Disfunção cognitiva no Lúpus Eritematoso Sistémico

• Autor(a) principal: Ricardo da Silva Vila Real
• Data de Publicação: 2021
• Tipo de documento: Dissertação
• Idioma: por
• Título da fonte: Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
• Texto Completo: https://hdl.handle.net/10216/134538
• topic: Ciências médicas e da saúde; Medical and Health sciences

Objective: The aim of this review is to describe, based on the latest literature, the main characteristics, etiology, diagnosis and treatment of cognitive dysfunction (CD) in Systemic Lupus Erythemathosus (SLE), as well as the peculiarities related to the pediatric population. Material and methods: The following terms were used to research the articles in PubMed: ("Systemic Lupus Erythematosus" OR "Juvenile Systemic Lupus Erythematosus") AND ("Cognitive disfunction" OR "Cognitive decline"). Only the articles written in English or Portuguese and published after 2016 were selected. Those articles in which the main focus was not CD and isolated clinical cases were excluded. Subsequently, articles of interest mentioned in the references of previously selected articles were also included, resulting in a total of 135 studies analyzed. Results: Frequently reported in literature as the most frequent neuropsychiatric manifestation (NPM) in SLE, CD has a multifactorial etiology, being influenced by biological, psychological and social factors. The pathophysiology is still not well understood, although it is hypothesized that ischemic and inflammatory mechanisms are possible causal factors. The distinction between CD in a context of Neuropsychiatric SLE (NPSLE) or secondary to other conditions constitutes a huge diagnostic challenge. CD must be investigated from an early stage of the disease, although no effective and reproducible screening method has been validated in SLE. MoCA (Montreal Cognitive Assessment) was the one who demonstrated a higher degree of reliability, while in the pediatric population the Ped-ANAM (Pediatric Automated Neuropsychological Assessment Metric) is in preliminary validation. Treatment is essentially supportive, centered on the correction of exacerbating causes such as depression and anxiety. Conclusions: Despite being seen as a minor NPM and having an usual subtle presentation, CD has a significant impact on the quality of life of patients with SLE. Thus, increased research efforts should be encouraged in an attempt to find possible biomarkers that make the diagnosis more specific and that can possibly be used as targets for the development of future therapeutic interventions.