Study Links Brain Atrophy to Age, Education, and Neuroinflammation in People with Systemic Lupus Erythematosus

A new study of adults with systemic lupus erythematosus (SLE) found cerebral atrophy or brain shrinkage is linked to older age, longer disease duration, lower education levels, presence of neuropsychiatric systemic lupus erythematosus (NPSLE), and more severe disease damage and cognitive difficulties. The discovery supports the idea that ongoing immune-related inflammation can gradually damage nerve cells and brain tissue. Many people with lupus sometimes have confusion, memory loss, and trouble expressing thoughts. The medical term is cognitive dysfunction. These symptoms can come and go. 

Cognitive dysfunction can affect some people with lupus and may include difficulties with memory, concentration or expressing thoughts. Researchers studied a diverse Southeast Asian group of 70 people using strict criteria. Non-contrast CT brain scans were performed on the group, and their brain changes were graded using the validated Global Cortical Atrophy (GCA) score and their cognitive function was evaluated using the Montreal Cognitive Assessment (MoCA). More than half (52.9%) of the group (median age 40) showed signs of brain shrinkage. People with brain shrinkage tended to be older, have lived with lupus longer, have lower education levels, more overall disease damage, and performed worse on cognitive and memory tests, showing the importance of regular cognitive check-ups for people with lupus.  

Cerebral atrophy was also observed among some participants without diagnosed NPSLE, indicating that structural brain changes may occur even in the absence of recognized neuropsychiatric involvement. In contrast, having more education was linked to a lower risk. 65.7% of highly educated participants showed no brain shrinkage, compared to 72.7% of those with low-to-medium education who did. After accounting for other factors, highly educated participants had about 78% lower odds of cerebral atrophy, though this finding was borderline and would need to be confirmed in a larger study.  Because the study assessed participants at one point in time, it cannot determine what caused the brain changes or how they progressed. 

Future research using advanced brain scans and tests of spinal fluid may help to better understand how inflammation affects the brain in lupus and which areas are most vulnerable. These results highlight the need for strong disease control and management of blood vessel health to protect the brain and the importance of early screening for cognitive issues and proactive treatment to prevent long-term brain injury in lupus. Learn more about lupus and the nervous system. 

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