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Does Lupus Cause Memory Loss

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How Is Lupus Brain Involvement Diagnosed

Living with Lupus: Lupus and the Brain

A doctor can do a physical examination, test blood and spinal fluid, or take imaging tests or electrical studies of the brain. These sometimes help in figuring out what is going on. But a diagnosis often is difficult to make because infection and side effects from medicines can lead to the same signs and symptoms as active brain lupus, and no single test can show without question that lupus is the cause.

Mental Health Problems And Seizures

A study from the Canadian Institute of Health Research found that the prevalence of mental health issues in those with lupus has significant implications for future medical research and individual management of the condition. Many of these neurological diseases occur before the diagnosis of lupus. The results of the study could mean that some cognitive disorders may create ideal chemical conditions for lupus to develop, or that individuals who have lupus are also affected by some mental health conditions more frequently, either before, or after diagnosis. The most prevalent neurological conditions within those with lupus are headaches, mood disorders, and anxiety or depression. Seizures also occur in between five to ten percent of patients with lupus at some point in their lifetime. Seizures are one of the eleven criteria used to diagnose lupus.

Media Release: Dalhousie Researchers Discover That Brain Fog Memory Loss In Lupus Patients May Be Linked To Leaky Blood Vessels

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For the millions of people who suffer from lupus, a devastating complication of the disease can be the loss of certain cognitive functions, such as memory and the ability to concentrate.

It has long been known that lupus is a disease in which the;body’s immune system attacks its own organs. But, scientists studying lupus have struggled to understand why roughly 40 per cent of patients experience;confusion, fatigue and difficulty expressing their thoughts — a collection of symptoms known as cognitive dysfunction or lupus fog.

Now, researchers at Dalhousie University have used;a new brain imaging technique to uncover;a possible explanation which involves the blood-brain barrier –;the lining of the brains blood vessels that blocks harmful substances from entering the brain. When that barrier leaks, foreign molecules can seep from the blood vessels into the brain and trigger inflammation that can undermine brain function.

The researchers have found that;lupus patients with leaky blood vessels in the brain were twice as likely to have impaired cognitive function, compared to patients with non-leaky blood vessels.

These findings are an important step forward, says study lead author Lyna Kamintsky,;a;PhD student in the Department of Medical Neuroscience at Dal. Usually when people think of cognitive difficulties, they imagine an issue with the brains most famous cells the neurons.

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How Do We Hear

Hearing is a surprisingly complicated process.;

First, sound starts as a vibration in the air. This vibration, which takes the form of a sound wave travels are caught by the outer ear. This ear is cupped to direct the sound wave into the narrow passageway in our head called the ear canal.;

The ear canal leads to the eardrum which is a membrane that vibrates. At this point, the sound waves need to be amplified. This is performed by the three smallest bones in the body, named for the shapes they resemble:

  • The malleus
  • The incus
  • The stapes
  • These amplifications travel to the cochlea, a snail-like, fluid-filled structure. Fluid carries sound and vibrations better than air. This fluid ripples along a membrane that runs through the whole organ, called the basilar membrane. Cells called hair cells are located on this membrane, and are named for the tiny hair-like cilia that react to these ripples.

    Much like whiskers, hair cells are attached to a neuron. When they react, they send neural impulses to the brain through a bundle of nerves called the auditory nerve.;

    The brain processes these impulses into what we recognize as sound and puts the sound together with other sensory input and information to interpret sound.;Quite the process!

    Analysis Of Effect Size Across Cognitive Domains In Sle

    Lupus and Memory Loss: Survival Tips for Dealing With ...

    We now turn our attention to the concept of effect size across five general cognitive domains. Our emphasis is on the Cohen D statistic , an easily understood statistic that represents the difference between SLE and control means, divided by the pooled SD. The literature provides too few studies to support a formal meta-analysis. Nevertheless, examining effects across the available studies may shed light on the degree and quality of cognitive impairment in SLE, and permit gross comparison with MS. To be included in this section, studies must have met three criteria: SLE sample n⥠20; healthy control group with n⥠10 and matched on demographics or with statistical control for the same; and reproducible testing procedure, if not a standardized test battery the experimental tasks are clearly described so that the study could be replicated. Studies were included regardless of whether the patients were described as NP-SLE, CNS-SLE, or non-CNS-SLE. However, studies using NP- or CNS-SLE patients were only considered if overt neurological involvement such as focal neurological syndromes caused by stroke or other focal brain injury were excluded. A surprisingly few number of studies met these standards for inclusion.

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    How Does Lupus Contribute To Hearing Loss

    Vasculitis is the blockage or stiffening of blood vessels in the body. It can be caused by autoimmune damage or a build-up of immune cells and immune cell residues in the circulatory system.

    Vasculitis can cause hearing loss by:

    • blocking oxygen flow to hair cells and auditory nerve
    • fatiguing the body and brain
    • through small strokes

    SLE is known to cause vasculitis and increase the risks of heart disease and stroke, making hearing loss a secondary symptom for some patients.;It can also be a combination of damage to ear structures and vasculitis, and SLE damage to the neurons of the ear and the brain.;

    Cerebral Pathology In Sle

    In autoimmune disease, immune cells act on the self tissues as if they were foreign, thereby causing injury to multiple organ systems . In some ways, SLE is a model autoimmune disease in that both cellular and humoral reactivity to multiple soft-tissues can potentially injure every organ in the body .

