Childhood-Onset Systemic Lupus Erythematosus: Neurocognitive Function

Childhood-Onset Systemic Lupus Erythematosus: Neurocognitive Function

Bibliographic Details
Main Author: Ruth, Natasha M.
Language:English
Published: University of Cincinnati / OhioLINK 2006
Subjects:
Systemic Lupus Erythematosus
Neurocognitive Function
ANAM
Online Access:http://rave.ohiolink.edu/etdc/view?acc_num=ucin1148060762
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spelling ndltd-OhioLink-oai-etd.ohiolink.edu-ucin11480607622021-08-03T06:11:11Z Childhood-Onset Systemic Lupus Erythematosus: Neurocognitive Function Ruth, Natasha M. Systemic Lupus Erythematosus Neurocognitive Function ANAM The frequency of neurocognitive involvement in childhood-onset systemic lupus erythematosus (cSLE) is unknown. Estimates vary widely between studies. Reasons include a lack of sensitive and specific measures of cognitive impairment for children with cSLE. Formal neurocognitive testing, the current gold standard for diagnosis of cognitive impairment, is costly and unavailable in a routine clinical setting. The objectives of this study are 1) To determine the prevalence of neurocognitive involvement (NCI) in children with cSLE as measured by formal neurocognitive testing and to determine the impact of neurocognitive outcomes on the overall health related quality of life of patients with cSLE ; 2) to assess the usefulness of the computer based pediatric Automated Neuropsychological Assessment Metrics (pANAM) and the Self Assessment Neuropsychiatric Questionnaire (NSAQ) for identifying children with NCI in a clinical setting. METHODS: A sample of cSLE patients (n= 24) and age & gender matched controls (best-friends or JIA patients) were studied. For cSLE patients information on disease activity, damage, medication use, and the results of standard of care laboratory testing were obtained. The NSAQ (46 items; yes/no answers) adapted from a previously published NCI self-report questionnaire, and the p-ANAM were completed by all subjects (duration 30- 45 min), while only those with cSLE underwent formal neurocognitive testing assessing various aspects of cognition (FNCT). NCI was defined as z-score in 2 cognitive domains between -1.0 and -1.99 or 1 cognitive domain < -2.0 on FNCT (based on adult SLE study)1. Quality of life information was obtained on all patients using the Child Health Questionnaire (CHQ) for children < 18 years of age or the Medical Outcome Survey Short Form (SF-36) for children > 18 years of age. RESULTS: Forty percent (24/60) of all cSLE patients followed at the center were sampled (mean age: 16; range:10-21 yrs, Caucasian: Non-Caucasian = 13 :11). NCI was present in 10 of 24 cSLE patients. The prevalence of NCI in cSLE was significantly higher than in normative populations (42% vs. 20.5%; p<.032). Compared to those without NCI, there was a trend towards a higher prevalence of renal disease (6/10 vs. 4/14),higher disease activity and poorer health related quality of life (psychosocial summary p<0.12) among cSLE pts with NCI; however, none of the SOC test including antiphospholipid and anti-dsDNA antibodies, medication, or global damage differed between the two groups. On many of the pANAM subtests, the “throughput score” (representing the product of speed and accuracy of task performance) was moderately correlated with the FNCT results (p<.05). Conversely, the NSAQ was neither sensitive nor specific for identifying pts with NCI. Several of the pANAM subtests were significantly different between cSLE patients and controls including: simple reaction time, procedural reaction time, logical reasoning symbolic. CONCLUSIONS: There is a high prevalence of NCI among children with cSLE. The diagnosis of NCI in cSLE is difficult in the clinical setting suggesting that screening tools for NCI are required. Although self-assessment questionnaires are thought to be useful for adults with SLE, this appears not to be true for children. Similar to the ANAM developed for adults, the pANAM shows potential for detecting NCI in a clinical setting. 2006-07-13 English text University of Cincinnati / OhioLINK http://rave.ohiolink.edu/etdc/view?acc_num=ucin1148060762 http://rave.ohiolink.edu/etdc/view?acc_num=ucin1148060762 unrestricted This thesis or dissertation is protected by copyright: all rights reserved. It may not be copied or redistributed beyond the terms of applicable copyright laws.
collection NDLTD
language English
sources NDLTD
topic Systemic Lupus Erythematosus
Neurocognitive Function
ANAM
spellingShingle Systemic Lupus Erythematosus
Neurocognitive Function
ANAM
Ruth, Natasha M.
Childhood-Onset Systemic Lupus Erythematosus: Neurocognitive Function
author Ruth, Natasha M.
author_facet Ruth, Natasha M.
author_sort Ruth, Natasha M.
title Childhood-Onset Systemic Lupus Erythematosus: Neurocognitive Function
title_short Childhood-Onset Systemic Lupus Erythematosus: Neurocognitive Function
title_full Childhood-Onset Systemic Lupus Erythematosus: Neurocognitive Function
title_fullStr Childhood-Onset Systemic Lupus Erythematosus: Neurocognitive Function
title_full_unstemmed Childhood-Onset Systemic Lupus Erythematosus: Neurocognitive Function
title_sort childhood-onset systemic lupus erythematosus: neurocognitive function
publisher University of Cincinnati / OhioLINK
publishDate 2006
url http://rave.ohiolink.edu/etdc/view?acc_num=ucin1148060762
work_keys_str_mv AT ruthnatasham childhoodonsetsystemiclupuserythematosusneurocognitivefunction
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