The featured article is ‘Neuropsychological Impairment in Systemic Lupus Erythematous: A Comparison with Multiple Sclerosis’ by Benedict and colleagues and freely available here.
The authors begin with an introduction to SLE and MS before outlining their aims which is to explore the contrast of the two conditions in terms of effects on cognition. There is no methodology section and although we do not know the inclusion criteria for papers in this review, we consider this as a review article which is informed by the authors considerable knowledge in this area. In the first section, the authors look at the mechanisms of cerebral injury in SLE including autoantibodies mediated injury and small vessel disease as well as large vessel disease. The authors express an interest in determining the effects of subclinical processes and will therefore be excluding focal brain injury from their subsequent analysis.
The authors then look at imaging findings. They note that MRI can be unremarkable in SLE (although they note the efficacy of Gadolinium enhanced MRI in active disease) but also cite studies showing interesting results with Diffuse Tensor Imaging (DTI) , Diffuse Weighted Imaging (DWI) and Magnetization Transfer Imaging (MTI). In an MTI study they cite, the MTI histograms were abnormal in people with SLE and neurological or psychiatric involvement in SLE. The authors also mention some SPECT and MRS evidence.
The authors comment on studies showing evidence of cognitive impairment in SLE and also cite evidence suggesting that this is not due to depression or steroid treatment (indeed they find evidence from one study that this may actually improve cognition). They also cite evidence suggesting a subcortical pattern of cognitive impairment. They explore the potential immune-mediated relationship with cognition further and find some evidence of a relationship between CRP and IL-6 levels and cognitive impairment.
They then review the material on cognitive performance and note that the effect sizes on different tests are comparable to those found in MS and display the results from various studies graphically. They then finish with a comparison of MS and SLE. They outline some of the pathology found in MS as well as the neuropsychological findings and conclude that in both SLE and MS there is shared pattern of observations on neuropsychological testing and they argue that this is secondary to white matter involvement.
The authors findings are multiple and complex and it would be interesting to see a model which encompasses these findings and which can be tested against further data.
STT5 (Identified cognitive profiles – leading to larger confirmation studies, if confirmed – construction of relevant rehabilitation intervention, trialling of intervention, if successful incorporation into policy – local implementation)
Steps To Treatment (STT)
STT = Steps To Treatment. An estimate of the number of steps between the results and translation into treatment. This is an opinion.
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