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Cognitive dysfunction and associated neuroimaging biomarkers in antiphospholipid syndrome: a systematic review

Donnellan, C; Cohen, H; Werring, DJ; (2022) Cognitive dysfunction and associated neuroimaging biomarkers in antiphospholipid syndrome: a systematic review. Rheumatology , 61 (1) pp. 24-41. 10.1093/rheumatology/keab452. Green open access

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Abstract

OBJECTIVES: Cognitive dysfunction is common in patients with antiphospholipid antibodies (aPL) (including primary antiphospholipid syndrome (APS) or APS associated with systemic lupus erythematosus (SLE)). Neuroimaging biomarkers may contribute to our understanding of mechanisms of cognitive dysfunction in these cohorts. This review aimed to investigate: (1) the prevalence of cognitive dysfunction in studies including neuroimaging biomarkers; and (2) associations between cognition and neuroimaging biomarkers in patients with APS/aPL. METHODS: We conducted a systematic search of electronic databases PubMed, Science Direct, Scopus and PsycINFO and included studies with descriptions of neuroimaging findings, cognitive dysfunction, or both, in patients with aPL positivity (lupus anticoagulant, IgG and IgM anticardiolipin and anti-β2 glycoprotein-I antibodies). RESULTS: Of 120 search results we included 20 eligible studies (6 APS, 4 SLE with APS/aPL and 10 neuropsychiatric SLE (NPSLE)). We identified a medium risk of bias in 6/11 (54%) of cohort studies and 44% of case-control studies, as well as marked heterogeneity in cognitive assessment batteries, APS and aPL definitions and neuroimaging modalities and protocols. The prevalence of cognitive dysfunction ranged between 11% and 60.5%. Structural MRI was the most common imaging modality, reporting cognitive dysfunction to be associated with white matter hyperintensities, ischaemic lesions and cortical atrophy (4 with cerebral atrophy, 2 with white matter hyperintensities, and 2 with cerebral infarcts). CONCLUSION: Our findings confirm that cognitive impairment is commonly found in patients with aPL (including APS, SLE and NPSLE). The risk of bias, and heterogeneity in cognitive and neuroimaging biomarkers reported does not allow for definitive.

Type: Article
Title: Cognitive dysfunction and associated neuroimaging biomarkers in antiphospholipid syndrome: a systematic review
Location: England
Open access status: An open access version is available from UCL Discovery
DOI: 10.1093/rheumatology/keab452
Publisher version: http://dx.doi.org/10.1093/rheumatology/keab452
Language: English
Additional information: Copyright © The Author(s) 2021. Published by Oxford University Press on behalf of the British Society for Rheumatology. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (https://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com.
Keywords: Antiphospholipid syndrome, antiphospholipid antibodies, assessment, cognitive dysfunction, neuroimaging biomarkers
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > UCL Queen Square Institute of Neurology
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > UCL Queen Square Institute of Neurology > Brain Repair and Rehabilitation
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Cancer Institute
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Cancer Institute > Research Department of Haematology
URI: https://discovery.ucl.ac.uk/id/eprint/10129400
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