    The mental status of SLE patients can be temporarily affected by multiple, transient metabolic and systemic processes . For example, pleocytosis can develop within the CSF leading to low grade encephalopathy or subacute confusional state . Meningeal inflammation may occur in up to 20% of SLE patients . Increased intracranial pressure can arise from a hypercoagulability state or thrombosis within the cerebral venous system . Psychosis is well known in SLE and can indirectly influence cognitive performance . While these and other transient or fluctuating processes are clinically important, it is the underlying cerebral disease which is of most relevance for the neuropsychology researcher.

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    Cognitive Disorder In Sle

    Impaired cognitive capacity has been reported in a large number of SLE studies using a variety of selection criteria and neuropsychological testing methods. The incidence of cognitive impairment has varied widely across studies, by as much as 21â80% , due to variation in testing methods, lack of proper control groups, differences in sample composition, and most important, variation in thresholds for positive tests. The lack of specificity in some of these studies is concerning. For example, in one study the frequency of cognitive impairment in SLE was 43%, but using the same criteria resulted in a false positive rate among healthy controls of 19% . Nevertheless, there is now agreement that a significant proportion of SLE patients are cognitively impaired, even in the absence of recent disease activity and overt neurologic or psychiatric signs of CNS involvement . The more recent opinions on the frequency of cognitive impairment in non-NP-SLE or NP-SLE who are free of acute illness range from 25â35% . As would be expected, most studies conclude that neuropsychological impairment is more prominent in NP- or CNS-SLE .

    What Are The Risks For Developing Lupus Fog

    Memory Problems in Lupus and What to do about them

    To date, researchers have not studied the risk of developing lupus fog. However, several studies have looked at the risk for developing dementia in people with lupus. Dementia is a much more serious phenomenon than lupus fog. These studies agree that the risk for dementia in SLE patients is 1.5 to 2 times that of the risk in normal people. However, the absolute risk is only about 3% overall quite a small risk.

    The differences in cognitive dysfunction among those with lupus versus those without it are often due to several factors. The stage of the disease, differences in the diagnoses made by physicians, and the differences among populations in a particular study can all influence the research study results .

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    Urine Changes And Kidney Disease

    Urine abnormalities, such as high levels of protein in the urine, can indicate that lupus has affected the kidneys. Some people develop lupus nephritis, an inflammation of the kidneys that can cause them to leak protein and blood cells into urine. Left untreated, this can lead to kidney failure.

    Symptoms of kidney disease also often include swelling of the ankles, feet, legs, and, less commonly, the face or hands, as well as puffy eyes upon waking. Dark-colored and foamy urine, high blood pressure, and weight gain may also appear. After speaking with you about your symptoms, including those you may have had in the past or that come and go, your NYU Langone rheumatologist orders a series of diagnostic tests.

    Dementia Tied To Most Common Form Of Lupus Study Finds

    While an association was found between dementia and the most common form of lupus, links to other autoimmune diseasesrheumatic arthritis, Sjögrens syndrome, and Behcets diseasewere not found.

    A new study has found a significant association between dementia and the most common form of lupus, and that patients with the autoimmune disease are at high risk for early vascular dementia and should be screened to prevent occurrence.

    Researchers from Korea also looked at other autoimmune diseasesrheumatic arthritis , Sjögrens syndrome , and Behcets disease but found no association with dementia.

    The study, published in PLoS One, determined that a diagnosis of systemic lupus erythematosus; resulted in being 2.4 times more likely to have dementia even after excluding other comorbidities.

    The study was conducted using a database consisting of individuals who submitted medical claims from 2002-2013. Of the 6028 patients with dementia, 261 had RA, 108 had SS, 12 had SLE, and 6 had BD. Only the rate of SLE was significantly higher in dementia patients compared to the control group.

    SLE significantly increased dementia risk regardless of type , results showed. The associations did not hold up for the group with relatively lesser comorbidities or the elderly.

    VaD is the second-most common cause of dementia. It is generally linked to cardiovascular risk factors, but with immunological damage to brain blood vessels and neuronal cells also involved, the authors said.

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    Lupus Research: Brain Connections

    A five-year study on cognitive function, called Brain CONNECTIONS, evaluated lupus patients every four months with a wide variety of tests. In one test, participants were given a list of words and asked to recall them after about 10 minutes. Although most participants had problems recalling the words, they were able to pick out the original 10 words from a list of 20 words. This indicates interference with access to the information that exists in the brain.

    Researchers with the Brain CONNECTIONS study also measured cognitive dysfunction and biological changes in the participants and found a high incidence of anatomic brain abnormalities. People whose MRIs showed brain abnormalities were more likely to have problems with focussed attention and reaction time, and also had higher lupus disease activity. This suggests that both functional and structural damage to the brain is evident early in the disease process, which underscores the need for research into the underlying mechanism of the brains involvement in lupus. Important neurological syndromes seen in lupus Central nervous system vasculitis The most serious neurological syndrome associated with SLE is central nervous system vasculitis, an inflammation of the brains blood vessels. Most episodes take place early, within five years of lupus diagnosis. Antibodies attack the blood vessels, causing inflammation, which can seriously affect the flow of blood.

