Skip to main content Accessibility help
×
×
Home

Comparison of Neuropsychological Impairment and Vocational Outcomes in Systemic Lupus Erythematosus and Multiple Sclerosis Patients

  • Thomas J. Covey (a1) (a2), Janet L. Shucard (a1), David W. Shucard (a1) (a2), Shane Stegen (a1) and Ralph H.B. Benedict (a1)...
Abstract

Systemic lupus erythematosus (SLE) and multiple sclerosis (MS) are chronic immunologic diseases that can cause cognitive dysfunction. MS is a central nervous system (CNS) disease characterized by demyelination and progressive brain atrophy. SLE is an autoimmune disease capable of damaging multiple organ systems, including the CNS. Cognitive disturbances are seen in both SLE and MS. The present study is concerned with understanding the similarities and differences between the cognitive profiles of SLE and MS as well as the relationship between cognitive impairment and vocational disability in these patients. We examined 47 SLE patients, 47 MS patients, and 44 healthy controls. The groups were well matched on demographics and the patient groups were also matched on disease duration and severity. Group comparisons revealed that generative verbal fluency and visual-spatial memory are more profoundly affected in MS than SLE; whereas depression, fatigue, and working memory deficits are similarly involved in both diseases. Logistic regression analysis revealed that executive function, in particular, was predictive of vocational outcomes in SLE and MS patients. (JINS, 2012, 18, 530–540)

Copyright
Corresponding author
Correspondence and reprint requests to: Ralph H.B. Benedict, Buffalo General Hospital, Department of Neurology, 100 High Street (E-2), Buffalo, New York 14203. E-mail: benedict@buffalo.edu
References
Hide All
Abreu, M.R., Jakosky, A., Folgerini, M., Brenol, J.C., Xavier, R.M., Kapczinsky, F. (2005). Neuropsychiatric systemic lupus erythematosus: Correlation of brain MR imaging, CT, and SPECT. Clinical Imaging, 29(3), 215221.
Ainala, H., Loukkola, J., Peltola, J., Korpela, M., Hietaharju, A. (2001). The prevalence of neuropsychiatric syndromes in systemic lupus erythematosus. Neurology, 57, 496500.
Amato, M.P., Bartolozzi, M.L., Zipoli, V., Portaccio, E., Mortilla, M., Guidi, L., De Stefano, N. (2004). Neocortical volume decrease in relapsing-remitting MS patients with mild cognitive impairment. Neurology, 63(1), 8993.
Amato, M.P., Ponziani, G., Pracucci, G., Bracco, L., Siracusa, G., Amaducci, L. (1995). Cognitive impairment in early-onset multiple sclerosis: Pattern, predictors, and impact on everyday life in a 4-year follow-up. Archives of Neurology, 52(2), 168172.
Amato, M.P., Ponziani, G., Siracusa, G., Sorbi, S. (2001). Cognitive dysfunction in early-onset multiple sclerosis: A reappraisal after 10 years. Archives of Neurology, 58(10), 16021606.
Appenzeller, S., Bonilha, L., Rio, P.A., Min Li, L., Costallat, L.T., Cendes, F. (2007). Longitudinal analysis of gray and white matter loss in patients with systemic lupus erythematosus. Neuroimage, 34(2), 694701.
Appenzeller, S., Cendes, F., Costallat, L.T. (2009). Cognitive impairment and employment status in systemic lupus erythematosus: A prospective longitudinal study. Arthritis Care & Research, 61(5), 680687.
Appenzeller, S., Vasconcelos Faria, A., Min Li, L., Costallat, L.T., Cendes, F. (2008). Quantitative magnetic resonance imaging analyses and clinical significance of hyperintense white matter lesions in systemic lupus erythematosus patients. Annals of Neurology, 64(6), 635643.
Archibald, C.J., Fisk, J.D. (2000). Information processing efficiency in patients with multiple sclerosis. Journal of Clinical & Experimental Neuropsychology, 22, 686701.
Arnett, P.A., Rao, S.M., Grafman, J., Bernardin, L., Luchetta, T., Binder, J.R., Lobeck, L. (1997). Executive functions in multiple sclerosis: An analysis of temporal ordering, semantic encoding, and planning abilities. Neuropsychology, 11, 535544.
