Association of depression and cognitive functioning in patients with systemic lupus erythematosus (SLE) in a metropolitan Atlanta cohort Open Access

Shan, Holly (Spring 2021)

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Significance: Systemic lupus erythematosus (SLE) is a chronic inflammatory autoimmune disease with health consequences that can be debilitating for patients, regardless of gender or age. Cognitive dysfunction is a common obstacle for patients with SLE but is often ignored in a clinical setting. Preliminary studies have found depression is associated with such symptoms; however, few studies explore the association between depression and SLE-induced cognitive functions. Insights from such studies serve to improve and expand the quality of care for SLE. 

Objective: To examine whether there are associations between depression and performance on cognitive tests measuring episodic memory, working memory, processing speed, attention, inhibition control, and cognitive flexibility in a cohort of patients from metropolitan Atlanta with SLE.

Participants: 50 participants with SLE were recruited from the Georgians Organized Against Lupus (GOAL) cohort (Mean age: 49.0 ± 12.4).


Measures: Depression was measured with the Patient-Reported Outcomes Measurement Information System (PROMIS) questionnaire; both t-scores and dichotomized scores (no vs. any symptoms of depression) were used. Cognitive performance was measured at the same visit using the NIH Toolbox Fluid Cognition Battery, CLOX Drawing task, and Trail Making B task. 

Results: No statistically significant associations were found between PROMIS depression scores and any of the cognitive function measures. There were slight associations between higher PROMIS depression scores and worse performance on cognitive tests (Pearson’s r correlation coefficients were all negative and had magnitudes <0.1; Linear regression beta coefficients were all negative and had magnitudes <2). All participants with any depressive symptoms had lower scores on all but one cognitive function test compared to participants with no depressive symptoms.

Conclusions: In this cohort of SLE patients, depression was not associated with cognitive function. This may indicate that other factors play a role in cognitive decline in the setting of SLE.

Table of Contents

Table of Contents

Abstract 1

Introduction and Background 6

Epidemiology of SLE 7

Depression and Cognitive Impairment in SLE 8

Cognitive Impairments Specific to SLE 10

Purpose of Study 12

Hypothesis 13

Methods and Materials 13

Study Variables 15

Statistical Analysis 17

Results 18

Discussion 20

Tables and Figures 26

Table 1. Additive criteria for SLE diagnosis by the European League Against Rheumatism and American College of Rheumatology 26

Table 2. Neuropsychiatric symptoms in SLE (American College of Rheumatology, 1999) 27

Table 3. Demographic Summary of Study Participants (n = 50) 28

Table 4. Pearson’s r Correlations between Cognitive Function Measures and PROMIS Depression T Scores. 29

Table 5. Linear Regressions of Crude Associations of Cognitive Function Measures per 10 units of PROMIS Depression T scores 30

Table 6. Results of T-Test of Cognitive Function Measures and PROMIS Depression T Scores of patients with depressive symptoms and patients without depressive symptoms 31

Figure 1. Distribution of PROMIS Depression T Scores 32

Figure 2. Picture Sequence Memory vs. Depression 33

Figure 3. Flanker Inhibitory Control vs. Depression 34

Figure 4. Dimensional Change Card Sort vs. Depression 35

Figure 5. List Sorting Working Memory vs. Depression 36

Figure 6. Pattern Comparison Processing Speed vs. Depression 37

Figure 7. CLOX Score vs. Depression 38

Figure 8. Trail B Making Time vs. Depression 39

Works Cited 40

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