    What Is Lupus Fog

    How to Improve Memory Loss

    Lupus fog is a general name for the cognitive impairments that often appear with lupus, including concentration and memory problems, confusion, and difficulty expressing yourself. These cognitive problems are often worse during flares.

    The good news: Lupus fog doesnât usually get progressively worse, like dementia or Alzheimer’s disease, says Lisa Fitzgerald, MD, a rheumatologist at the Lupus Center of Excellence at the Beth Israel Deaconess Medical Center in Boston. Instead, memory issues will probably wax and wane, just like other lupus symptoms.

    The exact cause of lupus fog is hard to pin down, experts say. In some cases, lupus can damage cells in the brain, leading directly to cognitive problems. However, in most cases other factors play a role, including fatigue, stress, and depression. Lupus fog is sometimes worse in people who also have fibromyalgia. Although it’s possible that side effects from drugs such as NSAIDs or steroids could worsen lupus fog, experts say that switching medicines rarely resolves the problem.

    While researchers study possible causes of lupus fog, Orosz focuses on coping strategies that help people deal with it.

    “When you’re a person dealing with lupus fog, you don’t worry that much about what’s causing it,” says Orosz. “What you care about is learning how to work around it.”

    Here are some tips that may help you deal with lupus fog.

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    What Can Be Done About Cognitive Dysfunction And Lupus Fog

    Reassurance from loved ones helps a lot, as well as behavioral counseling, physical or speech therapy, biofeedback, techniques for relaxing the body and mind, and concentration strategies. A lupus diary can be useful to track when fogs happen and what works for dealing with them. Medicines may lessen the fatigue or depression that makes thinking hard. Doctors are learning a lot about how lupus antibodies hurt brain cells and are testing medicines for dementia that might someday help people with lupus.

    Neurological Tests For Lupus

    Your doctor may order one or more laboratory tests to determine whether or not your lupus is causing neurological involvement and to what extent. These tests may include magnetic resonance imaging , electroencephalogram , electromyogram , computed tomography scan, lumbar puncture or blood tests. X-rays may also be used on occasion to diagnose neurological damage.

    • CT and MRI obtain images of the brain that reveal strokes, tumours, bleeding and abscesses.
    • EEG detects abnormal electrical activity of the brain, which may be associated with seizures .
    • EMG and nerve conduction studies detect abnormal electrical activity of muscles and nerves.
    • Spinal fluid analysis reveals distinct changes in the spinal fluid that point to various disorders .
    • Blood tests may show bleeding problems, or antibodies that can lead to abnormal blood clotting .

    While we dont completely understand the mechanisms by which lupus affects the central nervous system, we know that there are several neurological syndromes that affect many people. Although cognitive impairment is believed to be very common in lupus, few patients undergo specific testing to document it. Symptoms include difficulty finding words and retrieving information. People with the condition often refer to it as lupus fog.

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    Central Nervous System Dementia & Lupus

    Lupus is an autoimmune disease that causes inflammation throughout the body, including the central and peripheral nervous system.;Over time, this inflammation causes damage and inhibits function.

    Because of this worry, researchers have explored the link between dementia and lupus. A used the largest database in Israel, the Clalit Healthcare Database, to look for a connection.

    The researchers retroactively compared 4,886 people with lupus to 24,430 controls matched for age and sex.

    The result: People with lupus had dementia at three-times;the rate of control participants. 1.65% of Lupus Warriors had dementia compared to 0.51% of controls. Using a;multivariate logistic regression analysis;to account for other risk factors and age, the researchers concluded that people with lupus are 51% more likely to develop dementia in their lifetime.

    Important To Treat Underlying Disease

    Memory Loss Quiz

    Specialists should treat the underlying disease rather than focus on the symptoms of brain fog, Keenan says. He encourages patients to get adequate sleep and assess potential disruptions to sleep such as apnea. In some situations, we recommend a sleep study to identify potential complications, Keenan says. Overmedicating can also cause fatigue and a reduction in mental focus, he adds.

    Opinions vary among rheumatologists about the origin of brain fog. The causes are more unclear in fibromyalgia patients than in some other autoimmune diseases such as lupus because we believe the condition is associated with long-term potentiation, synaptic plasticity, and neurogenesis, he says. Its clear that the plasticity of the immune system is involved as well as the so-called cleaning process that occurs within our nervous system.

    Some patients report more debilitating effects than others, and those reports vary significantly. The symptoms may improve with better control of FM or SLE, but Keenan says fatigue and brain fog can persist for long periods and may be debilitating to some patients.

    In addition to sheer fatigue and significant sleep cycle disruption, which may be a contributor to mental confusion in patients with FM, other physical processes may be involved. Its hard to say how much of this is related to the neuro-endocrine pathways that may be impacted by inflammatory or immune system disease, Keenan says.

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