Avaliação cognitiva de pacientes com lúpus eritematoso sistêmico : um estudo transversal no Brasil

Abstract

Resumo: Problemas relacionados à cognição são frequentemente encontrados no Lúpus Eritematoso Sistêmico (LES) e contribuem para o prejuízo da qualidade de vida desses pacientes. O objetivo desse trabalho é avaliar o desempenho cognitivo em uma amostra de pacientes brasileiros diagnosticados com LES e possíveis associações dessa avaliação com dano cumulativo, atividade de doença, perfil clínico/sorológico e dose cumulativa de glicocorticoides. Cento e três pacientes com LES e 95 pacientes no grupo controle foram estudados quanto ao desempenho cognitivo por meio dos questionários MoCA (Montreal Cognitive Assessment) e Mini Mental State Examination (MMSE). Nos pacientes com LES a atividade de doença foi mensurada pelo Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) e o dano cumulativo de órgãos pelo Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SLICC/ACR/DI). A escala Center for Epidemiological Studies-Depression (CES-D) foi usada para a avaliação de depressão. Dados sobre o perfil clínico e sorológico, tratamento e dose cumulativa de glicocorticoides também foram coletados. Nessa amostra os pacientes com LES tiveram pior performance no MoCA (p=0.009) e no MMSE (p=0.01) quando comparado aos controles. Os resultados do MoCA mostraram que os domínios visuespacial e de abstração (p=0.03 e p=0.002 respectivamente) e os resultados do MMSE que a linguagem e orientação espacial estavam reduzidas (p=0.002 e p=0.001 respectivamente) quando comparadas aos controles. Ambos os questionários (MoCA com r=-0.29 e MMSE r=-0.21) se correlacionaram negativamente com o SLICC/ACR/DI e o MoCA com o SLEDAI (r=-0.22). Não foram encontradas associações com dose cumulativa de glicocorticoides, grau de depressão, perfil clínico/sorológico. Nessa pesquisa, os pacientes com LES apresentaram piores desempenhos no domínio visuespacial e abstração, quando avaliados pelo MoCA, e orientação espacial e linguagem, quando avaliados pelo MMSE, quando comparado aos controles. Um pior desempenho cognitivo estava correlacionado com dano cumulativo e atividade de doença.

Abstract: Problems related to cognition are frequently found in Systemic Lupus Erythematosus (SLE) and contribute to impairing the quality of life of these patients. The aim of this study is to evaluate cognitive performance in a sample of Brazilian patients diagnosed with SLE and possible associations of this assessment with cumulative damage, disease activity, clinical/serological profile and cumulative dose of glucocorticoids. One hundred and three patients with SLE and 95 patients in the control group were studied regarding their cognitive performance using the MoCA (Montreal Cognitive Assessment) and Mini Mental State Examination (MMSE) questionnaires. In patients with SLE, disease activity was measured by the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) and cumulative organ damage by the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (CLICC/ACR/DI). The Center for Epidemiological Studies-Depression (CES-D) scale was used to assess depression. Data on the clinical and serological profile, treatment and cumulative dose of glucocorticoids were also collected. In this sample, patients with SLE had worse performance in MoCA (p=0.009) and MMSE (p=0.01) when compared to controls. The MoCA results showed that the visual-spatial and abstraction domains (p=0.03 and p=0.002 respectively) and the MMSE results that language and spatial orientation were reduced (p=0.002 and p=0.001 respectively) when compared to controls. Both questionnaires (MoCA with r=-0.29 and MMSE r=- 0.21) were negatively correlated with the SLICC/ACR/DI and the MoCA with the SLEDAI (r=-0.22). No associations were found with cumulative dose of glucocorticoids, degree of depression, clinical/serological profile. In this research, patients with SLE had worse performances in the visuospatial domain and abstraction, when evaluated by the MoCA, and spatial orientation and language, when evaluated by the MMSE, when compared to controls. Worse cognitive performance was correlated with cumulative damage and disease activity.