In people with depressive illness, there is often a general slowing and clouding of mental functions (cognition). These troublesome and not infrequent disruptions in mental functioning tend to be under-reported to physicians and are rarely confirmed to be due to any specific structural change. Fortunately, these transient alterations in mental functioning improve as the depressive condition improves.
Changes in cognition often occur in people with lupus, including subtle changes in:
- other cognitive functions such as:
- diminished attention
- lapses in awareness
- impairment in recall, problem-solving, calculations, planning, and/or visual-spatial functioning).
These are quite a nuisance and can have a profound impact upon the person's self-image, daily life and planning, and in their relationships with friends, co-workers, and loved ones.
Such changes often do not come to the physician's attention unless formal mental status testing is done. The true incidence of cognitive impairment is unknown, other than that it is common.
There is no specific or characteristic cognitive deficit found in people with SLE; rather, there is a wide spectrum, variety, and combination. These deficits, though, do not appear to be related to emotional stress or use of medication such as corticosteroids.
Occasionally in SLE patients with no overt central nervous system pathology, cognitive functioning improves with anti-malarial drugs or low doses of corticosteroids.
Prognosis for Recovery
Recovery from depression is usually a gradual process. Dramatic improvements do not usually occur in a few days; however, one begins to see some progress after a few weeks.
Even when signs of clinical depression seem to clear quickly, it is not unusual for an individual to relapse when the medication is stopped. For this reason, medication should be continued for approximately six months or longer and the dosage should be tapered slowly over a 3-4 week period when treatment is discontinued.