Hanly John G, Omisade Antonina, Su Li, Farewell Vernon, Fisk John D
Dalhousie University, Halifax, Nova Scotia, Canada.
Arthritis Rheum. 2010 May;62(5):1478-86. doi: 10.1002/art.27404.
Computerized neuropsychological testing may facilitate screening for cognitive impairment in systemic lupus erythematosus (SLE). This study was undertaken to compare patients with SLE, patients with rheumatoid arthritis (RA), and patients with multiple sclerosis (MS) with healthy controls using the Automated Neuropsychological Assessment Metrics (ANAM).
Patients with SLE (n = 68), RA (n = 33), and MS (n = 20) were compared with healthy controls (n = 29). Efficiency of cognitive performance on 8 ANAM subtests was examined using throughput (TP), inverse efficiency (IE), and adjusted IE scores. The latter is more sensitive to higher cognitive functions because it adjusts for the impact of simple reaction time on performance. The results were analyzed using O'Brien's generalized least squares test.
Control subjects were the most efficient in cognitive performance. MS patients were least efficient overall (as assessed by TP and IE scores) and were less efficient than both SLE patients (P = 0.01) and RA patients (P < 0.01), who did not differ. Adjusted IE scores were similar between SLE patients, RA patients, and controls, reflecting the impact of simple reaction time on cognitive performance. Thus, 50% of SLE patients, 61% of RA patients, and 75% of MS patients had impaired performance on >or=1 ANAM subtest. Only 9% of RA patients and 11% of SLE patients had impaired performance on >or=4 subtests, whereas this was true for 20% of MS patients.
ANAM is sensitive to cognitive impairment. While such computerized testing may be a valuable screening tool, our results emphasize the lack of specificity of slowed performance as a reliable indicator of impairment of higher cognitive function in SLE patients.
计算机化神经心理学测试可能有助于系统性红斑狼疮（SLE）认知功能障碍的筛查。本研究旨在使用自动神经心理学评估指标（ANAM），比较SLE患者、类风湿关节炎（RA）患者、多发性硬化症（MS）患者与健康对照者。
将68例SLE患者、33例RA患者、20例MS患者与29例健康对照者进行比较。使用吞吐量（TP）、逆效率（IE）和调整后的IE分数来检查8项ANAM子测试的认知表现效率。后者对更高的认知功能更敏感，因为它调整了简单反应时间对表现的影响。结果采用奥布赖恩广义最小二乘法检验进行分析。
对照受试者在认知表现方面效率最高。MS患者总体效率最低（通过TP和IE分数评估），并且比SLE患者（P = 0.01）和RA患者（P < 0.01）效率都低，而SLE患者和RA患者之间没有差异。SLE患者、RA患者和对照者的调整后IE分数相似，反映了简单反应时间对认知表现的影响。因此，50%的SLE患者、61%的RA患者和75%的MS患者在≥1项ANAM子测试中表现受损。只有9%的RA患者和11%的SLE患者在≥4项子测试中表现受损，而MS患者中这一比例为20%。
ANAM对认知功能障碍敏感。虽然这种计算机化测试可能是一种有价值的筛查工具，但我们的结果强调，在SLE患者中，表现减慢作为更高认知功能障碍的可靠指标缺乏特异性。
