![]() Study participants for the SLE group (N=95) were recruited consecutively from the Monash Lupus Clinic site of the Australian Lupus Registry and Biobank (ALRB) between October 2018 and February 2020. The second objective was to evaluate the performance of the MoCA as a screening tool in SLE by determining the sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of various MoCA cut-off thresholds. The first objective was to evaluate the construct validity of the MoCA for screening in SLE by determining if there was an association between MoCA scores and performance on conventional cognitive testing. We aimed to address methodological deficiencies in these previous studies by analysing across different definitions of cognitive dysfunction using the American College of Rheumatology (ACR) recommended conventional cognitive test battery and testing multiple MoCA cut-offs to determine the optimum threshold for clinical application. The Automated Neuropsychological Assessment Metrics test has also been evaluated in SLE, 15 but practical considerations limit its use as a screening tool, including accessibility, cost and testing time. In addition, this study excluded patients with SLE with cerebrovascular disease or mood disorders despite these being common comorbidities in SLE which may contribute to cognitive dysfunction, 13 14 making these results less applicable to a typical SLE cohort in clinical practice. 10 However, this study did not specify the method, definition or threshold used to define cognitive impairment on the cognitive test battery comparator and did not evaluate a range of MoCA cut-off thresholds. 10 11 Of the studies assessing the use of the MoCA in SLE, only one used a broad conventional cognitive test battery to define cognitive dysfunction. 9 Three studies have assessed the MoCA for use in SLE, 10–12 and have suggested that it is a more sensitive test than the MMSE. 9 The MoCA is a freely available brief screening tool that was initially designed in 1996 to screen for early cognitive impairment in the setting of dementia. The Montreal Cognitive Assessment (MoCA) and the Mini Mental State Examination (MMSE) are both cognitive screening tools that meet these characteristics and have undergone preliminary assessment for use in SLE. 6 7 Cognitive dysfunction in patients with SLE is known to affect a wide range of cognitive domains 8 and hence it is also important that screening covers a broad range of domains. It is essential that a screening tool is based on objective cognitive tests, as patient-reported symptoms are frequently discordant with objective tests and may be affected by factors such as mood disorders. The ideal characteristics of a screening test include sufficient sensitivity to detect potential cases and that it should be easily accessible and simple to administer. This further adds to the potential utility of a screening tool as a first step to identify patients who may benefit from comprehensive cognitive testing. Neuropsychological assessments themselves are time-consuming, and are expensive for routine use, because these services are often not covered by healthcare benefits or insurance. 4 5 Although the pathogenesis of cognitive dysfunction in SLE remains poorly understood, early detection and recognition of cognitive changes may help us develop strategies that improve patients’ quality of life.įormal evaluation by a clinical neuropsychologist including cognitive testing remains the gold standard for the diagnosis of cognitive impairment, but is not practical for use on a routine basis in the SLE clinical care setting. Many patients with SLE report cognitive dysfunction as one of the most distressing symptoms of their condition, 2 3 adversely impacting function and employment. 1 Cognitive dysfunction is common in SLE and can present insidiously. SLE is a chronic multisystem autoimmune disease associated with significant morbidity and reduced life expectancy.
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