Microstructural Brain Damage in Lupus Patients Leads to Cognitive Dysfunction

Lupus patients may experience microstructural brain damage related to cognitive dysfunction with steroid medication.

Lupus patients experience microstructural brain damage related to cognitive dysfunction with steroid medication as per a study at the National University Of Singapore, Yong Loo Lin School Of Medicine, published in the journal Rheumatology.

Systemic lupus erythematosus (SLE) is a type of autoimmune disease where the immune system of the body attacks its own tissues. This causes widespread inflammation that result in damage to the organs like joints, skin, lungs, kidneys, blood vessels, and brain.

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‘Lupus patients may experience microstructural brain damage related to cognitive dysfunction with steroid medication. This mandates the need for regular cognitive assessment among SLE patients on long-term steroid treatments. ’

When compared to patients in western countries, Asian SLE patients have more severe disease outcomes. The prevalence of adult SLE is 40 per 100,000 adult populations in Singapore.

SLE and Brain Damage

SLE patients are commonly found to have cognitive dysfunction like impairment of simple reaction time, sustained and selected attention, memory search, working memory, and short-term memory for learned associations, and a negative impact on vocational capability.

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But the exact neural mechanism leading to cognitive dysfunction in patients with SLE remains unknown. Hence the study aimed to explore these mechanisms through non-invasive diffusion magnetic resonance imaging (MRI).

The study examined the brains of SLE patients and if the steroid dosage adjustment would alleviate cognitive dysfunction. The free-water signals in the white matter of the brain were examined using the novel free water diffusion MRI technique along with computerized neuropsychological assessment.

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White matter free water refers to water molecules surrounding white matter in the brain that can diffuse unhindered.

It was found that the SLE patients had significantly higher white matter-free water than their healthy counterparts. This suggests the possible micro vascular degradation and/or inflammation – a significant relation to cognitive dysfunction.

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“The clinical implications of the study would indicate to physicians that steroids should be judiciously prescribed, aiming for the lowest possible dose for the shortest possible duration. While systemic use of steroids will continue to be the mainstay of treatment for moderate to severe SLE-related inflammation, there are other therapeutic options that could produce similar results: these should be considered first in order to reduce steroid use or shorten the necessary course,” says Associate Prof. Anselm Mak at the National University Of Singapore.

Moreover, the study also claimed that other SLE manifestations could also be symptomatically treated without the prescription of steroids. And SLE patients on long-term steroid treatments should also be regularly assessed and monitored for cognitive dysfunction using Automated Neuropsychiatric Assessment Matrix (ANAM).

Source-Medindia