TOPLINE:

Among patients with systemic lupus erythematosus (SLE), 46% experienced cognitive impairment at some point over a year. More than half of the patients never experienced cognitive impairment, whereas 17% showed persistent impairment.

METHODOLOGY:

• Researchers assessed the course of cognitive impairment over a year among 175 adult patients with SLE (mean age at enrollment, 41.2 years; 89.1% female; 58.9% White and 20% Black) at the University of Toronto Lupus Clinic, Toronto, Ontario, Canada (July 2016-February 2022).
• Patients were evaluated at baseline, 6 months, and 12 months using the modified American College of Rheumatology (ACR) Neuropsychological Battery. This modified battery comprised 11 tests across six cognitive domains, including simple attention and processing speed and executive functioning.
• Cognitive impairment was defined as a z-score ≤ -1.5 in one or more tests in certain domains or in two or more tests in others.
• Patients were categorized into three groups: those with persistent cognitive impairment noted at all three timepoints over 1 year, those with fluctuating cognitive impairment noted at only one or two timepoints, and those who did not experience impairment at any timepoint (no-impairment group).

TAKEAWAY:

• Cognitive impairment was observed in 46% of the patients with SLE in at least one assessment over a year; 17% showed persistent impairment, 29% showed fluctuating impairment, and 54% did not experience impairment.
• In the persistent cognitive impairment group, the learning and memory domain was affected in 70%-77% of the patients and the visual-spatial construction domain in 67%-80%. Impairment in learning and memory and visual-spatial construction domains was also observed in the no-impairment group (in up to 19% and 20%, respectively).
• The persistent cognitive impairment group included higher proportions of Black patients (P = .04) and those who were divorced or separated (P = .036) than the no-impairment group; patients in the persistent cognitive impairment group had higher levels of SLE damage based on the Systemic Lupus International Collaborating Clinics/ACR Damage Index (P = .017).
• No variables were identified as independently associated with cognitive impairment persistence in multivariate analysis.

IN PRACTICE:

“These findings likely reflect the multifactorial and heterogeneous nature of [cognitive impairment] in SLE and underscore the complexity of mechanisms underlying cognitive function fluctuations, which are presumably influenced by lupus-specific, psychological, and treatment-related factors,” the authors of the study wrote.

SOURCE:

The study, led by Oshrat E. Tayer-Shifman, MD, Gray Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, Israel, was published online on December 23, 2025, in RMD Open.

LIMITATIONS:

The follow-up period of only 1 year was relatively short, which may not capture long-term cognitive changes. Some patients classified as never having cognitive impairment may have experienced it in the past. The small size of the persistent cognitive impairment group limited the ability to detect statistically significant differences.

DISCLOSURES:

The study was supported by grants from the Arthritis Society Canada, Canadian Institutes of Health Research, Physicians’ Services Incorporated Foundation, and other sources. Some authors reported receiving support from various sources, including the Department of Medicine, University of Toronto, and Lupus Ontario. No competing interests were declared.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.