Detailled Information

Ad Hoc Committee on Lupus Response Criteria: Cognition Sub-committee, Mikdashi JA, Esdaile JM, Alarcón GS, Crofford L, Fessler BJ, Shanberg L, Brunner H, Gall V, Kalden JR, Lockshin MD, Liang MH, Roberts N Jr, Schneider M. Proposed response criteria for neurocognitive impairment in systemic lupus erythematosus clinical trials. Lupus. 2007;16(6):418-25.

Reliability and validity of the proposed American College of Rheumatology neuropsychological battery for systemic lupus erythematosus

Validity Evidence for the Use of Automated Neuropsychologic Assessment Metrics As a Screening Tool for Cognitive Impairment in Systemic Lupus Erythematosus

Measures of Cognition in Rheumatic Diseases

The ACR-NB measures cognitive deficits in adult patients with SLE and assesses changes over time.

The ACR-NB consists of 10 neuropsychological tests, as reported by the Ad Hoc Committee on Lupus Response Criteria: Cognition Sub-committee in 2007. The National Adult Reading Test (NART) is used to estimate the intelligence quotient. The Revised Wechsler Adult Intelligence Scale (WAIS-R) Digit Symbol Substitution Test measures associative learning, motor speed, attention, and visuoperceptual functions. The Trail Making Test Part B measures executive function, flexibility, and visuomotor skills. The Stroop Color and Word Test measures cognitive flexibility and interference. The California Verbal Learning Test (CVLT) measures verbal learning and memory. The Rey-Osterrieth Complex Figure Test (RCFT) measures visuospatial ability and visuospatial memory. The WAIS, third edition, (WAIS-III) letter number sequencing measures verbal working memory. The COWAT measures letter fluency, and the Animal Naming Test measures category fluency. The Finger Tapping Test measures simple fine motor speed. Overall, the cognitive domains covered in the battery include manual motor speed, attention, processing speed, language processing, learning and memory (visuospatial and verbal), and executive functioning, which have been shown to be affected in SLE. Some domains include multiple neuropsychological tests that measure the particular cognitive function.

Raw scores are recorded for all tests. Depending on the test manual, they may be converted to Z or T scores for comparison with normative data stratified by age and sex.

Once scores have been recorded and converted to either Z or T scores, they are compared with published normative data appropriate for age, education, sex, and ethnic group or with control subjects. The ACR committee reported the following scoring system to correspond with the ACR-NB: Scores of 2 or more SDs below the estimated population mean in domains of attention, memory, and psychomotor speed are interpreted as CI. Scores of 1.5 to 1.9 SDs below the mean are deemed cognitive decline. Focal impairment was defined as one or more tests within one domain affected, and multifocal impairment was defined as two or more domains affected. However, the definition of CI varies and is not standardized in all studies. In RA, impairment was defined as a score of 1 SD below age-stratified population norms for each cognitive test. A total cognitive function score (a summation of all test scores indicating impairment) of 4 or more indicated CI. Another study in SLE defined CI as a Z score of −1.5 or less in two or more domains, defined cognitively normal as Z scores in all domains greater than −1.5, and defined indeterminate as a Z score of −1.5 or less in only one domain

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