Background Cognitive dysfunction in systemic lupus erythematosus (SLE) is common yet often flies under the radar, subtle in onset and frequently overlooked in clinical practice. This study sheds light on the cognitive toll of SLE, mapping the domain-specific impairments and probing their links to clinical features, anti-NR2 antibodies, and structural brain changes. Patients and methods We assessed 100 female SLE patients using the Montreal Cognitive Assessment (MoCA). Those scoring less than or equal to 25 were classified as having mild cognitive impairment (MCI). Clinical, serological (including anti-NR2 antibodies), and neuroimaging data were analyzed. A subset of 23 MCI patients underwent volumetric MRI to explore brain structural correlates, focusing on hippocampal and caudate atrophy. Results Nearly one in four (24%) patients showed cognitive impairment. Compared with cognitively intact peers, MCI patients more frequently had arthritis, leukopenia, and proteinuria. MoCA domain analysis revealed widespread deficits, particularly in visuospatial/executive function (91.7%), attention (79.2%), and language (50%). Anti-NR2 antibodies were strikingly elevated in the MCI group (79.2 vs. 17.1%, P < 0.001) and strongly correlated with lower MoCA scores (ρ=–0.490, P < 0.001). MRI revealed hippocampal atrophy in 17.4% and caudate atrophy in 8.7% of MCI patients-partially mirroring their cognitive profile. Conclusion Cognitive impairment in SLE is not only prevalent but also patterned, affecting key domains of executive function and attention. Elevated anti-NR2 antibodies and hippocampal volume loss emerge as promising biomarkers, offering a window into the mechanisms of lupus-related cognitive decline, and potentially guiding earlier intervention.
Shoela et al. (Tue,) studied this question.