Diagnostic Options for Cognitive Dysfunction in Lupus

September 22, 2020

Cognitive impairment can be an ongoing issue for patients with rheumatic disease, such as lupus. A proper diagnosis includes a battery of tests, says Noa Shwartz, M.D., a physician-researcher with Albert Einstein College of Medicine in New York.

Cognitive impairment can be an ongoing issue for patients with rheumatic disease, such as lupus. A proper diagnosis includes a battery of tests, says Noa Shwartz, M.D., a physician-researcher with Albert Einstein College of Medicine in New York.

Dr. Shwartz spoke on this issue at the Congress of Clinical Rheumatology East annual meeting held earlier this month.

“It’s a topic that’s clouded in mystery,” said Noa Shwartz, M.D., a physician-researcher with Albert Einstein College of Medicine in New York, in remarks at the annual Congress of Clinical Rheumatology East 2020 meeting. “Even mild cognitive impairment is reported to be disruptive to the daily function of lupus patients who identify it as one of the top complaints of their disease directly detracting from their quality of life.”

Rheumatic diseases are frequently linked to cognitive dysfunction, with links to corticosteroids, cyclophosphamide and methotrexate, Dr. Shwartz said.

For diagnostics, the gold standard remains a comprehensive battery of tests, a process that can take hours and is “not a bedside tool in any way,” Dr. Shwartz said. She also recommends the Automated Neuropsychological Assessment Metric (ANAM), a self-administered exam that is typically completed in about 40 minutes. ANAM can be done in one sitting and is not prone to confounders like language proficiency. For an even simpler option, the Montreal Cognitive Assessment Tool is a one-page questionnaire that takes about 5-10 minutes to complete and can be used to rule out impairment.

When the dysfunction is chronic, Dr. Shwartz recommends exercise and neurocognitive rehabilitation—an approach she praised in part for its high level of patient satisfaction.

She added that fish oil supplements have shown promise in early studies for addressing oxidative stress and the loss of omega-3 fatty acids, though it is still too early to draw conclusions.

“Several pathways likely lead to cognitive dysfunction, and it is important to continue exploring these pathways to improve our diagnostic and therapeutic capabilities,” Dr. Shwartz said.

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REFERENCE

Congress of Clinical Rheumatology, Destin, Fla., 9 a.m., Sept. 11, 2020.