Screening for cognitive impairment in systemic lupus erythematosus: Application of the Montreal Cognitive Assessment (MoCA) in a Greek patient sample

Background Cognitive impairment (CI) is one of the most frequent neuropsychiatric manifestations of systemic lupus erythematosus (SLE). Given that extensive neuropsychological testing is not always feasible in routine clinical practice, brief cognitive screening tools are desirable. The aim of this study was to evaluate the Montreal Cognitive Assessment (MoCA) as a screening tool for CI in SLE. Methods Consecutive SLE patients followed at a single centre were evaluated using MoCA and an extensive neuropsychological test battery (NPT), including the Digits Forward and Digits Backwards, Rey Auditory Verbal Learning Memory Test, Trail Making Test, Stroop Colour-Word Test, Semantic and Phonetic Verbal Fluency tests and a 25-problem version of the General Adult Mental Ability test. The criterion validity of MoCA was assessed through receiver operating characteristic (ROC) analyses using three different case definitions: i) against normative population data, ii) and iii) against average performance of a comparison group of rheumatoid arthritis (RA) patients, to adjust for possible confounding effects of chronic illness and inflammatory processes on cognitive performance. The effect of patient-related (age, years of education, anxiety, depression, fatigue and pain) and disease-related (activity, damage, age at diagnosis, disease duration, use of glucocorticoid, psychotropic and pain medication) parameters on the MoCA was examined. Results A total of 71 SLE patients were evaluated. MoCA significantly correlated with all NPT scores and was affected by education level ( p < 0.001), but not by other demographic or clinical variables. The optimal cutoff for detecting CI, as defined on the basis of normative population data, was 23/30 points, demonstrating 73% sensitivity and 75% specificity. A cutoff of 22/30 points, using neuropsychological profiles of the RA group as inflammatory disease controls, exhibited higher sensitivity (100%, based on both definitions) and specificity (87% and 90%, depending on the definition). The standard cutoff of 26/30 points displayed excellent sensitivity (91–100%) with significant expenses in specificity (43–45%). Conclusion The MoCA is an easily applied tool, which appears to be reliable for identifying CI in SLE patients. The standard cutoff score (26/30) ensures excellent sensitivity while lower cutoff scores (22–23/30) may, also, provide higher specificity.

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Memory Performance in Patient with Systemic Lupus Erythematosus Using MoCA-Ina in Hasan Sadikin Genneral Hospital Bandung

Indonesian Journal of Rheumatology ◽

10.37275/ijr.v9i1.67 ◽

2018 ◽

Vol 9 (1) ◽

Author(s):

Safira Anjalia ◽

Paulus Anam Ong ◽

Nur Atik ◽

Laniyati Hamijoyo

Keyword(s):

Systemic Lupus Erythematosus ◽

Cognitive Impairment ◽

Lupus Erythematosus ◽

Cognitive Assessment ◽

Memory Impairment ◽

Montreal Cognitive Assessment ◽

Systemic Lupus ◽

Cross Sectional ◽

Delayed Recall ◽

Immediate Recall

Background: The involvement of neuropsychiatry is reported in 6% to 91% of Systemic Lupus Erythematosus (SLE) patients. It can cause fatal morbidity and mortality. Memory impairment is one of the most common symptoms of neuropsychiatry involvement. This study aims to find out the performance of memory test in SLE patients using Indonesian version of Montreal Cognitive Assessment (MoCA-Ina).Method: This cross sectional study recruited 30 SLE patients. Cognitive abilities and patient’s memory were examined using Indonesian version of Montreal Cognitive Assessment (MoCA-Ina). Cognitive impairment was determined when total MoCA-Ina score was below 26. For memory evaluation, immediate recall or delayed recall impairment was determined when the patient failed in each memory subtests.Results: The mean of total MoCA-Ina score was 24.97 (SD±3.14). Fifty percent of the SLE patients had cognitive impairment, with the domain involved being delayed recall (86.67%), attention (60%), language (56.67%), abstraction (53.33%), and visuo-spatial/ executive function (36.67%). Most patients (86.67%) could completely repeat immediate recall. Whileonly 4 (13.33%) subjects could repeat delayed recall completely without any clue. Of the 26 SLE patients who failed to recall completely, 24 (92.3%) of them succeeded to recall completely after getting clue(s).Conclusion: Memory impairment is the most frequent cognitive impairment in SLE patients, especially in delayed recall. By using the memory subtests of MoCAIna, more than four fifth of patients with SLE was detected having delayed recall memory impairment and almost all of them could recalled completely after getting clue(s). This findings indicated that the finalstep of memory process retrieval in SLE was interrupted while being encoded, but retention pathway were stillintact.Keywords: Systemic Lupus Erythematous, Memory, MoCA-Ina

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Montreal Cognitive Assessment and Magnetic Resonance Imaging Identify Cognitive Impairment in Young Patients with Neuropsychiatric Systemic Lupus Erythematosus

