Intraindividual Change in Cognitive Function Among Adults With Systemic Lupus Erythematosus: A Markov Analysis Over 7 Years

Abstract

Objective

Cognitive impairment is prevalent in systemic lupus erythematosus (SLE). There remain gaps in understanding cognition and SLE longitudinally. We studied intraindividual change in cognition in SLE over time.

Methods

Data were from the University of California, San Francisco Lupus Outcome Study, which included 1281 adults with SLE. The Hopkins Verbal Learning Test‐Revised (HVLT‐R) and the Controlled Oral Word Association Test (COWAT) were administered annually over 7 years. A two‐state Markov analysis was used to model transition intensities for probabilities of change in cognition. Logistic regression examined the association between clinical variables and cognitive change.

Results

Minimal transition between cognitive states was observed in the Markov analysis. Using the COWAT, higher levels of self‐reported depression were associated with decreased likelihood of cognitive improvement (Relative Risk [RR]: 0.98; 95% confidence interval [CI]: 0.96‐0.99), and higher self‐reported disease severity was associated with cognitive decline (RR: 1.05; 95% CI: 1.02‐1.09). Using the HVLT‐R, increasing age (RR: 1.02; 95% CI: 1.01‐1.03) and higher education level (RR: 1.82; 95% CI: 1.28‐2.58) were associated with cognitive improvement, and higher self‐reported disease severity (RR: 1.02; 95% CI: 1.01‐1.03) and depression (RR: 1.05; 95% CI: 1.03‐1.07) were associated with cognitive decline.

Conclusion

Most individuals with SLE did not transition between states of high (Z score ≥ −1.5) or low (Z score < −1.5) cognition in a Markov analysis over a 7‐year assessment period, highlighting a degree of relative stability in cognition over time. Increasing age and higher education levels were associated with greater likelihood of cognitive improvement. Greater self‐reported SLE disease severity and depression were associated with cognitive decline.