Researchers at the Schroeder Arthritis Institute have validated a screening tool that could streamline the diagnosis of cognitive impairment in individuals with lupus.
Individuals with lupus commonly experience cognitive impairment—often known as brain fog or lupus fog—but it is rarely diagnosed because screening for this symptom is time-consuming and costly.
The standard test for cognitive impairment in lupus is the American College of Rheumatology Neuropsychological Battery (ACR-NB). This one-hour test is costly because it requires trained personnel to administer and score.
“Screening for cognitive impairment in lupus is often delayed or entirely lacking,” explains Dr. Zahi Touma, a Scientist at the Schroeder Arthritis Institute and senior author of the study. “We need tests that can quickly and accurately assess cognitive function in the clinic, and tools to help clinicians interpret the results of these tests.”
Dr. Touma’s team examined the effectiveness of an alternative to the ACR-NB, called the Automated Neuropsychological Assessment Metrics (ANAM). ANAM is a collection of computer-based tests that assess a wide range of cognitive functions, including attention, reaction time, processing speed and decision making.
The research team administered the ANAM test to 300 adults with systemic lupus erythematosus (SLE), and compared the results with those obtained using the ACR-NB. The ANAM accurately identified cognitive impairment in over 90% of cases that were previously identified using the ACR-NB, suggesting that clinicians can use it as a screening tool for patients with SLE.
The researchers also identified the eight ANAM subtests that are most useful for identifying cognitive impairment, including tests for attention, language processing, and learning and memory. Focusing on only this subset of tests reduced the total test time from 40 minutes to as little as 15 minutes.
To complement the shortened ANAM, the team developed a decision tree—a tool that clinicians can use to easily interpret test results. Using this tool, a clinician can answer a series of simple yes or no questions related to a patient’s ANAM scores and age to determine whether this patient has cognitive impairment.
“Our decision tree makes it easy for clinicians to interpret test results, which enables faster screening,” says Kimberley Yuen, a summer student in Dr. Touma’s lab and the first author of the study. “The faster clinicians can detect cognitive impairment, the faster they can intervene to help their patients.”
An important next step for the researchers is to determine the effectiveness of the ANAM and decision tree in patients who have arthritis, joint stiffness or reduced sensation in their hands—common symptoms of lupus. For these patients, scores on ANAM tests that involve hand movements, such as finger tapping, may be influenced by motor impairments and would be less useful for detecting cognitive changes.
This work was supported by the Arthritis Society, the Canadian Rheumatology Association, the Canadian Institutes of Health Research, Physician’s Services Incorporated, the Province of Ontario Early Research Award, the Lupus Research Alliance and the UHN Foundation. Dr. Touma’s laboratory is supported by donations from the Kathi and Peter Kaiser family, the Lou and Marissa Rocca family, and the Bozzo family.
Yuen K, Beaton D, Bingham K, Katz P, Su J, Diaz Martinez JP, Tartaglia MC, Ruttan L, Wither JE, Kakvan M, Anderson N, Bonilla D, Choi MY, Fritzler MJ, Green R, Touma Z. Validation of the automated neuropsychological assessment metrics for assessing cognitive impairment in systemic lupus erythematosus. Lupus. 2022 Jan. doi: 10.1177/09612033211062530.
Dr. Zahi Touma (L) is a Scientist at the Schroeder Arthritis Institute, an Associate Professor in the Department of Medicine at the University of Toronto, and a Staff Rheumatologist at the Toronto Western Hospital and Mount Sinai Hospital. Kimberley Yuen (R) is a medical student at Queen’s University and has been a summer research student in Dr. Touma’s lab for the past two years.