Baker, K., Pope, J. (2009). Employment and work disability in systemic lupus erythematosus: A systematic review. Rheumatology, 48, 281284.
Beatty, W.W. (2002). Fluency in multiple sclerosis: Which measure is best? Multiple Sclerosis, 8, 261264.
Beatty, W.W., Hames, K.A., Blanco, C.R., Paul, R.H., Wilbanks, S.L. (1995). Verbal abstraction deficit in multiple sclerosis. Neuropsychology, (9), 198205.
Beck, A.T., Steer, R.A., Brown, G.K. (2000). BDI-fast screen for medical patients: Manual. San Antonio, TX: Psychological Corporation.
Belmont, H.M., Abramson, S.B., Lie, J.T. (1996). Pathology and pathogenesis of vascular injury in systemic lupus erythematosus: Interactions of inflammatory cells and activated endothelium. Arthritis and Rhematism, 39, 922.
Benedict, R.H.B. (1997). Brief visuospatial memory test-revised: Professional manual. Odessa, FL: Psychological Assessment Resources, Inc.
Benedict, R.H.B., Bruce, J., Dwyer, M.G., Weinstock-Guttman, B., Tjoa, C., Tavazzi, E., Zivadinov, R. (2007). Diffusion-weighted imaging predicts cognitive impairment in multiple sclerosis. Multiple Sclerosis, 13(6), 722730.
Benedict, R.H.B., Fishman, I., McClellan, M.M., Bakshi, R., Weinstock-Guttman, B. (2003). Validity of the Beck Depression Inventory—Fast Screen in multiple sclerosis. Multiple Sclerosis, 9, 393396.
Benedict, R.H.B., Holtzer, R., Motl, R.W., Foley, F.W., Kaur, S., Hojnacki, D., Weinstock-Guttman, B. (2011). Upper and lower extremity motor function and cognitive impairment in Multiple Sclerosis. Journal of the International Neuropsychological Society, 17, 643653.
Benedict, R.H.B., Shucard, J.L., Zivadinov, R., Shucard, D.W. (2008). Neuropsychological impairment in systemic lupus erythematosus: A comparison with multiple sclerosis. Neuropsychology Review, 18(2), 149166.
Benedict, R.H.B., Wahlig, E., Bakshi, R., Fishman, I., Munschauer, F., Zivadinov, R., Weinstock-Guttman, B. (2005). Predicting quality of life in multiple sclerosis: Accounting for physical disability, fatigue, cognition, mood disorder, personality, and behavior change. Journal of the Neurological Sciences, 231, 2934.
Benton, A.L., Sivan, A.B., Hamsher, K., Varney, N.R., Spreen, O. (1994). Contributions to neuropsychological assessment (2nd ed.). New York: Oxford University Press.
Bosma, G.P., Rood, M.J., Zwinderman, A.H., Huizinga, T.W., van Buchem, M.A. (2000). Evidence of central nervous system damage in patients with neuropsychiatric systemic lupus erythematosus, demonstrated by magnetization transfer imaging. Arthritis and Rhematism, 43, 4854.
Cercignani, M., Iannucchi, G., Rocca, M.A., Comi, G., Horsfield, M.A., Filippi, M. (2000). Pathologic damage in MS assessed by diffusion-weighted and magnetization transfer MRI. Neurology, 54, 11391144.
Chipchase, S.Y., Lincoln, N.B., Radford, K.A. (2003). Measuring fatigue in people with multiple sclerosis. Disability and Rehabilitation, 25, 778784.
Comi, G., Filippi, M., Martinelli, V., Sirabian, G., Visciani, A., Campi, A., Canal, N. (1993). Brain magnetic resonance imaging correlates of cognitive impairment in multiple sclerosis. Journal of the Neurological Sciences, 115(Suppl 73), S66S73.
Covey, T.J., Zivadinov, R., Shucard, J.L., Shucard, D.W. (2011). Information processing speed, neural efficiency, and working memory performance in multiple sclerosis: Differential relationships with structural MRI. Journal of Clinical and Experimental Neuropsychology, 33, 11291145.
