This instrument has presented a 54.8% sensitivity and a 100% specificity. On the other hand, from 17 MMSE detected patients (38.6% of SLE group) with cognitive impairment showed 24 ± 1 average score, being 22 minimum and 25 as maximum score. This instrument showed a sensitivity of 54.8% and a specificity of 30.76% for identifying cognitive impairment in SLE patients. The CSI classified 26 patients (59.1%) with cognitive impairment, with a minimum score of 26, maximum score of 30, and an average score of 37.1 ± 1.2 (SD). Using this battery, we evaluated visual, verbal, and abstract reasoning, visual and verbal memory, language, attention (selective, divided, and sustained), processing speed, and motor control. The neuropsychological battery we used comprised the following: the Matrix Wechsler Adult Intelligence Scale-Fourth Edition (WAIS-IV) test, Vocabulary WAIS-IV test, Analogies WAIS-IV test, Rey–Osterrieth complex figure test, Test de Aprendizaje Verbal España-Complutense (TAVEC), Semantic and phonemic fluency tests, D2 test, Stroop test, Trail Making test A and B, Paced Auditory Serial Addition test (PASAT), Digit-Symbol coding WAIS-IV test, letter–number sequencing WAIS-IV test, and Finger Tapping test. A higher score indicates more severe cognitive impairment. Each of the questions is scored on a scale of 0 to 4, and thus the maximum score is 84 points. The CSI comprises 21 questions that aim to determine the ability of the person to perform certain cognitive tasks during activities of daily living. The result of this test is given as follows: no deterioration (30–26 points), doubtful or possible deterioration (25 points), mild to moderate dementia (24–10), moderate to severe dementia (9–6), and severe dementia (<6 points). It evaluates orientation, learning-evocation, attention, language, and visual-spatial construction. The MMSE measures cognitive impairment in people with dementia or delirium. A score ≤25 is considered positive for cognitive impairment. The MoCA test evaluates attention, concentration, executive functions, memory, language, visuospatial cognitive capacity, abstraction, calculation, and orientation. A complete medical examination was performed and subsequently the neuropsychological battery was applied, followed by the MoCA, MMSE (validated in Spanish language 18, 19), and the CSI (translated into Spanish by the LUMINA group 17, 20). We excluded patients who had cerebral vascular disease, hypertension, dyslipidemia, diabetes, thyroid pathology, a history of head trauma with loss of alertness or established neurological damage, drug abuse or dependence, or underlying psychiatric illness, as evaluated by a complete medical examination and a semi-structured psychiatric interview (MINI Plus 7.0). The study was approved by the relevant institutional review board (002017-188). All patients were able to read and write Spanish fluently, with a minimum of 6 years of elementary school, and were legally capable of giving informed consent. In this observational cross-sectional study, we recruited SLE patients who attended the outpatient rheumatology clinic of the Hospital Civil Juan I, Menchaca, Guadalajara, from August to December 2017. The aim of our study was therefore to evaluate and compare the efficacy of three screening tests for cognitive impairment (the Mini Mental State Examination, 13, 14 the Montreal Cognitive Assessment, 15, 16 and the Cognitive Symptom Inventory 17) against the gold standard 7, 12 to identify the most efficient screening test, in patients with SLE. 7, 10, 12 Consequently, we considered it necessary to evaluate the use of other screening tools in comparison with the neuropsychological battery. The neuropsychological battery (gold standard) is time-consuming to implement. Hence, there is a need to assess cognitive impairment appropriately. 9– 11 This could affect the self-concept of patients as well as their ability to communicate. In the 19 neuropsychiatric syndromes described by the American College of Rheumatology (ACR) in 1999, 6, 7 one of the most frequent is cognitive impairment (present in up to 65% of SLE patients 8), which can be associated with alterations in simple or complex attention, memory, visual–spatial processing, language, reasoning and problem solving, psychomotor speed, and executive functions. 1– 5 Neuropsychiatric involvement could affect the patients’ quality of life negatively, resulting in poor cognitive development, disability, and death. Systemic lupus erythematosus (SLE) is an inflammatory, chronic, and multisystemic disease, with up to 60% of patients showing neuropsychiatric manifestations.
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