorbid IQ matched controls were recruited. The median (range) age was 45 (21-64) and median disease duration 13 years (0.2-39). 60% were Caucasian and the rest predominantly Asian, and all had good English proficiency. Prevalence of CD varied based on definition used; 18% had ≥2 cognitive domains ≥2 SD below the healthy control mean, whereas 48% were considered impaired if this threshold was reduced to ≥1.5 SD below. Age and premorbid IQ were significantly associated with multiple cognitive endpoints, and SDI was associated with four endpoints including the most severe definition of CD. Increased parity and past strokes correlated with poorer cognition in two endpoints. In contrast, clinical variables such as SLEDAI, antiphospholipid antibodies and past seizures only correlated with one endpoint each. There were no associations with other antibodies or any medications including glucocorticoids. Subgroup analysis showed univariate associations of CD with increased waist circumference, hypertriglyceridemia and low IGS. Conclusion: Clinical associations of CD in SLE vary according to the cognitive domain or impairment definition used. SDI was the disease-related factor most consistently associated with CD, while IGS was negatively and metabolic features positively associated with CD. Studies of CD in SLE should use standardised methods to determine CD. References: [1]Liang et al. The American College of Rheumatology nomenclature and case definitions for neuropsychiatric lupus syndromes. Arthritis Rheum. 1999;42(4). Table 1. Multivariate Analysis of Clinical Predictors of Cognitive Dysfunction in SLE Cognitive Dysfunction Definitions 1 Individual Cognitive Domains (Tests) 2 domains -1.5 SD 1 domain -2 SD 2 domains -2 SD Visual Memory (ROCF recall) Verbal Memory (CVLT 1-5) Verbal Fluency (COWAT FAS) Working Memory (LNS score) Processing Speed (Coding score) Complex attention (TMT B time) Psychomotor Speed (Finger tap) Odds ratio (logistic regression) Coefficient (linear regression) Age 1.06* 1.06* -0.03* -0.014* -0.03** Premorbid IQ 0.89** 0.86** 0.85* 0.056** 0.044** 0.072** 0.028** 0.026* 0.05** 0.017 SLEDAI 0.86 0.89 Time-adjusted mean SLEDAI 0.14** -0.012 PGA 0.79** 0.44 SDI 1.91* -0.25** -0.15** -0.22** Past stroke or TIA 7.94 13.19* -0.97** Past seizures -0.65* -0.24 Methotrexate -0.23 Anti Ro 0.22 Anti-cardiolipin 0.38* Any APLS abs 0.037** Parity 2.21** -0.05 -0.051 -0.22** Substance use 2.58 -0.49* -0.62* 1 Impairment defined by number of cognitive domains either 1.5 or 2 SD below healthy control group mean * p value &lt;0.05 ** p value &lt;0.005 Abbreviations: SLEDAI - SLE Disease Activity Index, PGA - Physician global assessment, SDI - SLE International Collaborating Clinics Damage Index, TIA - Transient Ischaemic Attack, abs - Antibodies, APLS - Antiphospholipid Syndrome, ROCF - Rey-Ostrrieth Complex Figure Test, CVLT - California Verbal Learning Test, COWAT - Controlled Oral Word Association Test, LNS and Coding - Letter Number Sequencing &amp; Coding subsets of Wechsler Adult Intelligence Scale IV, TMT - Trail Making Test Acknowledgements: We would like to acknowledge the patients who contribute to the Australian Lupus Registry and Biobank (ALRB) and participated in this study. The ALRB has received sponsorship from AstraZeneca, UCB and Arthritis Victoria. Disclosure of Interests: None declared