Journal Article

POS1127 THE MOCA TEST IN THE EVALUATION OF COGNITIVE DEFICITS IN SYSTEMIC LUPUS ERYTHEMATOSUS: ANALYSIS OF A MONOCENTRIC COHORT

Serafini, C., Congia, M., Piga, M., Mathieu, A., Floris, A., Cauli, A., Chessa, E., Angioni, M. M., Carta, M. G.

2024

Overview

Background:Cognitive deficits (CDs) are frequent and worsen the quality of life of Systemic Lupus Erythematosus (SLE) patients. The Montreal Cognitive Assessment (MoCA) is a feasible test used to screen the presence of cognitive deficits.Objectives:The aim of the study is to evaluate whether the MoCA is a valid test for identifying SLE patients who require a targeted neuropsychological evaluation for CDs and to discriminate which factors influence MoCA’s alterations (including subjective cognitive symptomatology).Methods:A cross-sectional study was conducted between April 2019 and November 2022 in which adult patients with SLE (ACR/EULAR 2019 criteria) and HC with similar demographic characteristics were recruited. Demographic, clinical, clinimetric, serological and therapeutic data were collected (Table 1). CDs were screened with the MoCA test performed by certified personnel (altered if<26/30). A neuropsychologist explored deficits in 8 cognitive domains with a battery of neuropsychological tests. Depressive symptoms were evaluated with the Center for Epidemiologic Studies Depression Scale CES-D, (altered if>15) and fatigue with FACIT-F (altered if<30).Results:Ninety-nine patients and 36 HCs were enrolled (Table 1). MoCA test was altered in 44 SLE and 7 HCs (44.4% VS 19.4%, p=0.008). MoCA values in SLE correlated significantly with the alterations found in the battery test in the domains of memory, executive functions, complex attention and problem solving (Rey Immediate Words p=0.014; Recognition p=0.043, Stroop Test p=0.010, FAB p =0.005, Digit Symbol p=0.018). High MoCA scores correlated with the absence of CDs (mean 26.86±1.86, p=0.012). At least one subjective cognitive symptom was reported by 31/57 SLE and 13/36 HC but no correlation was found with the MoCA alterations, while a correlation emerged with the CES-D values (p=0.002) and fibromyalgia (p=0.003). At multivariate analysis after correction for age, gender, level of education, disease duration, fibromyalgia, dyslipidemia, SLEDAI-2K, anti-RibP titre, the factors that influenced MoCA were male gender (β=-0.206, p=0.014), education <8 years (β=0.444, p<0.001), dyslipidemia (β=-0.205, p=0.016), and antiRib-P (β=-0.221, p=0.008).Conclusion:MoCA test is useful for screening but not for diagnosis of CDs in SLE patients. Low level of education, male gender, dyslipidemia and anti-Rib-P titer were factors independently associated with MoCA alterations. No correlation between subjective cognitive symptoms with MoCA alterations was found, while a correlation emerged with CES-D values and fibromyalgia.REFERENCES:NIL.Table 1.Demographics, clinics, clinimetrics, serological, therapeutics characteristics of the cohortsVariablesSLE (N=99)HC (N=36)Gender, F (%)92 (92.9%)34 (94.4%)Age, mean (SD)43.6 (±12.36)40 (±14.2)Education ≤8 years, N (%)29 (29.3%)4 (11.1%)Disease duration years, median (IQR)10.3 (3.3-18.2)-Neuropsychiatric Lupus, N (%)19 (19.2%)-Dyslipidemia, N (%)22 (22.5%)9 (25%)Hypertension, N (%)33 (33.7%)4 (11.1%)Smoking, N (%)17 (17.5%)8 (23.5%)MoCA test, mean (SD)25.3 (±3.05)27 (±2.9)>=1 cognitive domain altered N (%)17 (53%)-CES-D altered (>15), N (%)46 (46.5%)14 (38.9%)CES-D, median (IQR)16 (9-21.8)13 (7-17.3)FACIT altered (<30), N (%)23 (44.2%)8 (22.2%)FACIT, median (IQR)33 (25-40)42.5 (33.8-47)Subjective cognitive symptoms N (%)31 (54.4%)13 (36.1%)Fibromyalgia, N (%)21 (21.2%)-SLEDAI-2K, median (IQR)2 (0-5.5)-PGA, median (IQR)0.2 (0-0.8)-SLICC-DI, median (IQR)0.0 (0-1)-LLDAS, N (%)58 (58.3%)-Anti-dsDNA, median (IQR)9.2 (2.2-36.8)-C3, median (IQR)89 (73-97.5)-Anti-phospholipids, N (%)29 (30.5%)-Anti Rib-P, N (%)20 (21.3%)-PDN dose mg/die, median (IQR)4.6 (2.5-7.5)-Hydroxychloroquine, N (%)78 (78.8%)-Immunosuppressors, N (%)80 (80.8%)-Acknowledgements:NIL.Disclosure of Interests:Elisabetta Chessa: None declared, cristina serafini: None declared, Alberto Floris: None declared, Maria Maddalena Angioni: None declared, MATTIA CONGIA: None declared, Alessandro Mathieu: None declared, Alberto Cauli: None declared, Mauro Giovanni Carta: None declared, Matteo Piga AstraZeneca, GSK, Otsuka, Roche, AstraZeneca, GSK.

• Publisher: BMJ Publishing Group Ltd and European League Against Rheumatism,Elsevier B.V,Elsevier Limited
• Subject: Anti-DNA antibodies / Autoantibodies / Cognitive Function / Demographics / Demography / Diagnostic test / Dyslipidemia / Epidemiology / Fibromyalgia / Gender / Hydroxychloroquine / Lupus / Mental disorders / Metabolic disorders / Multivariate analysis / Neurological complications / Neuropsychology / Phospholipids / Problem solving / Psychology / Quality of life / Scientific Abstracts / Serology / Systemic lupus erythematosus