Feb 22, 2022

Relieving impairment for those with lupus

A syringe and text describing lupus
Dr. Kathleen Bingham

The symptoms of lupus can range from skin rash to joint pain to fever, but not everyone knows that people with lupus also experience a high risk of cognitive impairment, depression, and anxiety. These symptoms can impair their ability to function and have a drastic impact on their quality of life. Dr. Kathleen Bingham and her team are studying the relationship between anxiety and depression and the development of cognitive impairment, opening a path to relieving cognitive impairment for those with lupus.

What is a cognitive domain?

KB: Cognition refers to mental processes involved in gaining knowledge and understanding, and a cognitive domain is an area of cognition, such as memory, attention or language.

What is systemic lupus erythematosus?

KB: Systemic lupus erythematosus, commonly known as “lupus”, is an autoimmune disease, or a disease where the body’s immune system attacks its own tissues and organs. Lupus can involve almost any organ system, including the brain.

What motivated this research?

KB: Patients with lupus are at high risk of cognitive impairment, as well as depression and anxiety. All of these symptoms significantly impact quality of life. However, we do not know what cognitive domains are most associated with depression and anxiety, nor do we know whether improvement in depression and anxiety symptoms leads to an improvement in cognition. In this study, we examined the relationships between depression and anxiety symptoms and performance in various cognitive domains over the course of one year, to determine which cognitive domains are most associated with depression and anxiety, and how cognition and depression and anxiety relate to each other over time.

What was the most important finding of this study, in your opinion?

KB: We found that many lupus patients with cognitive impairment have depression and anxiety, and that these patients continue to experience all of these difficulties over the course of one year. Patients with depression and anxiety tended to have difficulty in more complex cognitive domains such as memory and executive function (planning, organization, working memory).

How does this change treatment in the future?

KB: It is important for clinicians treating patients with lupus to be aware that many patients with depression and anxiety will have cognitive impairment, and vice versa, and to screen for these issues when they come up. We have some treatments for depression and anxiety, but not for cognitive impairment in lupus. Hopefully, as we gain a better understanding of the mechanism underlying these challenges, we will be able to offer more targeted treatments.

Any next steps?

KB: Because our study participants’ cognitive scores and mood and anxiety symptoms did not change over time, we were not able to determine whether cognition might improve with depression or anxiety treatment. We hope to examine this question further in larger patient groups over longer periods of time.

What is the major take home message for the public?

KB: Lupus is a serious illness that affects many organ systems, including the brain. It is associated with cognitive impairment, depression and anxiety—all issues that significantly affect quality of life. We know that lupus patients with cognitive difficulties (particularly in the areas of memory and executive function) are very likely to have depression and anxiety, and that these symptoms persist over time. The next step is to determine whether treating depression and anxiety helps to improve cognition.

ImPACT logo: Psychiatry articles that change treatment

ImPACT Committee includes Krista Lanctôt, Alastair Flint, Meng-Chuan Lai and Simone Vigod.

Bingham KS, DiazMartinez J, Green R, Tartaglia MC, Ruttan L, Su J, Wither JE, Kakvan M, Anderson N, Bonilla D, Choi MY, Fritzler MJ, Beaton DE, Katz P, Touma Z. Longitudinal relationships between cognitive domains and depression and anxiety symptoms in systemic lupus erythematosus. Semin Arthritis Rheum. 2021 Dec;51(6):1186-1192. doi: 10.1016/j.semarthrit.2021.09.008.