Kozora Elizabeth, Arciniegas David B, Filley Christopher M, West Sterling G, Brown Mark, Miller David, Grimm Alex, Devore Maria D, Wingrove Christy, Zhang Lening
National Jewish Medical and Research Center and University of Colorado Denver Health Sciences Center, Denver, Colorado 80206, USA.
Arthritis Rheum. 2008 Nov 15;59(11):1639-46. doi: 10.1002/art.24189.
To examine neuropsychological and neurologic functioning in systemic lupus erythematosus (SLE) patients without histories of overt neuropsychiatric disorders (non-NPSLE patients).
Sixty-seven non-NPSLE patients and 29 healthy controls were administered a standardized neurologic examination and measures of cognition, depression, and self-reported cognitive functioning.
Non-NPSLE patients scored lower than controls on the total score of the neurologic examination (P < 0.0001). Item analysis indicated that the physician's description of mentation and mood was the only item that differed significantly between patients with SLE and controls (P = 0.004). Compared with controls, non-NPSLE patients had significantly higher rates of impairment on logical reasoning (P = 0.012) and verbal memory (P = 0.03), and trends toward greater impairment on visual attention (P = 0.06) and working memory (P = 0.098). There were no significant differences between non-NPSLE patients and controls on a cognitive impairment index (CII): 20.9% of non-NPSLE patients and 13.8% of controls were impaired. Patients with SLE scored higher on depressive symptoms (P < 0.0001) and perceived cognitive difficulties (P = 0.001) compared with controls.
The utility of a standardized neurologic examination in SLE for excluding overt neurologic dysfunction and assuring a non-NPSLE group selection was demonstrated. In contrast to our earlier study, we did not find differences between non-NPSLE patients and controls on the CII. Slightly lower CII scores in non-NPSLE patients and higher CII scores in controls may have reduced cognitive differences between these groups. Non-NPSLE patients demonstrate specific decline in the areas of attention, memory, and reasoning; continued studies of associated brain regions are warranted.
研究无明显神经精神疾病史的系统性红斑狼疮（SLE）患者（非神经精神性狼疮患者）的神经心理学和神经功能。
对67例非神经精神性狼疮患者和29例健康对照者进行标准化神经检查以及认知、抑郁和自我报告认知功能测量。
非神经精神性狼疮患者的神经检查总分低于对照组（P < 0.0001）。项目分析表明，医生对精神状态和情绪的描述是SLE患者与对照组之间唯一有显著差异的项目（P = 0.004）。与对照组相比，非神经精神性狼疮患者在逻辑推理（P = 0.012）和言语记忆（P = 0.03）方面的损害发生率显著更高，在视觉注意力（P = 0.06）和工作记忆（P = 0.098）方面有更大损害的趋势。非神经精神性狼疮患者与对照组在认知损害指数（CII）上无显著差异：20.9%的非神经精神性狼疮患者和13.8%的对照组存在损害。与对照组相比，SLE患者的抑郁症状（P < 0.0001）和感知到的认知困难（P = 0.001）得分更高。
证明了标准化神经检查在SLE中用于排除明显神经功能障碍和确保非神经精神性狼疮患者组选择的效用。与我们早期的研究不同，我们未发现非神经精神性狼疮患者与对照组在CII上存在差异。非神经精神性狼疮患者稍低的CII分数和对照组稍高的CII分数可能缩小了这些组之间的认知差异。非神经精神性狼疮患者在注意力、记忆和推理方面表现出特定下降；有必要继续研究相关脑区。