The Journal of Rheumatology ◽

10.3899/jrheum.181231 ◽

2019 ◽

Vol 46 (6) ◽

pp. 653.1-653 ◽

Cited By ~ 1

Author(s):

YA-CHI LI ◽

DEH-MING CHANG ◽

CHUN-CHI LU

Keyword(s):

Magnetic Resonance Imaging ◽

Systemic Lupus Erythematosus ◽

Cognitive Impairment ◽

Magnetic Resonance ◽

Lupus Erythematosus ◽

Cognitive Assessment ◽

Young Patients ◽

Montreal Cognitive Assessment ◽

Resonance Imaging ◽

Systemic Lupus

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Screening for cognitive dysfunction in systemic lupus erythematosus: the Montreal Cognitive Assessment Questionnaire and the Informant Questionnaire on Cognitive Decline in the Elderly

Lupus ◽

10.1177/0961203318815299 ◽

2018 ◽

Vol 28 (1) ◽

pp. 51-58 ◽

Cited By ~ 6

Author(s):

N.E. Chalhoub ◽

M.E. Luggen

Keyword(s):

Systemic Lupus Erythematosus ◽

Cognitive Decline ◽

Cognitive Dysfunction ◽

Lupus Erythematosus ◽

Cognitive Assessment ◽

The Elderly ◽

Screening Tools ◽

Montreal Cognitive Assessment ◽

Systemic Lupus ◽

Assessment Questionnaire

Background Cognitive dysfunction (CD) is among the most common neuropsychiatric manifestations of systemic lupus erythematosus (SLE). Traditional neuropsychological testing and the Automated Neuropsychologic Assessment Metrics (ANAM) have been used to assess CD but neither is an ideal screening test. The Montreal Cognitive Assessment Questionnaire (MoCA) and the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) are brief and inexpensive tests. This study evaluated the MoCA and IQCODE as screening tools. Methods SLE patients fulfilling American College of Rheumatology (ACR) classification criteria were evaluated using the ANAM as the reference standard. The performance characteristics of the MoCA and IQCODE were assessed in comparison with normal controls (NCs) and rheumatoid arthritis (RA) patients. Four different definitions of CD were utilized. Results In total, 78 patients were evaluated. MoCA and ANAM scores were significantly correlated ( r = 0.51, p < 0.001). At the optimal cutoff, the sensitivity of the MoCA was ≥ 90% (depending on definition of CD) vs RA patients and ≥83% vs NCs. ANAM and IQCODE scores did not correlate ( p = 0.8152). IQCODE sensitivities were low for both RA patients and NCs regardless of definition and cutoff used. Conclusion The MoCA appears to be a promising and practical screening tool for identification of patients with SLE at risk for CD.

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Validity of brief screening tools for cognitive impairment in rheumatoid arthritis and systemic lupus erythematosus

Arthritis Care & Research ◽

10.1002/acr.21566 ◽

2012 ◽

Vol 64 (3) ◽

pp. 448-454 ◽

Cited By ~ 24

Author(s):

Laura J. Julian ◽

Jinoos Yazdany ◽

Laura Trupin ◽

Lindsey A. Criswell ◽

Edward Yelin ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Systemic Lupus Erythematosus ◽

Cognitive Impairment ◽

Lupus Erythematosus ◽

Screening Tools ◽

Systemic Lupus ◽

Brief Screening

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Features of Cognitive Dysfunction in Patients with Systemic Lupus Erythematosus

Ukraïnsʹkij žurnal medicini bìologìï ta sportu ◽

10.26693/jmbs06.05.199 ◽

2021 ◽

Vol 6 (5) ◽

pp. 199-203

Author(s):

S. O. Makarov ◽

Keyword(s):

