Intraindividual Change in Cognitive Function Among Adults With Systemic Lupus Erythematosus: A Markov Analysis Over 7 Years.
Intraindividual Change in Cognitive Function Among Adults With Systemic Lupus Erythematosus: A Markov Analysis Over 7 Years.
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DOI：
10.1002/acr2.11529
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发表时间：
2023-03
影响因子：
3.4
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认知障碍在系统性红斑狼疮（SLE）中普遍存在。在认知和系统性红斑狼疮的纵向认识上仍存在空白。随着时间的推移，我们研究了SLE患者认知的个体变化。数据来自加州大学旧金山分校狼疮结局研究，其中包括1281名SLE成人患者。Hopkins Verbal Learning Test - Revised （HVLT - R）和Controlled Oral Word Association Test （COWAT）每年进行一次，为期7年。二态马尔可夫分析用于模拟认知变化概率的转移强度。逻辑回归检验了临床变量与认知变化之间的关系。在马尔可夫分析中观察到认知状态之间的最小过渡。使用COWAT，较高水平的自我报告抑郁与认知改善可能性降低相关（相对危险度[RR]: 0.98； 95%可信区间[CI]: 0.96 ~ 0.99），较高水平的自我报告疾病严重程度与认知能力下降相关（RR: 1.05; 95% CI: 1.02 ~ 1.09）。使用HVLT‐R，年龄增加（RR: 1.02; 95% CI: 1.01‐1.03）和高等教育水平（RR: 1.82; 95% CI: 1.28‐2.58）与认知能力改善相关，较高的自我报告疾病严重程度（RR: 1.02; 95% CI: 1.01‐1.03）和抑郁（RR: 1.05; 95% CI: 1.03‐1.07）与认知能力下降相关。在一项为期7年的马尔可夫分析中，大多数SLE患者并没有在高（Z评分≥- 1.5）或低（Z评分< - 1.5）认知状态之间转换，这表明随着时间的推移，认知具有一定程度的相对稳定性。年龄的增长和教育程度的提高与认知能力提高的可能性更大有关。自我报告的SLE疾病严重程度和抑郁与认知能力下降有关。
Cognitive impairment is prevalent in systemic lupus erythematosus (SLE). There remain gaps in understanding cognition and SLE longitudinally. We studied intraindividual change in cognition in SLE over time. Data were from the University of California, San Francisco Lupus Outcome Study, which included 1281 adults with SLE. The Hopkins Verbal Learning Test‐Revised (HVLT‐R) and the Controlled Oral Word Association Test (COWAT) were administered annually over 7 years. A two‐state Markov analysis was used to model transition intensities for probabilities of change in cognition. Logistic regression examined the association between clinical variables and cognitive change. Minimal transition between cognitive states was observed in the Markov analysis. Using the COWAT, higher levels of self‐reported depression were associated with decreased likelihood of cognitive improvement (Relative Risk [RR]: 0.98; 95% confidence interval [CI]: 0.96‐0.99), and higher self‐reported disease severity was associated with cognitive decline (RR: 1.05; 95% CI: 1.02‐1.09). Using the HVLT‐R, increasing age (RR: 1.02; 95% CI: 1.01‐1.03) and higher education level (RR: 1.82; 95% CI: 1.28‐2.58) were associated with cognitive improvement, and higher self‐reported disease severity (RR: 1.02; 95% CI: 1.01‐1.03) and depression (RR: 1.05; 95% CI: 1.03‐1.07) were associated with cognitive decline. Most individuals with SLE did not transition between states of high (Z score ≥ −1.5) or low (Z score < −1.5) cognition in a Markov analysis over a 7‐year assessment period, highlighting a degree of relative stability in cognition over time. Increasing age and higher education levels were associated with greater likelihood of cognitive improvement. Greater self‐reported SLE disease severity and depression were associated with cognitive decline.