D'Esposito, M., Onishi, K., Thompson, H., Robinson, K., Armstrong, C., Grossman, M. (1996). Working memory impairments in multiple sclerosis: Evidence from a dual-task paradigm. Neuropsychology, 10, 5156.
Delis, D.C., Kaplan, E., Kramer, J.H. (2001). Delis-Kaplan executive function system. San Antonio, TX: Psychological Corporation.
Delis, D.C., Kramer, J.H., Kaplan, E., Ober, B.A. (2000). California verbal learning test manual (2nd ed.). San Antonio, TX: Psychological Corporation.
DeLuca, J., Chelune, G., Tulsky, D.S., Lengenfelder, J., Chiaravalloti, N. (2004). Is speed of processing or working memory the primary information processing deficit in multiple sclerosis? Journal of Clinical & Experimental Neuropsychology, 26, 550562.
Denburg, S.D., Carbotte, R.M., Denburg, J.A. (1987). Cognitive impairment in systemic lupus erythematosus: A neuropsychological study of individual and group deficits. Journal of Clinical and Experimental Neuropsychology, 9(4), 323339.
Denburg, S.D., Carbotte, R.M., Denburg, J.A. (1997). Psychological aspects of systemic lupus erythematosus: Cognitive, function, mood, and self-report. The Journal of Rheumatology, 24, 9981003.
Denney, D.R., Sworowski, L.A., Lynch, S.G. (2005). Cognitive impairment in three subtypes of multiple sclerosis. Archives of Clinical Neuropsychology, 20(8), 967981.
Drew, M.A., Starkey, N.J., Isler, R.B. (2009). Examining the link between information processing speed and executive functioning in multiple sclerosis. Archives of Clinical Neuropsychology, 24, 4758.
Ellis, S.G., Verity, M.A. (1979). Central nervous system involvement in systemic lupus erythematosus: A review of neuropathologic findings in 57 cases. Seminars in Arthritis and Rheumatism, 8, 212221.
Emmer, B.J., Veer, I.M., Steup-Beekman, G.M., Huizinga, T.W., van der Grond, J., van Buchem, M.A. (2010). Tract-based spatial statistics on diffusion tensor imaging in systemic lupus erythematosus reveals localized involvement of white matter tracts. Arthritis & Rheumatism, 62, 37163721.
Filley, C.M., Heaton, R.K., Nelson, L.M., Burks, J.S., Franklin, G.M. (1989). A comparison of dementia in Alzheimer's disease and multiple sclerosis. Archives of Neurology, 46, 157161.
Fitzgibbon, B.M., Fairhall, S.L., Kirk, I.J., Kalev-Zylinska, M., Pui, K., Dalbeth, N., McQueen, F.M. (2008). Functional MRI in NPSLE patients reveals increased parietal and frontal brain activation during a working memory task compared with controls. Rheumatology (Oxford), 47, 5053.
Foong, J., Rozewicz, L., Quaghebeur, G., Davie, C.A., Kartsounis, L.D., Thompson, A.J., Ron, M.A. (1997). Executive function in multiple sclerosis. The role of frontal lobe pathology. Brain, 120(Pt 1), 1526.
Forn, C., Belenguer, A., Parcet-Ibars, M.A., Avila, C. (2008). Information-processing speed is the primary deficit underlying the poor performance of multiple sclerosis patients in the Paced Auditory Serial Addition Test (PASAT). Journal of Clinical & Experimental Neuropsychology, 30(7), 789796.
Geurts, J., Barkhof, F. (2008). Gray matter pathology in multiple sclerosis. The Lancet Neurology, 7(9), 841851.
Glanz, B.I., Schur, P.H., Lew, R.A., Khoshbin, S. (2005). Lateralized cognitive dysfunction in patients with systemic lupus erythematosus. Lupus, 14(11), 896902.
Govoni, M., Castellino, G., Padovan, M., Borrelli, M., Trotta, F. (2004). Recent advances and future perspective in neuroimaging in neuropsychiatric systemic lupus erythematosus. Lupus, 13(3), 149158.
Gronwall, D.M. (1977). Paced auditory serial addition task: A measure of recovery from concussion. Perceptual and Motor Skills, 44, 367373.
