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Abstract Background: Cognitive impairment (CI) frequently occurs in patients with systemic lupus erythematosus (SLE) and may result from neuroinflammation processes and vascular changes in the brain. The cerebral hemodynamics underlying SLE with CI (SLE-CI) remain unclear. We aimed to explore changes in cerebral blood flow (CBF) and intrinsic functional connectivity (FC) in patients with SLE-CI. Methods: We enrolled 97 patients with systemic lupus erythematosus (SLE) and 51 heathy controls (HCs) matched for age and gender. The CI status of patients was measured using the Montreal Cognitive Assessment (MoCA). Based on the findings, the patients were subdivided into two subgroups, the SLE-CI (n = 40) and SLE-NC (n = 57) subgroups. Sagittal three-dimensionT1-weighted (3D-T1), arterial spin labeling (ASL) and resting-state functional (rs-fMRI) sequences were obtained. Seed-based FC was calculated using the CBF results as regions of interest (ROIs). Correlation analysis was performed for further examination of differences in alterations and clinical scores between the patient subgroups. Results: Compared with patients with SLE-NC, patients with SLE-CI had higher CBF in the left hippocampus, thalamus, and cerebellum crus II and lower CBF in the left frontal lobe. Left hippocampus gray matter (GM) atrophy was detected in patients with SLE-CI but not in patients with SLE-NC. Secondary analyses revealed that compared with patients with SLE-NC, patients with SLE-CI had increased FC of the left insula gyrus when the left cerebellum crus II was set as the seed region and decreased FC in the homolateral parahippocampus when the left hippocampus was set as the seed region. Correlation analysis revealed that CBF in the left hippocampus, cerebellum, and thalamus was negatively associated with MoCA and memory scores and slightly positively associated with Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) scores. CBF in the left frontal lobe was positively associated with MoCA and visual space execution capability scores and slightly negatively associated with SLEDAI scores and serum double-stranded DNA (dsDNA) titer. Conclusion: The changes of structure, function, and network in hippocampus gray matter may be biomarkers of cognitive impairment in patients with NPSLE.
Liu et al. (Tue,) studied this question.