What is an autoimmune disease?

Sometimes, a person can experience problems with memory, finding the right to say, multi-tasking, information processing, or other cognitive, motor, or mood changes as a result of a medical condition. Autoimmune diseases, such as Multiple Sclerosis and Lupus, cause chronic inflammation in the brain, and are examples of medical conditions that can lead to cognitive problems. 

What is Multiple Sclerosis (MS)?

MS is an autoimmune disease in which the immune system attacks the brain and spinal cord (AKA the central nervous system) causing demyelination, which is the deterioration of the protective covering of nerves. This causes the slowing down of messages being transferred to and from the brain by nerves. MS is considered a chronic disease, punctuated by flare ups. Some form of cognitive impairment affects 40–60% of people with MS, and cognitive problems are linked to severity, duration, and flare up recurrence. MS is typically diagnosed between the ages 20-40.

What causes MS?

No definitive cause of MS has been found. A common hypothesis is that a viral infection primes an already vulnerable immune system for a delayed immune reaction later in life. Another common hypothesis is that MS develops in response to a chronic infection (e.g., Epstein Barr). Genetic factors are also involved.

What are symptoms of MS?

The type of cognitive problem and the severity of the problem caused by MS can vary significantly from person to person. Most commonly, people experience issues with their thinking and sensory/motor functioning: 

• Visual difficulties/blurred vision

• Numbness/tingling in limbs

• Motor weakness and balance problems

• Slurred speech

• Taking longer to get things done

• Problems remembering events or conversations

• Trouble multitasking

• Problems with attention 

• Difficulty with decision-making

• Fatigue, excessive tiredness

• Changes in mood

Diagnosis of MS

A diagnosis of MS is usually made when an MRI reveals plaques (or lesions) where demyelination in the brain or spinal cord has occurred. 

Course and risk factors

In some cases, MS may be progressive. Depending on the type of MS an individual has, increasing brain atrophy can eventually impact widespread regions of the brain. Often, individuals with MS can also experiences mood changes, such as depression and anxiety, sleep disturbance, fatigue, and pain. Above and beyond cognitive symptoms, these other factors can have a significant impact on quality of life if not treated.

What is Lupus?

Systemic lupus erythematosus (SLE), or commonly just called Lupus, is chronic inflammatory autoimmune disease. There is typically multi-system involvement; the immune system attacks its own tissue, which can lead to various organ damage. A diagnosis is usually made in 20s-30s.

What causes Lupus?

The cause of Lupus is unknown. Research indicates genetic factors are involved, and women are more likely to develop Lupus than men. Environmental factors also likely play a role.

What are symptoms of Lupus?

Up to 50% of people with Lupus can demonstrate trouble with their thinking, and people often complain of mental fogginess and sluggishness. As with MS, cognitive symptoms of Lupus are very diverse. However, the causes of cognitive problems in Lupus is more variable and less well understood than in MS. Symptoms can include:

• Decreased ability to pay attention

• Slowed processing speed

• Motor changes

• Memory problems 

• Seizures

• Mood changes, depression

• Psychiatric symptoms, including psychosis

• Fatigue, excessive tiredness

• Generalized pain

Diagnosis of Lupus

A diagnosis of Lupus is made based on an individual having several of the following symptoms: malar/butterfly rash, discoid rash, photosensitivity, oral ulcers, arthritis, heart/lung inflammation), renal disorder, neurologic problems, hematologic disorder, immunologic changes, antinuclear antibody (abnormal titer of ANA).

Course and risk factors

In Lupus, worsening or progressive symptoms may or may not be part of the disease course. However, research shows that people with Lupus are at an increased risk for other serious illnesses that must also be addressed, like cerebrovascular disease.

How can neuropsychological assessment help?

An individual diagnosed with an autoimmune disease may be referred by their doctor for neuropsychological testing. Neuropsychological assessment can be helpful in determining the nature and extent of an individual’s cognitive impairment, and in providing treatment recommendations, such as work-related support, cognitive rehabilitation therapy, cognitive behavioral therapy, medication options, and lifestyle changes (e.g., exercise, nutrition) that research has shown to be effective in ameliorating symptoms.