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Updated: Aug 15, 2026
Diffusion Tensor Magnetic Resonance Imaging in the Analysis of Neurodegenerative Diseases
Published on: July 28, 2013
Fatigue and cognitive function in systemic lupus erythematosus: associations with white matter microstructural
S J Wiseman1, M E Bastin1, I F Hamilton1
11 Centre for Clinical Brain Sciences, University of Edinburgh, UK.
Abstract:
Objective The objective of this study was to investigate fatigue and cognitive impairments in systemic lupus erythematous (SLE) in relation to diffuse white matter microstructural brain damage. Methods Diffusion tensor MRI, used to generate biomarkers of brain white matter microstructural integrity, was obtained in patients with SLE and age-matched controls. Fatigue and cognitive function were assessed and related to SLE activity, clinical data and plasma biomarkers of inflammation and endothelial dysfunction. Results Fifty-one patients with SLE (mean age 48.8 ± 14.3 years) were included. Mean diffusivity (MD) was significantly higher in all white matter fibre tracts in SLE patients versus age-matched healthy controls ( p < 0.0001). Fatigue in SLE was higher than a normal reference range ( p < 0.0001) and associated with lower MD ( ß = -0.61, p = 0.02), depression ( ß = 0.17, p = 0.001), anxiety ( ß = 0.13, p = 0.006) and higher body mass index ( ß = 0.10, p = 0.004) in adjusted analyses. Poorer cognitive function was associated with longer SLE disease duration ( p = 0.003) and higher MD ( p = 0.03) and, in adjusted analysis, higher levels of IL-6 ( ß = -0.15, p = 0.02) but not with MD. Meta-analysis (10 studies, n = 261, including the present study) confirmed that patients with SLE have higher MD than controls. Conclusion Patients with SLE have more microstructural brain white matter damage for age than the general population, but this does not explain increased fatigue or lower cognition in SLE. The association between raised IL-6 and worse current cognitive function in SLE should be explored in larger datasets.
Insights
Systemic lupus erythematosus (SLE) patients exhibit increased brain white matter damage, but this damage does not directly cause their fatigue or cognitive issues. Higher IL-6 levels may correlate with poorer cognitive function in SLE.
Area of Science:
- Neuroscience
- Rheumatology
- Medical Imaging
Background:
- Systemic lupus erythematosus (SLE) is associated with neurological complications, including fatigue and cognitive impairment.
- The underlying neuropathological mechanisms in SLE, particularly white matter microstructural changes, require further investigation.
Purpose of the Study:
- To investigate the relationship between fatigue, cognitive function, and diffuse white matter microstructural brain damage in patients with SLE.
- To explore the association of these factors with SLE activity, clinical data, and plasma biomarkers.
Main Methods:
- Diffusion tensor magnetic resonance imaging (MRI) was used to assess brain white matter integrity in 51 SLE patients and age-matched controls.
- Fatigue and cognitive function were evaluated and correlated with SLE disease parameters and inflammatory biomarkers.
- A meta-analysis of 10 studies was conducted to confirm findings on white matter integrity in SLE.
Main Results:
- SLE patients showed significantly higher mean diffusivity (MD) in all white matter tracts compared to controls, indicating microstructural damage.
- Increased fatigue in SLE was associated with lower MD, depression, anxiety, and higher body mass index.
- Poorer cognitive function correlated with longer SLE duration and higher IL-6 levels, but not with MD.
Conclusions:
- Patients with SLE have greater age-related microstructural brain white matter damage than the general population.
- This brain damage does not appear to be the primary driver of increased fatigue or lower cognition in SLE.
- The association between elevated IL-6 and impaired cognitive function in SLE warrants further investigation in larger cohorts.