Systemic Lupus Erythematosus ◽

Cognitive Dysfunction ◽

Lupus Erythematosus ◽

Cognitive Assessment ◽

Lupus Anticoagulant ◽

Assessment Scale ◽

Montreal Cognitive Assessment ◽

Control Group ◽

Systemic Lupus ◽

Cardiolipin Antibodies

The purpose of the study was to explore the structure of cognitive impairment in patients with systemic lupus erythematosus and to determine the factors associated with its development. Materials and methods. Advanced examination of 64 patients with systemic lupus erythematosus was carried out. Neurological disorders were diagnosed in 54 patients (84.38% of patients). These patients were included in the main study group (group 1). In 10 (15.62% of patients) patients, these manifestations were not found and they entered the control group (group 2). The object of the study was cognitive impairment in patients with systemic lupus erythematosus. To assess the cognitive status of patients, the Montreal Cognitive Assessment Scale was used, a widely used questionnaire that evaluates cognitive functions across multiple domains. The laboratory study included blood tests to identify the type and titer of antinuclear antibodies, lupus anticoagulant, and antiphospholipid antibodies, in particular, anti-cardiolipin antibodies. Results and discussion. It was found that the complaints that patients usually present to describe impaired cognitive functions (such as "memory deterioration", "memory impairment", "decreased attention", "difficulty concentrating", etc.) were among the most common in patients with systemic lupus erythematosus. Thus, complaints of memory impairments were expressed by 37 patients (57.81% CI 45.71-69.91), impaired attention and concentration – 41 patients (64.06% CI 52.31-75.82), and between these complaints a strong correlation was established (r = 0.83; p <0.001). The results of the examination of patients using the Montreal Cognitive Assessment Scale showed that the average indicator among all examined is 25.0 (22.0; 27.5) points in the main group – 24.0 (22.0; 26.0) points, which is statistically significantly less (p <0.001) compared with the control group – 28.0 (27.0; 29.0) points. It was found that among patients who scored less than 26 points on the Montreal Cognitive Assessment Scale, there was a statistically significant decrease in indicators in the domains of memory, attention, and speech (p <0.001). It was found that there is a correlation between the presence of anti-cardiolipin antibodies with CD (determined by the Montreal Cognitive Assessment Scale) (rs = -0.56; p <0.001), the same correlation was found in relation to lupus anticoagulant (rs = -0.56; p <0.001). Conclusion. Cognitive dysfunction is one of the most common neurological manifestations of systemic lupus erythematosus. Among the examined patients, decrease in indicators in the domains of memory, attention and speech is the most often observed. Cognitive dysfunction may be associated with the production of certain classes of autoantibodies: antiphospholipid antibodies (in particular, anti-cardiolipin antibodies) and lupus anticoagulant

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Prevalence of cognitive impairment using the Montreal Cognitive Assessment questionnaire among patients with systemic lupus erythematosus: a cross-sectional study at two tertiary centres in Malaysia

Lupus ◽

10.1177/0961203319852153 ◽

2019 ◽

Vol 28 (7) ◽

pp. 854-861 ◽

Cited By ~ 2

Author(s):

A Kanapathy ◽

N R Nik Jaafar ◽

S S Shaharir ◽

L F Chan ◽

M Rozita ◽

...

Keyword(s):

Systemic Lupus Erythematosus ◽

Cognitive Impairment ◽

Confidence Interval ◽

Disease Activity ◽

Lupus Erythematosus ◽

Educational Level ◽

Cognitive Assessment ◽

Associated Factors ◽

Male Gender ◽

Systemic Lupus

Introduction Cognitive impairment is a common neuropsychiatric manifestation of systemic lupus erythematosus (SLE). However, it is not routinely assessed for despite its high prevalence and significant disease burden. Aims This study aimed to determine the prevalence of mild cognitive impairment (MCI) using the Montreal Cognitive Assessment (MoCA) and its associated factors among patients diagnosed with SLE in Malaysia. Methods A total of 200 SLE patients were recruited prospectively from the outpatient clinics of two tertiary hospitals in Malaysia. Standardized clinical interview was utilized to obtain information on socio-demographic characteristics. All patients were then assessed using the MoCA questionnaire for presence of cognitive impairment; the Patient Health Questionnaire 9 (PHQ-9) for presence of depressive symptoms; and the Wong–Baker Faces Pain Scale (WBFPS) for severity of pain. The evaluation of disease activity and severity were performed by the treating rheumatologists and nephrologists using the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) and Systemic Lupus International Collaborating Clinics Damage Index (SLICC DI). Results The prevalence of MCI was 35%. The significant associated factors from the bivariate analysis were male gender ( p = 0.04), educational level ( p = 0.00), WBFPS score ( p = 0.035) and anticardiolipin IgM ( p = 0.01). Further analysis using logistic regression model found that male gender (OR = 7.43, 95% confidence interval 1.06–52.06, p = 0.04), lower educational level (OR = 4.4, 95% confidence interval 1.47–13.21, p = 0.01) and presence of anticardiolipin IgM (OR = 6.81, 95% confidence interval 1.45–32.01, p = 0.031) were associated with impaired MoCA scores. Also, increasing pain scores increased the risk of patients being affected by cognitive impairment. Conclusion Over one-third of patients with SLE in our cohort were found to have MCI. Risk factors included male gender, lower educational level, higher pain score and presence of anticardiolipin IgM. Physicians are encouraged to perform routine screening to detect cognitive dysfunction in patients with SLE in their clinical practice as part of a more comprehensive management.

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Performance of Screening Tests for Cognitive Impairment in Systemic Lupus Erythematosus

The Journal of Rheumatology ◽

10.3899/jrheum.161125 ◽

2017 ◽

Vol 44 (11) ◽

pp. 1583-1589 ◽

Cited By ~ 17

Author(s):

Stephanie G. Nantes ◽

Jiandong Su ◽

Ashneet Dhaliwal ◽

Kenneth Colosimo ◽

Zahi Touma

Keyword(s):

Systemic Lupus Erythematosus ◽

Cognitive Impairment ◽

Lupus Erythematosus ◽

Verbal Learning ◽

Positive Likelihood Ratio ◽

Intellectual Ability ◽

Screening Tests ◽

Systemic Lupus ◽

Predictive Values ◽

Sensitivity Specificity

Objective.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.Methods.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.Results.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.Conclusion.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.

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