Consensus needed to resolve inconsistencies in metrics and definitions used to assess cognitive impairment in SLE

The assessment and definition of cognitive impairment in patients with systemic lupus erythematosus (SLE) is inconsistent in the entire literature; This suggests the need for consensus to standardize measurement tools and terminology, according to researchers in a systematic review published in Seminars in Arthritis & Rheumatology.

Cognitive impairment is common in patients with SLE. In 1999, the American College of Rheumatology (ACR) developed a comprehensive, one-hour neuropsychological battery that defines cognitive impairments with a threshold of 2 or more standard deviations below the estimated population average in the areas of attention, memory, and psychomotor speed. The ACR’s neuropsychological battery and definition of cognitive impairment have been largely adjusted, leading to inconsistencies in the assessment of patients with SLE.

The systematic review was conducted to characterize the measurement tools and definitions used to assess cognitive impairment in SLE.

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Several databases, including Ovid Medline, Embase, and PsychINFO, were used to search for articles on cognitive impairment in adult patients with SLE. Studies using a neuropsychological battery were rated for alignment with the neuropsychological ACR battery. The researchers also assessed the definitions of cognitive impairment and divided the various measurement tools into the following categories: neuropsychological battery, screening, incomplete / mixed or computerized.

The literature search resulted in 8727 references, of which 118 were selected for a detailed review and 97 were included in this systematic review. Overall, the use of the neuropsychological ACR battery was inconsistent. When it was used, other tests were added to it. None of the 43 studies that used a neuropsychological battery matched the ACR’s published neuropsychological battery. Variations were found in the thresholds and domains used to classify cognitive impairments. Neuropsychological battery tests have been most commonly used to assess cognitive impairment; However, screening tests and computerized neuropsychological batteries are becoming increasingly popular.

The main limitation of the study was the difficulty of differentiating neuropsychological and non-neuropsychological battery tools due to the heterogeneity of the tools used.

“As cognitive research at SLE continues to grow, it is imperative to develop a comprehensive and standardized methodology for definition and evaluation [cognitive impairment] it is both clinically feasible and standardized in the field, ”the researchers concluded. “A consensus meeting to remove existing inconsistencies should be considered to expand the scope of the [cognitive impairment] in the SLE. “


Yuen K., Green R., Bingham K. et al. Metrics and Definitions Used in Assessing Cognitive Impairment in Systemic Lupus Erythematosus: A Systematic Review. Seminars in arthritis and rheumatology. Published online June 9, 2021. doi: 10.1016 / j.semarthrit.2021.05.018

This article originally appeared on Rheumatology Advisor

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