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Rheumatology Advance Access originally published online on November 24, 2007
Rheumatology 2008 47(1):50-53; doi:10.1093/rheumatology/kem287
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© The Author 2007. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Functional MRI in NPSLE patients reveals increased parietal and frontal brain activation during a working memory task compared with controls

B. M. Fitzgibbon1, S. L. Fairhall1, I. J. Kirk1, M. Kalev-Zylinska2, K. Pui4, N. Dalbeth2, S. Keelan2, E. Robinson3, M. During2 and F. M. McQueen2

Departments of 1Psychology, 2Molecular Medicine and Pathology, 3Biostatistics, University of Auckland and 4Rheumatology, Auckland District Health Board, Auckland, New Zealand.

Correspondence to: F. M. McQueen, Associate Professor in Rheumatology, Department of Molecular Medicine and Pathology, Faculty of Medicine and Health Sciences, University of Auckland, Park Rd, Auckland, New Zealand. E-mail: f.mcqueen{at}auckland.ac.nz


  Abstract

Objectives. Anatomical MRI brain scans may not reflect neurological dysfunction in patients with NPSLE. We used blood-oxygen-level-dependent functional MRI (BOLD-fMRI) to investigate working memory function in NPSLE patients.

Methods. Twenty-seven females took part: nine NPSLE patients (mean age 40 yrs; SLEDAI 10.9); nine RA patients and nine healthy controls. Subjects were tested using the n-back paradigm for working memory, where patients indicate when a stimulus matches one presented n trials previously. Functional scans used 3 mm slices x 30, repetition time 2570 ms, echo time 50 ms. Echo planar images were superimposed onto T1w anatomical images (Siemens 1.5 T). Data analysis used Brain Voyager QX Version 1.7.

Results. During the memory task, there was activation in areas serving working memory, executive function and attention in all groups. Nine regions of interest were selected for activation during working memory (N-back task vs fixation, P ≤ 0.005). In six out of nine regions, there was greater activation in the NPSLE group. This reached significance in three regions: the posterior inferior parietal lobules of both hemispheres [Brodmann area (BA) 7] separately and combined (P = 0.014, 0.016 and 0.004, respectively), and the supplementary motor area (mid-line frontal lobe)(BA32/6; P = 0.032).

Conclusions. NPSLE patients showed greater frontoparietal activation than the other groups during the memory task, suggesting a greater need to recruit extra cortical pathways, possibly to supplement impaired function of standard pathways.

KEY WORDS: Functional MRI, SLE, Neuropsychiatric manifestations, Imaging, Cognitive function

Submitted 9 May 2007; revised version accepted 12 September 2007.
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