This blog was originally posted on Micha Abeles' website here.
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Certain autoimmune diseases like Lupus may also be linked to dementia. The condition, which tends to occur more frequently in women and is infamous for its detrimental impacts on joints and the skin, can impact organ systems throughout the body. A study by Daniela Amital is discussed in the International Journal of Geriatric Psychiatry.
Lupus, short for Systemic Lupus Erythematosus, is an autoimmune disease where the body’s immune system mistakenly attacks healthy tissue. As for Dementia, it is a cognitive process that can entail severe dysfunction (i.e., challenges in completing simple tasks, memory deficiencies, impaired decision-making), is attributed to a range of potential etiologies.
The journal article notes that 4,886 patients with SLE were assessed through an analysis of their healthcare records. This group was compared to patients without Lupus, and researchers sought to determine whether there was a noticeable difference in the incidence of dementia. The strength of the association was significant, as they found SLE patients were 51% more likely to develop dementia (and of course, association and cause may match up, but further research is needed before the two can be tied together definitively).
In addition to this recent study, quite a bit of research literature is available regarding the neurologic and psychiatric sequelae (effects) of Lupus on patients. Some studies have explored the role of high dose corticosteroids on cognition. These powerful drugs have been effective in SLE treatment regimens, but their side effects are intense as well. If a patient has coexisting depression, Pseudodementia may take hold. Physicians typically differentiate this by working on treating mood symptoms. If depression treatment fails to lead to improved cognitive function, further exploration of other causes may be warranted.
One small RCT trial demonstrated improved cognition in SLE patients who used low doses of Prednisone. Thus, some physicians have suggested that Prednisone may harbor utility as an intervention for Lupus-associated dementia. However, any such decisions are made on a patient by patient basis according to the expertise of clinicians. Rheumatologists who excel in treating autoimmune conditions are particularly well-suited for the job. Interestingly, the study mentioned above led by Amital concluded that the search for SLE is appropriate in patients whose dementia presents earlier than expected. While Alzheimer’s tends to emerge later on in life, SLE may be a relevant factor in the early cognitive decline.
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