Hachulla, E., Michon-Pasturel, U., Leys, D., Pruvo, J.P., Queyrel, V., Masy, E., Devulder, B. (1998). Cerebral magnetic resonance imaging in patients with or without antiphospholipid antibodies. Lupus, 7, 124131.
Hanly, J.G., Liang, M.H., Moore, P.M., Lahita, R.G. (1997). Cognitive disorders in systemic lupus erythematosus: Epidemiologic and clinical issues (pp. 60–68). New York: The New York Academy of Sciences.
Heaton, R.K. (1985). Neuropsychological findings in relapsing-remitting and chronic-progressive multiple sclerosis. Journal of Consulting & Clinical Psychology, 53, 103110.
Houtchens, M.K., Benedict, R.H.B., Killiany, R., Sharma, J., Jaisani, Z., Singh, B., Bakshi, R. (2007). Thalamic atrophy and cognition in multiple sclerosis. Neurology, 69, 113123.
Johnson, R.T., Richardson, E.P. (1968). The neurological manifestations of systemic lupus erythematosus: A clinical-pathological study of 24 cases and review of the literature. Medicine, 47, 337369.
Kozora, E., Arciniegas, D.B., Filley, C.M., West, S.G., Brown, M., Miller, D., Zhang, L. (2008). Cognitive and neurologic status in patients with systemic lupus erythematosus without major neuropsychiatric syndromes. Arthritis Care & Research, 59(11), 16391646.
Kozora, E., Filley, C.M. (2011). Cognitive dysfunction and white matter abnormalities in systemic lupus erythematosus. Journal of the International Neuropsychological Society, 17, 18.
Kozora, E., Hanly, J.G., Lapteva, L., Filley, C.M. (2008). Cognitive dysfunction in systemic lupus erythematosus: Past, present, and future. Arthritis & Rheumatism, 58(11), 32863298.
Krupp, L.B., LaRocca, N.G., Muir-Nash, J., Steinberg, A.D. (1989). The fatigue severity scale. Application to patients with multiple sclerosis and systemic lupus erythematosus. Archives of Neurology, 46, 11211123.
Kurtzke, J.F. (1983). Rating neurologic impairment in multiple sclerosis: An expanded disability status scale (EDSS). Neurology, 33, 14441452.
Kutzelnigg, A., Lucchinetti, C.F., Stadelmann, C., Bruck, W., Rauschka, H., Bergmann, M., Lassmann, H. (2005). Cortical demyelination and diffuse white matter injury in multiple sclerosis. Brain, 128, 27052712.
Lengenfelder, J., Bryant, D., Diamond, B.J., Kalmar, J.H., Moore, N.B., DeLuca, J. (2006). Processing speed interacts with working memory efficiency in multiple sclerosis. Archives of Clinical Neuropsychology, 21(3), 229238.
Leritz, E., Brandt, J., Minor, M., Reis-Jensen, F., Petri, M. (2000). “Subcortical” cognitive impairment in patients with systemic lupus erythematosus. Journal of the International Neuropsychological Society, 6, 821825.
Liang, M.H., Socher, S.A., Larson, M.G., Schur, P.H. (1989). Reliability and validity of six systems for the clinical assessment of disease activity in systemic lupus erythematosus. Arthritis and Rheumatism, 32, 11071118.
Lin, X., Tench, C.R., Morgan, P.S., Constantinescu, C.S. (2008). Use of combined conventional and quantitative MRI to quantify pathology related to cognitive impairment in multiple sclerosis. Journal of Neurology, Neurosurgery, and Psychiatry, 79, 437441.
Loukkola, J., Laine, M., Ainiala, H., Peltola, J., Metsanoja, R., Auvinen, A., Hietaharju, A. (2003). Cognitive impairment in systemic lupus erythematosus and neuropsychiatric systemic lupus erythematosus: A population-based neuropsychological study. Journal of Clinical & Experimental Neuropsychology, 25(1), 145151.
Lublin, F.D., Reingold, S.C. (1996). Defining the clinical course of multiple sclerosis: Results of an international survey. Neurology, 46(4), 907911.
