Neurologists are often called to evaluate central nervous system [CNS] manifestations in patients with
suspected or definite systemic lupus erythematosus [SLE]. The manifestations are highly diverse and often have major
prognostic consequences. The major difficulties are to determine if the given manifestation is primarily due to SLE
activity in the brain, or a consequence of metabolic disturbances, infection, or corticosteroid use. The true incidence of
CNS manifestations attributable to SLE is not entirely clear, but several studies show prevalence rate between 15-75%,
depending on criteria adopted. For cognitive impairment, the prevalence ranges from 17-59%. Cognitive impairment may
be attributed to emotional distress, corticosteroid use, active systemic disease or primary CNS dysfunction. These
manifestations may occur even in the absence of other neuropsychiatric [NP] manifestations clearly attributable to SLE.
The etiology of cognitive impairment may be related to autoimmune mechanisms, such as brain-specific autoantibodies.
Despite several studies using computer tomography [CT] and magnetic resonance imaging [MRI], brain structural
abnormalities could not be associated with cognitive findings in SLE patients. Functional neuroimaging methods may be
more sensitive for detecting subclinical brain involvement related to cognitive dysfunction in SLE. Despite the fact that
cognitive impairment may be residual in patients with previous CNS involvement, it also may be an early marker of CNS
involvement in previous asymptomatic patients. This article will review clinical assessment, pathogenic mechanism, and
the role of neuroimaging methods in the evaluating of SLE patients with cognitive impairment.