PO:14:206 | Factors impacting subjective cognitive impairment in systemic lupus erythematosus patients: clearing away the lupus brain fog

Elisabetta Chessa¹, Marta Paola Pireddu², Fabio Congiu², Giulia Rizzo², Cristina Serafini³, Elena Ragusa², Alberto Cauli^1|2, Matteo Piga^1|2. | ¹SC Reumatologia- AOU Cagliari, Cagliari, Italy; ²Dipartimento di Scienze Mediche e Sanità Pubblica, Università di Cagliari, Cagliari, Italy; ³PO Sirai - Unità di Nefrologia e Dialisi, Carbonia (CA), Italy.

Background. Systemic lupus erythematosus (SLE) patients (pts) often suffered from an impairment in cognitive functions, but a universal definition of “brain fog” does not exist. The objective of the study was to evaluate the prevalence of subjective impairment and objective mental alterations (depression, cognition, fatigue) adopting screening tools validated in SLE; also we aimed to investigate which factors were associated with brain fog.

Methods. A Cross-sectional study was conducted enrolling adult SLE pts. Brain fog referred to the presence of mental alterations (i.e.; memory, concentration, attention...) as reported by SLE participants. To minimize contribution of type B symptoms, we made a subanalysis of brain fog involving pts with active disease, namely lupus fog. Demographic, clinical, therapeutic data were collected (Table). Serum anti-ribosomal P antibodies (anti-RibP) were quantified using ELISA kits. Cognitive deficits were assessed by a neuropsychologist exploring deficits in 8 cognitive domains with a battery of neuropsychological tests and screened using the Montreal Cognitive Assessment (MoCA) test performed by certified personnel (cut-off<26/30). Depressive symptoms were evaluated using the Center for Epidemiologic Studies Depression Scale (CES-D) (>15). Fatigue was measured using FACIT-F (<34). Chi-squared test and the Mann-Whitney test were used for univariate analysis (UV-A); multivariate analysis (MV-A) was performed building logistic regression models including variables showing p <0.10.

Results. 114 SLE pts were enrolled (Table), 105 female (92.1%), mean age 43.7 years (+-12.2). Brain fog was found in 54% pts, with memory deficit reported in 49.1%, attention in 38.6%, concentration in 10.5% and afasia nominum in 5.3%. CES-D>15 was altered in 53.3%, MoCA<26 in 45% and FACIT<34 in 52.9%. At UV-A, an association emerged between the presence of brain fog and CES-D (Fig1A, score p<0.001), FACIT (Fig1A, score p=0.012), fibromyalgia (p<0.001), the neuropsychiatric involvement (p=0.015), anti-RNP (p=0.014), anti Rib-P (p=0.018) and disease duration (p=0.045). No association was found with MoCA test, the battery of neuropsychological test, disease activity scores or treatment. At MV-A, an independent association between brain fog and fibromyalgia (OR=34.6; 95%CI 2.3-523.1, p=0.011), CES-D score (OR=1.1 per unit, 95%CI 1.0-1.2, p=0.033) and disease duration (OR=1.1 per year, 95%CI 1.0-1.2, p=0.038) emerged. Out of 46 pts with clinically active disease, 21 were classified as lupus fog, resulting associated at UV-A with CES-D (Fig2A, score p=0.034), FACIT (Fig2A, score p=0.024) , fibromyalgia (p=0.017). MV-A showed independent association between lupus fog and FACIT score (OR=-0.146; 95%CI -0.275 to -0.017).

Conclusion. Brain fog is frequent in SLE pts, but did not correlate with cognitive dysfunction, but with longer disease duration, depressive symptoms, fibromyalgia and in active pts with fatigue. Our findings suggest that SLE pts may have a negative perception about proper cognitive performances, without having a real impairment, supporting the need for assessing depressive and fatigue symptoms during clinical visits.