Monastero, R., Bettini, P., Del Zotto, E., Cottini, E., Tincani, A., Balestrieri, G., Padovani, A. (2001). Prevalence and pattern of cognitive impairment in systemic lupus erythematosus patients with and without overt neuropsychiatric manifestations. Journal of the Neurological Sciences, 184(1), 3339.
Morrow, S.A., Drake, A., Zivadinov, R., Munschauer, F., Weinstock-Guttman, B., Benedict, R.H. (2010). Predicting loss of employment over three years in multiple sclerosis: Clinically meaningful cognitive decline. Clinical Neuropsycholgy, 7, 115.
Otte, A., Weiner, S.M., Peter, H.H., Mueller-Brand, J., Goetz, M., Moser, E., Nitzsche, E.U. (1997). Brain glucose utilization in systemic lupus erythematosus with neuropsychiatric symptoms: A controlled positron emission tomography study. European Journal of Nuclear Medicine, 24, 787791.
Panopalis, P., Julian, L., Yazdany, J., Gillis, J.Z., Trupin, L., Hersh, A., Yelin, E. (2007). Impact of memory impairment on employment status in persons with systemic lupus erythematosus. Arthritis and Rheumatism, 57(8), 14531460.
Parmenter, B.A., Shucard, J.L., Benedict, R.H.B., Shucard, D.W. (2006). Working memory deficits in multiple sclerosis: Comparison between the n-back task and the Paced Auditory Serial Addition Test. Journal of the International Neuropsychological Society, 12, 677687.
Parmenter, B.A., Shucard, J.L., Shucard, D.W. (2007). Information processing deficits in multiple sclerosis: A matter of complexity. Journal of the International Neuropsychological Society, 13, 417423.
Piras, M.R., Magnano, I., Canu, E.D., Paulus, K.S., Satta, W.M., Soddu, A., Aiello, I. (2003). Longitudinal study of cognitive dysfunction in multiple sclerosis: Neuropsychological, neuroradiological, and neurophysiological findings. Journal of Neurology, Neurosurgery, & Psychiatry, 74(7), 878885.
Pirko, I., Lucchinetti, C.F., Sriram, S., Bakshi, R. (2007). Gray matter involvement in multiple sclerosis. Neurology, 68, 634642.
Polman, C.H., Reingold, S.C., Edan, G., Filippi, M., Hartung, H.P., Kappos, L., Wolinsky, J.S. (2005). Diagnostic criteria for multiple sclerosis: 2005 revisions to the “McDonald Criteria”. Annals of Neurology, 58(6), 840846.
Qualls, C.E., Bliwise, N.G., Stringer, A.Y. (2000). Short forms of The Benton Judgment of Line Orientation Test: Development and psychometric properties. Archives of Clinical Neuropsychology, 15(2), 159163.
Rao, S.M. (1991). A manual for the brief, repeatable battery of neuropsychological tests in multiple sclerosis. New York, NY: National Multiple Sclerosis Society.
Rao, S.M., Leo, G.J., Bernardin, L., Unverzagt, F. (1991). Cognitive dysfunction in multiple sclerosis. I. Frequency, patterns, and prediction. Neurology, 41, 685691.
Rao, S.M., Leo, G.J., Ellington, L., Nauertz, T., Bernardin, L., Unveragt, F. (1991). Cognitive dysfunction in multiple sclerosis. II. Impact on employment and social functioning. Neurology, 41, 692696.
Roca, M., Torralva, T., Meli, F., Fiol, M., Calcagno, M.L., Carpintiero, S., Correale, J. (2008). Cognitive deficits in multiple sclerosis correlate with changes in fronto-subcortical tracts. Multiple Sclerosis, 14, 364369.
Rogers, J.M., Panegyres, P.K. (2007). Cognitive impairment in multiple sclerosis: Evidence-based analysis and recommendations. Journal of Clinical Neuroscience, 14, 919927.
Rovaris, M., Iannucci, G., Falautano, M., Possa, F., Martinelli, V., Comi, G., Filippi, M. (2002). Cognitive dysfunction in patients with mildly disabling relapsing-remitting multiple sclerosis: An exploratory study with diffusion tensor MR imaging. Journal of the Neurological Sciences, 195(2), 103109.
