From the University of Toronto; University of Toronto Lupus Clinic, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital; York University, Toronto, Ontario, Canada.
S.G. Nantes, BMSc, MD Candidate, University of Toronto; J. Su, MSc, University of Toronto Lupus Clinic, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital; A. Dhaliwal, HonBSc, University of Toronto; K. Colosimo, MA, Clinical Psychology, PhD(c), York University, Psychometrist and Research Analyst, University of Toronto Lupus Clinic, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital; Z. Touma, MD, FACP, FACR, PhD, Assistant Professor of Medicine, University of Toronto Lupus Clinic, Toronto Western Hospital, Centre for Prognosis Studies in the Rheumatic Diseases.
J Rheumatol. 2017 Nov;44(11):1583-1589. doi: 10.3899/jrheum.161125. Epub 2017 Sep 1.
There is a need for a cognitive function screening test that can be administered to patients with systemic lupus erythematosus (SLE) in clinic. The objectives of this study were to determine (1) prevalence of cognitive impairment (CI) in SLE by the Montreal Cognitive Assessment (MoCA), Mini Mental State Examination (MMSE), in relation to the Hopkins Verbal Learning Test-Revised (HVLT-R), and Perceived Deficits Questionnaire 5-Item (PDQ-5); and (2) associated factors with CI.
Consecutive patients followed at a single center were recruited. HVLT-R, MoCA, and MMSE were administered. Sensitivity/specificity, positive (PPV)/negative (NPV) predictive values, and positive likelihood ratio (LR+) of MoCA/MMSE were determined (compared to HVLT-R). A test on intellectual ability and questionnaires on anxiety, depression, and perceived cognitive deficits were completed. Regression analyses determined associations with CI.
Of 98 patients, 48% had CI using MoCA and 31% using HVLT-R. Sensitivity was higher for MoCA (73%) compared to MMSE (27%), though MMSE was more specific (90%) than MoCA (63%). PPV and LR+ were similar in MoCA and MMSE (PPV: 47%, 53%; LR+: 2.0, 2.6, respectively), but NPV was higher in MoCA (84%) than MMSE (74%). PDQ-5 predicted objective CI (HVLT-R: sensitivity 100%, specificity 89%). Although CI was associated with depression in univariate analyses, it did not hold in the multivariate analysis, while longer SLE disease duration and more years of education remained significant.
CI is highly prevalent and MoCA may be a useful tool to screen for CI in SLE. Patients with more years of education were less likely to have CI.
需要有一种认知功能筛查测试，可以在诊所中用于系统性红斑狼疮（SLE）患者。本研究的目的是确定（1）蒙特利尔认知评估（MoCA）、简易精神状态检查（MMSE）与霍普金斯词语学习测验修订版（HVLT-R）和感知缺陷问卷 5 项（PDQ-5）相关时，SLE 患者认知障碍（CI）的患病率；以及（2）与 CI 相关的因素。
连续招募在一个中心就诊的患者。进行 HVLT-R、MoCA 和 MMSE 检查。确定 MoCA/MMSE 的灵敏度/特异性、阳性（PPV）/阴性（NPV）预测值和阳性似然比（LR+）（与 HVLT-R 相比）。进行智力测试和焦虑、抑郁和感知认知缺陷问卷。回归分析确定与 CI 相关的因素。
98 例患者中，48%的患者 MoCA 结果异常，31%的患者 HVLT-R 结果异常。MoCA 的灵敏度（73%）高于 MMSE（27%），但 MMSE 的特异性（90%）高于 MoCA（63%）。MoCA 和 MMSE 的 PPV 和 LR+相似（PPV：47%，53%；LR+：2.0，2.6），但 MoCA 的 NPV（84%）高于 MMSE（74%）。PDQ-5 预测 HVLT-R 客观 CI（敏感性 100%，特异性 89%）。尽管在单变量分析中 CI 与抑郁相关，但在多变量分析中则不然，而 SLE 疾病持续时间较长和受教育年限较长则仍然具有显著性。
CI 发病率高，MoCA 可能是筛查 SLE 患者 CI 的有用工具。受教育年限较长的患者发生 CI 的可能性较小。
