Table 2.
Cognitive impairment in aPL carriers and APS patients.
| Study | Study Population | Control Group | Cognitive Tests | Main Results | Cognitive Impairment Frequency |
|---|---|---|---|---|---|
| aPL Carriers | |||||
| Schmidt et al., 1995 [13] | Elderly subjects (n = 53) | Age-matched non- aPL carriers | MWT-B, Janke and Debus, LGT-3, WCST, Alters Konzentrations of Gatterer, Purdue Pegboard | Impaired memory and visuopractical abilities. No brain abnormalities or differences in brain MRI. |
Not reported |
| Jacobson et al., 1999 [9] | Asymptomatic, aPL-carriers, non-elderly adults (n = 27) | Age- and education-matched non-aPL carriers | Wechsler, CVLT, Benton line orientation, COWAT, finger oscillation, grooved pegboard, RCFT, trail making, WCST, Beck, state-trait anxiety inventory | Impaired executive functioning, verbal learning, memory, and visuospatial abilities. Attentional processes and fine motor skills appeared unaffected. |
33% in aPL carries vs. 4% in controls |
| Erkan et al., 2010 [10] | High titers of aPL antibodies (n = 85) | Moderate titers of aPL antibodies (n = 58) | Not specified | Increased prevalence of cognitive impairment in the higher-titer group in a linear pattern | 12% in high titers vs. 3% in moderate titers group |
| Kozora et al., 2014 [11] | Non SLE aPL-carriers (n = 20) | SLE patients with negative aPL | FSIQ, Wechsler digit symbol and block design, trail making, Stroop color and word, CVLT, Rey-O Immediate, Rey-O Recall, LNST, COWAT, PASAT, Dig Vig, category test, finger tapping test | High frequency of cognitive impairment in both groups with no significant difference between the groups | 40% in non-SLE aPL carriers vs. 60% in the SLE non aPL carriers |
| Primary APS | |||||
| Tektonidou et al., 2006 [24] | Primary APS (n= 39) and secondary APS (SLE related) (n = 21) | Healthy age-, sex-, and education-matched controls | Wechsler digit span, symbol and block design, Rey AVLT, RCFT, SCWT, TMT, COWAT. | Impairment of visual learning, memory, visuomotor and visuospatial speed and flexibility, verbal fluency, and rapid auditory information processing impaired. No difference between primary APS and secondary APS Predictors for cognitive impairment: Livedo reticularis and presence of white ma ter lesions on MRI |
42% in APS patients vs. 18% in the controls |
| Coin et al., 2015 [23] | Primary APS (n = 15), Secondary APS with SLE (n = 12) and SLE without aPLs (n = 27) | Healthy, age- and education-matched controls | TAVEC, RCFT, Stroop color and word test, verbal phonemic fluency and semantic fluency (Spanish version), Ruff 2&7 selective attention test. | Impaired executive functions and memory (verbal and visual) | 80% in primary APS, 75% in secondary APS with SLE, 48% in SLE without aPLs, and 16% in the controls |
| Secondary APS | |||||
| Maeshima et al., 1992 [25] | Secondary APS with SLE (n = 21) | Healthy controls | MMSE, “Kana” pick-up test, Miyake’s paired associated memory scale, word recall, digit span, Watamori method, line bisection test, line cancellation task, recognition of intricate pictures and perspective cube copying test. | Higher cortical impairment in study group | 76% vs. missing data |
| Afeltra et al., 2003 [17] | Secondary APS with SLE (n = 61) | Healthy controls | Not specified | High titers of aPL were associated with cognitive impairment No details on cognitive impairment patterns |
58% |
| Mikdashi et al., 2004 [18] | Secondary APS with SLE (n = 130) | MMSE with other tests not explicitly specified | No details on cognitive impairment patterns | 27% in study group | |
| McLaurin et al., 2005 [33] | Secondary APS with SLE (n = 123) | Mild impairment battery from the Automated Neuropsychological Assessment Metrics (ANAM). | No details on cognitive impairment patterns | 37.5% in study group | |
| Tomietto et al., 2007 [28] | Secondary APS with SLE (n = 52) | Rheumatoid arthritis | Raven’s progressive matrices, comprehension, similarities, block design, and digit symbol of Wechsler, Wechsler memory scale, Rey auditory-verbal learning, trail-making, Corsi block, number cancellation, reverse numerical sequence (MMSE), Stroop word and color test, semantic and phonemic verbal fluency, denomination of Aachener Aphasie and token test. | Executive functions and complex attention were more frequently impaired in APS patients. | 68.6% in study group vs. 41.2% in controls |
| Murray et al., 2012 [29] | Secondary APS with SLE (n = 694) | HVLT-R, COWAT | Verbal memory and verbal fluency | 15% in entire cohort | |
| Conti et al., 2012 [19] | Secondary APS with SLE (n = 58) | Standardized testing from ACR and the CSI standardized in an Italian population | Visuospatial domain mainly impaired | Missing data | |
aPL—anti-phospholipid antibodies; APS—anti-phospholipid syndrome; MWT-B—mehrfachwahlwortschatztest; LGT-3—Bäumler’s Lern-und Gedächtnistest; WCST—Wisconsin card sorting test; MRI—magnetic resonance imaging; SLE—systemic lupus erythematosus; CVLT—California verbal learning test; COWAT—controlled oral word association test; RCFT—Rey complex figure test; FSIQ—full-scale intelligence quotient; Rey–O immediate, Rey–O recall—immediate and 30-min delayed recall of the Rey–Osterrieth complex figure test; LNST—Letter-–number sequencing test; PASAT—Paced auditory serial addition test; Dig Vig—digit vigilance test; Rey AVLT—Rey auditory verbal learning test; SCWT—Stroop color–word interference test; TMT—trail-making test; TAVEC—Spanish version of the California learning verbal test; MMSE—mini-mental-state examination; HVLT-R—Hopkins verbal learning test—revised; ACR—American college of rheumatology; CSI—cognitive symptoms inventory.