Screening for cognitive dysfunction in systemic lupus erythematosus: the Montreal Cognitive Assessment Questionnaire and the Informant Questionnaire on Cognitive Decline in the Elderly
Restricted accessResearch articleFirst published online January, 2019
Screening for cognitive dysfunction in systemic lupus erythematosus: the Montreal Cognitive Assessment Questionnaire and the Informant Questionnaire on Cognitive Decline in the Elderly
Cognitive dysfunction (CD) is among the most common neuropsychiatric manifestations of systemic lupus erythematosus (SLE). Traditional neuropsychological testing and the Automated Neuropsychologic Assessment Metrics (ANAM) have been used to assess CD but neither is an ideal screening test. The Montreal Cognitive Assessment Questionnaire (MoCA) and the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) are brief and inexpensive tests. This study evaluated the MoCA and IQCODE as screening tools.
Methods
SLE patients fulfilling American College of Rheumatology (ACR) classification criteria were evaluated using the ANAM as the reference standard. The performance characteristics of the MoCA and IQCODE were assessed in comparison with normal controls (NCs) and rheumatoid arthritis (RA) patients. Four different definitions of CD were utilized.
Results
In total, 78 patients were evaluated. MoCA and ANAM scores were significantly correlated (r = 0.51, p < 0.001). At the optimal cutoff, the sensitivity of the MoCA was ≥ 90% (depending on definition of CD) vs RA patients and ≥83% vs NCs. ANAM and IQCODE scores did not correlate (p = 0.8152). IQCODE sensitivities were low for both RA patients and NCs regardless of definition and cutoff used.
Conclusion
The MoCA appears to be a promising and practical screening tool for identification of patients with SLE at risk for CD.
HanlyJGFiskJDSherwoodG, et al.Cognitive impairment in patients with systemic lupus erythematosus. J Rheumatol1992; 19: 562–567.
2.
BreyRLHollidaySLSakladAR, et al.Neuropsychiatric syndromes in lupus: prevalence using standardized definitions. Neurology2002; 58: 1214–1220.
3.
AinialaHLoukkolaJPeltolaJ, et al.The prevalence of neuropsychiatric syndromes in systemic lupus erythematosus. Neurology2001; 57: 496–500.
4.
UntermanANolteJEBoazM, et al.Neuropsychiatric syndromes in systemic lupus erythematosus: a meta-analysis. Semin Arthritis Rheum2011; 41: 1–11.
5.
The American College of Rheumatology nomenclature and case definitions for neuropsychiatric lupus syndromes. Arthritis Rheum 1999; 42: 599–608.
6.
ReevesDLWinterKPBleibergJ, et al.ANAM genogram: historical perspectives, description, and current endeavors. Arch Clin Neuropsychol2007; 22(Suppl 1): S15–37.
7.
HanlyJGOmisadeASuL, et al.Assessment of cognitive function in systemic lupus erythematosus, rheumatoid arthritis, and multiple sclerosis by computerized neuropsychological tests. Arthritis Rheum2010; 62: 1478–1486.
8.
HollidaySLNavarreteMGHermosillo-RomoD, et al.Validating a computerized neuropsychological test battery for mixed ethnic lupus patients. Lupus2003; 12: 697–703.
9.
PetriMNaqibuddinMCarsonKA, et al.Cognitive function in a systemic lupus erythematosus inception cohort. J Rheumatol2008; 35: 1776–1781.
10.
BrunnerHIKlein-GitelmanMSZelkoF, et al.Validation of the Pediatric Automated Neuropsychological Assessment Metrics in childhood-onset systemic lupus erythematosus. Arthritis Care Res2013; 65: 372–381.
11.
BrunnerHIRuthNMGermanA, et al.Initial validation of the Pediatric Automated Neuropsychological Assessment Metrics for childhood-onset systemic lupus erythematosus. Arthritis Rheum2007; 57: 1174–1182.
12.
Vega-FernandezPVanderburgh WhiteSZelkoF, et al.Cognitive performance scores for the pediatric automated neuropsychological assessment metrics in childhood-onset systemic lupus erythematosus. Arthritis Care Res2015; 67: 1119–1127.
13.
NasreddineZSPhillipsNABedirianV, et al.The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment. J Am Geriatr Soc2005; 53: 695–699.
14.
LuisCAKeeganAPMullanM. Cross validation of the Montreal Cognitive Assessment in community dwelling older adults residing in the Southeastern US. Int J Geriatr Psychiatry2009; 24: 197–201.
15.
SmithTGildehNHolmesC. The Montreal Cognitive Assessment: validity and utility in a memory clinic setting. Can J Psychiatry2007; 52: 329–332.
16.
Dalrymple-AlfordJCMacAskillMRNakasCT, et al.The MoCA: well-suited screen for cognitive impairment in Parkinson disease. Neurology2010; 75: 1717–1725.
17.
MickesLJacobsonMPeavyG, et al.A comparison of two brief screening measures of cognitive impairment in Huntington’s disease. Mov Disord2010; 25: 2229–2233.
18.
DongYSharmaVKChanBP, et al.The Montreal Cognitive Assessment (MoCA) is superior to the Mini-Mental State Examination (MMSE) for the detection of vascular cognitive impairment after acute stroke. J Neurol Sci2010; 299: 15–18.
19.
CopersinoMLFals-StewartWFitzmauriceG, et al.Rapid cognitive screening of patients with substance use disorders. Exp Clin Psychopharmacol2009; 17: 337–344.
20.
AdhikariTPiattiALuggenM. Cognitive dysfunction in SLE: development of a screening tool. Lupus2011; 20: 1142–1146.
21.
NantesSGSuJDhaliwalA, et al.Performance of screening tests for cognitive impairment in systemic lupus erythematosus. J Rheumatol2017; 44: 1583–1589.
22.
JormAFJacombPA. The Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE): socio-demographic correlates, reliability, validity and some norms. Psychol Med1989; 19: 1015–1022.
23.
JormAF. The Informant Questionnaire on cognitive decline in the elderly (IQCODE): a review. Int Psychogeriatr2004; 16: 275–293.
24.
JormAFScottRCullenJS, et al.Performance of the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) as a screening test for dementia. Psychol Med1991; 21: 785–790.
25.
JormAF. A short form of the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE): development and cross-validation. Psychol Med1994; 24: 145–153.
26.
HochbergMC. Updating the American College of Rheumatology revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum1997; 40: 1725–1725.
GladmanDGinzlerEGoldsmithC, et al.The development and initial validation of the Systemic Lupus International Collaborating Clinics/American College of Rheumatology damage index for systemic lupus erythematosus. Arthritis Rheum1996; 39: 363–369.
29.
BeckATWardCHMendelsonM, et al.An inventory for measuring depression. Arch Gen Psychiatry1961; 4: 561–571.
30.
HarrisonJKFearonPNoel-StorrAH, et al.Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) for the diagnosis of dementia within a general practice (primary care) setting. The Cochrane Database Syst Rev2014, pp. CD010771–CD010771.
31.
TamLSWongAMokVC, et al.The relationship between neuropsychiatric, clinical, and laboratory variables and quality of life of Chinese patients with systemic lupus erythematosus. J Rheumatol2008; 35: 1038–1045.
32.
AppenzellerSCendesFCostallatLT. Cognitive impairment and employment status in systemic lupus erythematosus: a prospective longitudinal study. Arthritis Rheum2009; 61: 680–687.
33.
PanopalisPJulianLYazdanyJ, et al.Impact of memory impairment on employment status in persons with systemic lupus erythematosus. Arthritis Rheum2007; 57: 1453–1460.
34.
GlanzBISlonimDUrowitzMB, et al.Pattern of neuropsychologic dysfunction in inactive systemic lupus erythematosus. Neuropsychiatry Neuropsychol Behav Neurol1997; 10: 232–238.
35.
EmoriAMatsushimaEAiharaO, et al.Cognitive dysfunction in systemic lupus erythematosus. Psychiatry Clin Neurosci2005; 59: 584–589.
36.
SkeelRLJohnstoneBYangcoDT Jr, et al.Neuropsychological deficit profiles in systemic lupus erythematosus. Appl Neuropsychol2000; 7: 96–101.
37.
MonasteroRBettiniPDel ZottoE, et al.Prevalence and pattern of cognitive impairment in systemic lupus erythematosus patients with and without overt neuropsychiatric manifestations. J Neurol Sci2001; 184: 33–39.
38.
ManeetonBManeetonNLouthrenooW. Cognitive deficit in patients with systemic lupus erythematosus. Asian Pac J Allergy Immunol2010; 28: 77–83.
39.
GinsburgKSWrightEALarsonMG, et al.A controlled study of the prevalence of cognitive dysfunction in randomly selected patients with systemic lupus erythematosus. Arthritis Rheum1992; 35: 776–782.
