1583 Nantes, et al: Cognitive impairment screening in SLE Personal non-commercial use only. The Journal of Rheumatology Copyright © 2017. All rights reserved. Performance of Screening Tests for Cognitive Impairment in Systemic Lupus Erythematosus Stephanie G. Nantes, Jiandong Su, Ashneet Dhaliwal, Kenneth Colosimo, and Zahi Touma ABSTRACT. Objective. There is a need for a cognitive function screening test that can be administered to patients with systemic lupus erythematosus (SLE) in clinic. The objectives of this study were to determine (1) prevalence of cognitive impairment (CI) in SLE by the Montreal Cognitive Assessment (MoCA), Mini Mental State Examination (MMSE), in relation to the Hopkins Verbal Learning Test–Revised (HVLT-R), and Perceived Deficits Questionnaire 5-Item (PDQ-5); and (2) associated factors with CI. Methods. Consecutive patients followed at a single center were recruited. HVLT-R, MoCA, and MMSE were administered. Sensitivity/specificity, positive (PPV)/negative (NPV) predictive values, and positive likelihood ratio (LR+) of MoCA/MMSE were determined (compared to HVLT-R). A test on intellectual ability and questionnaires on anxiety, depression, and perceived cognitive deficits were completed. Regression analyses determined associations with CI. Results. Of 98 patients, 48% had CI using MoCA and 31% using HVLT-R. Sensitivity was higher for MoCA (73%) compared to MMSE (27%), though MMSE was more specific (90%) than MoCA (63%). PPV and LR+ were similar in MoCA and MMSE (PPV: 47%, 53%; LR+: 2.0, 2.6, respectively), but NPV was higher in MoCA (84%) than MMSE (74%). PDQ-5 predicted objective CI (HVLT-R: sensi- tivity 100%, specificity 89%). Although CI was associated with depression in univariate analyses, it did not hold in the multivariate analysis, while longer SLE disease duration and more years of education remained significant. Conclusion. CI is highly prevalent and MoCA may be a useful tool to screen for CI in SLE. Patients with more years of education were less likely to have CI. (First Release September 1 2017; J Rheumatol 2017;44:1583–9; doi:10.3899/jrheum.161125) Key Indexing Terms: COGNITIVE IMPAIRMENT SYSTEMIC LUPUS ERYTHEMATOSUS MONTREAL COGNITIVE ASSESSMENT MINI MENTAL STATE EXAMINATION HOPKINS VERBAL LEARNING TEST–REVISED From the University of Toronto; University of Toronto Lupus Clinic, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital; York University, Toronto, Ontario, Canada. The Toronto Lupus Clinic Research Program is supported financially by the University Health Network, the Lou Rocca family, and the Lupus Foundation of Ontario. Dr. Touma’s research is supported by the Young Operating and the Young Investigator Salary Award of the Arthritis Society, and the New Investigator Research Grant of the Physicians’ Services Inc. Foundation. S.G. Nantes, BMSc, MD Candidate, University of Toronto; J. Su, MSc, University of Toronto Lupus Clinic, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital; A. Dhaliwal, HonBSc, University of Toronto; K. Colosimo, MA, Clinical Psychology, PhD(c), York University, Psychometrist and Research Analyst, University of Toronto Lupus Clinic, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital; Z. Touma, MD, FACP, FACR, PhD, Assistant Professor of Medicine, University of Toronto Lupus Clinic, Toronto Western Hospital, Centre for Prognosis Studies in the Rheumatic Diseases. Address correspondence to Dr. Z. Touma, MD, FACP, FACR, PhD, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital, EW, 1-412, 399 Bathurst St., Toronto, Ontario M5T 2S8, Canada. E-mail address: zahi.touma@uhn.ca Accepted for publication June 23, 2017. life and employment potential 5,6,7 . As a result, early detection of CI may direct patient care to help patients adapt accord- ingly to lessen the effects of cognitive decline. Currently, the screening and diagnosis of CI in SLE is delayed and its monitoring is not well developed. This situation is likely due to the lack of appropriate cognitive screening assessment tools for this population 8,9,10,11,12,13 . Although there is no pattern of CI that is specific for patients with SLE, Hanly, et al noted that decreased attention, impaired working memory, and executive function (e.g., planning and multitasking) are often affected in patients with SLE in addition to overall cognitive slowing 14 . The gold standard test recommended by the American College of Rheumatology (ACR) to assess cognitive function is a 1–2 h battery (the ACR-SLE battery) of tests 15 . This test is time - consuming and is associated with a cost burden, limiting the practicality of its administration as a screening tool on all patients with potential cognitive decline. Kozora, et al confirmed the validity and reliability of the ACR-SLE battery for patients with SLE against the larger 4-h battery 15 . The ACR-SLE battery encompasses tests that have shown impairment in previous studies of patients with SLE and these tests highlighted a deficit in “complex attention, deficit in learning and recall, verbal and nonverbal fluency, complex Cognitive impairment (CI) is among the most common of the neuropsychiatric manifestations of systemic lupus erythe- matosus (SLE), with a prevalence ranging from 20–80% 1,2,3,4 . Even mild CI can significantly reduce a patient’s quality of www.jrheum.org Downloaded on December 11, 2021 from