Cognitive function in systemic lupus erythematosus: results of a 5-year prospective study
Cognitive function in systemic lupus erythematosus: results of a 5-year prospective study
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DOI：
10.1002/art.1780400825
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发表时间：
1997-08-01
影响因子：
--
通讯作者：
Fisk, JD
中科院分区：
文献类型：
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作者：
Hanly, JG;Cassell, K;Fisk, JD
神经心理学评估技术提高了对系统性红斑狼疮（SLE）认知功能异常的认识。横断面研究（1-6）定义了认知功能障碍的特征及其患病率，由于研究人群的差异，使用的特定神经心理学测试和认知障碍的定义，患病率从21%到66%不等。大多数研究已经在相当大比例的患者中确定了亚临床认知功能障碍（1-4）。重要的是要知道这些认知功能异常是否随着时间的推移进展到更严重的认知功能障碍，或者它们是否标志着神经精神性SLE（NPSLE）的其他临床明显表现的最终出现。为了解决这个问题，我们描述了一组女性SLE患者的认知功能和临床上明显的NPSLE的5年评估结果。在1989-1990年，70名连续的SLE患者接受了神经心理学评估（2）。间隔12个月后，59例患者进行了重复评估（7），从初始评估开始60个月后，53例患者进行了重新评估。临床上明显的神经精神事件归因于系统性红斑狼疮的记录，是皮质类固醇剂量。神经心理学评估基于3种认知功能标准化测试：韦氏成人智力量表修订版（WAIS-R）（8）、韦氏记忆量表修订版（WMS-R）（9）和加州言语学习测试（CVLT）（10）。这个测试组合主要集中在语言学习上。认知障碍的决策规则已在前面描述过（2）。为了确定认知障碍的功能意义，在最终评估时使用了2份经验证的自我管理生活质量问卷，即医学结局调查简表-36（SF-36）（11）和疾病影响概况（SIP）（12）。通过卡方分析比较不同亚组中的患者比例。通过t检验比较SF-36和SIP的平均评分。通过双向重复测量方差分析（ANOVA）检查了5年研究期间神经心理学测试表现的变化。时间是受试者内因素，对以下每个受试者间因素进行单独分析：在疾病过程中的任何时间出现临床上明显的NPSLE，每次评估时是否接受皮质类固醇治疗（交替服用和不服用皮质类固醇的患者形成第三组），以及在初始评估时存在认知损害（如由先前描述的决策规则确定的）（2）。分别对以下反应变量进行分析：WAS-R的信息、相似性、图片完成、区组设计和数字符号子测验，WMS-R的数字广度向前、数字广度向后、视觉记忆广度向前和视觉记忆广度向后;以及CVLT的列表A试验1-5、列表A试验1、列表A试验5、长延迟自由回忆和辨别性（即再认记忆）。在最初的评估中，70例SLE患者中有15例（21%）表现出认知功能障碍。在第二次评估时，平均12.8个月（范围11-17个月）后，59例患者中有8例（14%）受损。在前2次评估中出现认知障碍的19名患者中，除4名患者外，其余患者均可以在最终评估时进行评估，最终评估在初始评估后平均64.1个月（范围52-71个月）完成。在最终评估时，53名患者中有7名（13%）受损。
Neuropsychological assessment techniques have heightened the awareness of abnormalities in cognitive function in systemic lupus erythematosus (SLE). Cross-sectional studies (1-6) have defined the characteristics of cognitive dysfunction and its prevalence, which has varied from 21% to 66% due to differences in study populations, the particular neuropsychological tests used, and the definition of cognitive impairment. Most studies have identified subclinical cognitive dysfunction in a substantial proportion of patients (1-4). It is important to know whether these abnormalities in cognitive function progress over time to more profound cognitive dysfunction or whether they signal the eventual emergence of other clinically overt manifestations of neuropsychiatric SLE (NPSLE). To address this question, we describe the results of a 5-year evaluation of cognitive function and clinically overt NPSLE in an unselected group of female SLE patients. In 1989-1990, 70 consecutive SLE patients underwent neuropsychological assessment (2). After a 12-month interval, 59 patients had a repeat assessment (7), and 60 months from the time of the initial assessment, 53 patients were reevaluated. Clinically overt neuropsychiatric events attributed to SLE were recorded, as was the corticosteroid dosage. Neuropsychological evaluation was based on 3 standardized tests of cognitive function: the Wechsler Adult Intelligence Scale-Revised (WAIS-R)(8), the Wechsler Memory Scale-Revised (WMS-R)(9), and the California Verbal Learning Test (CVLT)(10). This test battery is focused primarily on verbal learning. Decision rules for cognitive impairment have been described previously (2). To determine the functional significance of cognitive impairment, 2 validated, self-administered quality-of-life questionnaires were used at the final assessment, ie, the Medical Outcomes Survey Short Form-36 (SF-36)(11) and the Sickness Impact Profile (SIP)(12). A comparison of the proportion of patients in different subgroups was performed by chi-square analysis. Mean scores for the SF-36 and SIP were compared by t test. Changes in neuropsychological test performance over the 5-year period of study were examined by 2-way repeated-measures analysis of variance (ANOVA). Time was the within-subjects factor, and a separate analysis was conducted for each of the following between-subjects factors: clinically overt NPSLE at any time in the disease course, presence or absence of corticosteroid treatment at the time of each assessment (with those patients who alternated between taking and not taking corticosteroids forming a third group), and presence of cognitive impairment at the initial assessment (as determined by the previously described decision rules)(2). Separate analyses were conducted for each of the following response variables: information, similarities, picture completion, block design, and digit symbol subtests of the WAS-R; digit span forward, digit span backward, visual memory span forward, and visual memory span backward of the WMS-R; and list A trials 1-5, list A trial 1, List A trial 5, long-delay free recall, and discriminability (ie, recognition memory) of the CVLT. At the initial assessment, 15 of the 70 SLE patients (21%) demonstrated cognitive impairment. At the second assessment, after a mean of 12.8 months (range 11-17 months), 8 of 59 patients (14%) were impaired. Of the 19 patients who were cognitively impaired at either of the first 2 assessments, all but 4 were available for evaluation at the final assessment, which was completed a mean of 64.1 months (range 52-71 months) after the initial assessment. At the final assessment, 7 of 53 patients (13%) were impaired …