Rovaris, M., Viti, B., Ciboddo, G., Gerevini, S., Capra, R., Iannucci, G., Filippi, M. (2000). Brain involvement in systemic immune mediated diseases: Magnetic resonance and magnetisation transfer imaging study. Journal of Neurology, Neurosurgery, & Psychiatry, 68, 170177.
Sanfilipo, M.P., Benedict, R.H., Weinstock-Guttman, B., Bakshi, R. (2006). Gray and white matter brain atrophy and neuropsychological impairment in multiple sclerosis. Neurology, 66(5), 685692.
Shucard, J.L., Lee, W.H., Hamlin, A.S., Shucard, D.W. (2011). The relationship between processing speed and working memory demand in systemic lupus erythematosus: Evidence from a visual N-Back Task. Neuropsychology, 25, 4552.
Shucard, J.L., Parrish, J., Shucard, D.W., McCabe, D., Benedict, R.H.B., Ambrus, J. (2004). Working memory and processing speed deficits in systemic lupus erythematosus as measured by the paced auditory serial addition test. Journal of the International Neuropsychological Society, 10, 3545.
Sibbitt, W.L. Jr., Sibbitt, R.R., Brooks, W.M. (1999). Neuroimaging in neuropsychiatric systemic lupus erythematosus. Arthritis and Rheumatism, 42, 20262038.
Smith, A. (1982). Symbol digit modalities test: Manual. Los Angeles: Western Psychological Services.
Steens, S.C., Admiraal-Behloul, F., Bosma, G.P., Steup-Beekman, G.M., Olofsen, H., Le Cessie, S., Van Buchem, M.A. (2004). Selective gray matter damage in neuropsychiatric lupus. Arthritis and Rheumatism, 50(9), 28772881.
Swirsky-Sacchetti, T., Field, H.L., Mitchell, D.R., Seward, J., Lublin, F., Knobler, R., Gonzalez, C.F. (1992). The sensitivity of the Mini-Mental State Exam in the white matter dementia of multiple sclerosis. Journal of Clinical Psychology, 48, 779786.
Swirsky-Sacchetti, T., Mitchell, D.R., Seward, J., Gonzales, C., Lublin, F., Knobler, R., Field, H.L. (1992). Neuropsychological and structural brain lesions in multiple sclerosis. Neurology, 42, 12911295.
Tan, E.M., Cohen, A.S., Fries, J.F., Massi, A.T., McShane, D.J., Rothfield, N.F. (1982). The 1982 revised criteria for the classification of systemic lupus erythematosus. Arthritis & Rheumatism, 25, 12711277.
Tekok-Kilic, A., Benedict, R.H.B., Weinstock-Guttman, B., Dwyer, M., Carone, D., Srinivasaraghavan, B., Zivadinov, R. (2007). Independent contributions of cortical gray matter atrophy and ventricle enlargement for predicting neuropsychological impairment in multiple sclerosis. Neuroimage, 36, 12941300.
Trapp, B.D., Peterson, J., Ransohoff, R.M., Rudick, R., Mork, S., Bo, L. (1998). Axonal transection in the lesions of multiple sclerosis. New England Journal of Medicine, 338, 278285.
Vasilesios, K.C., Krishnan, S., Tsokos, G.C. (2006). Systems biology in systemic lupus erythematosus: Integrating genes, biology and immune function. Autoimmunity, 39, 705709.
Vleugels, L., Lafosse, C., van Nunen, A., Nachtergaele, S., Ketelaer, P., Charlier, M., Vandenbussche, E. (2000). Visuoperceptual impairment in multiple sclerosis patients diagnosed with neuropsychological tasks. Multiple Sclerosis, 6, 241254.
Zhang, L., Harrison, M., Heier, L.A., Zimmerman, R.D., Ravdin, L., Lockshin, M., Ulug, A.M. (2007). Diffusion changes in patients with systemic lupus erythematosus. Magnetic Resonance Imaging, 25, 399405.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Journal of the International Neuropsychological Society
  • ISSN: 1355-6177
  • EISSN: 1469-7661
  • URL: /core/journals/journal-of-the-international-neuropsychological-society
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Keywords

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed