Background: The evaluation of cognitive deficits in patients affected by systemic lupus erythematosus (SLE) is often difficult due to the long time required for neuropsychological testing. The ACR Commitee proposed a 1-hour battery that has recently been applied in 53 lupic patients and compared to a comprehensive battery (1) but the normative italian population data do not exist for all the tests included in the brief battery proposed by the ACR Committee. Objectives: To determine the agreement between a 3-hours comprehensive battery (CB) and a 1-hour battery in the evaluation of cognitive impairment in Italian SLE patients. Methods: 52 unselected SLE patients and 20 rheumatoid arthritis (RA) controls underwent a 3- hours battery of neuropsychological tests (CB) sampling 15 cognitive functions (F) grouped into the 8 cognitive domains (D) defined by ACR Committee (2). The battery included 13 tests, from which 26 raw scores were derived and converted into z-scores and percentile scores using normative italian population data. The z-scores were grouped into 15 different summary scores, each one depicting a different F. Among the test of the CB, 8 tests, lasting 1 hour, were selected for the brief battery (BB) and the corrispondent 18 raw and z-scores were grouped into 14 summary scores, using the same method of the CB; the 14 summary scores evaluated all the same functions considered in the CB other than reasoning processes. The evaluation of the scores of the BB was performed by the same neuropsychologist, blind to the identity of the patients. Five tests of the BB and of the CB belong to the ACR 1–hour battery. The agreement for presence and severity of impairment (n° of functions impaired) on the CB and on the BB was evaluated with K measure of concordance (95% CI). Results: 31 of the 52 SLE patients (59.6%) versus 5 of 20 RA controls (25%) were impaired in at least 1 F with the CB (p= 0.017, OR=4.43, CI 1.4-14) while 33 SLE patients (63.5%) and 7 RA pts (35%) resulted impaired in at least 1 F with the BB. Any patient had deficits in the reasoning processes at the CB. Considering a cut-off of >2 F impaired for the definition of impairment, 20 SLE (38%) versus 0 RA patients resulted impaired both at the CB and at the BB. Agreement between the CB and the BB in detecting the presence of impairment was found in 50 SLE patients (96%, K measure of concordance 0.92, p<0.00001) and in 18 RA patients (90%, K measure 0.76, p=0.0004). Agreement between the CB and BB regarding severity of impairment was present in 42 SLE patients (80.8%, K measure 0.62, p<0.00001) and in 18 RA patients (90%, K measure 0.76, p=0.0004). Conclusion: Our 1-hour battery of neuropsychological tests might be a valid, reliable and less time-expensive instrument to establish the presence of cognitive impairment in italian SLE patients since normative italian data are not available for all the tests included in the 1-hour proposed ACR battery. The agreement regarding severity of cognitive impairment between the CB and BB is moderate, therefore a comprehensive battery should be applied once cognitive impairment has been identified through a brief battery.
A brief battery for the evaluation of cognitive deficits in italian SLE patients
Gremese E;
2005-01-01
Abstract
Background: The evaluation of cognitive deficits in patients affected by systemic lupus erythematosus (SLE) is often difficult due to the long time required for neuropsychological testing. The ACR Commitee proposed a 1-hour battery that has recently been applied in 53 lupic patients and compared to a comprehensive battery (1) but the normative italian population data do not exist for all the tests included in the brief battery proposed by the ACR Committee. Objectives: To determine the agreement between a 3-hours comprehensive battery (CB) and a 1-hour battery in the evaluation of cognitive impairment in Italian SLE patients. Methods: 52 unselected SLE patients and 20 rheumatoid arthritis (RA) controls underwent a 3- hours battery of neuropsychological tests (CB) sampling 15 cognitive functions (F) grouped into the 8 cognitive domains (D) defined by ACR Committee (2). The battery included 13 tests, from which 26 raw scores were derived and converted into z-scores and percentile scores using normative italian population data. The z-scores were grouped into 15 different summary scores, each one depicting a different F. Among the test of the CB, 8 tests, lasting 1 hour, were selected for the brief battery (BB) and the corrispondent 18 raw and z-scores were grouped into 14 summary scores, using the same method of the CB; the 14 summary scores evaluated all the same functions considered in the CB other than reasoning processes. The evaluation of the scores of the BB was performed by the same neuropsychologist, blind to the identity of the patients. Five tests of the BB and of the CB belong to the ACR 1–hour battery. The agreement for presence and severity of impairment (n° of functions impaired) on the CB and on the BB was evaluated with K measure of concordance (95% CI). Results: 31 of the 52 SLE patients (59.6%) versus 5 of 20 RA controls (25%) were impaired in at least 1 F with the CB (p= 0.017, OR=4.43, CI 1.4-14) while 33 SLE patients (63.5%) and 7 RA pts (35%) resulted impaired in at least 1 F with the BB. Any patient had deficits in the reasoning processes at the CB. Considering a cut-off of >2 F impaired for the definition of impairment, 20 SLE (38%) versus 0 RA patients resulted impaired both at the CB and at the BB. Agreement between the CB and the BB in detecting the presence of impairment was found in 50 SLE patients (96%, K measure of concordance 0.92, p<0.00001) and in 18 RA patients (90%, K measure 0.76, p=0.0004). Agreement between the CB and BB regarding severity of impairment was present in 42 SLE patients (80.8%, K measure 0.62, p<0.00001) and in 18 RA patients (90%, K measure 0.76, p=0.0004). Conclusion: Our 1-hour battery of neuropsychological tests might be a valid, reliable and less time-expensive instrument to establish the presence of cognitive impairment in italian SLE patients since normative italian data are not available for all the tests included in the 1-hour proposed ACR battery. The agreement regarding severity of cognitive impairment between the CB and BB is moderate, therefore a comprehensive battery should be applied once cognitive impairment has been identified through a brief battery.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
