Cognitive function impairment in patients with antiphospholipid syndrome: Association with clinical, laboratory and brain magnetic resonance imaging findings

Abstract

Background

Cognitive dysfunction is frequent in patients with antiphospholipid syndrome (APS) although not included in the classification criteria.

Aim of the work

To assess the cognitive function in APS patients and to study any relation to clinical, laboratory and brain magnetic resonance imaging (MRI) findings.

Patients and methods

This study was conducted on 113 patients: 30 with primary APS, 44 secondary APS and 39 systemic lupus erythematosus (SLE) patients without APS. Cognitive function was assessed using Mini-Mental State Examination (MMSE) and Montreal cognitive assessment-Basic (MOCA-B). APS clinical manifestations, disease damage indices, APS immunological profile and MRI abnormalities were recorded.

Results

Of the 74 APS patients, 70 (94.6 %) were females. Their mean age was 32.3 ± 8 years and mean disease duration was 9.4 ± 5.9 years. Cognitive impairment was significantly higher in APS patients (n = 44, 59.9 %) than in SLE patients without APS (n = 2, 5.1 %) when assessed by MOCA-B (p < 0.001). There was no significant difference between primary and secondary APS subtypes as regards cognitive impairment assessed by MMSE (0 vs 3) and MOCA-B (17 vs 27p = 0.81). The presence of cognitive impairment was associated with neuropsychiatric manifestations (p < 0.0001); seizures (p = 0.01), TIAs (p = 0.04), migraine/headache (p = 0.03), ACL (p = 0.02), anti-β2GP (p < 0.001), triple positivity of APL (p = 0.002), abnormal brain MRI (p = 0.002) and brain infarcts. A significant negative correlation was found between MOCA-B and cumulative damage of APS (r = 0.5, p < 0.001).

Conclusion

Cognitive impairment was detected in APS patients especially those with neuropsychiatric manifestations, positive ACL, anti- β2GP and triple positivity of APL or abnormal brain MRI.