2021 Recipients of the Lupus Canada Catalyst Award

Researchers: Dr. Zahi Touma & Dr. Michelle Barraclough

University Health Network

A pilot study examining the relationship between cognitive dysfunction and cognitive fatigue in SLE using structural and functional MRIs of the brain and focusing on the underlying mechanism

Project Summary

Dr. Touma is a leading clinician-scientist at the Toronto Lupus Clinic, one of the largest centers for specialized lupus care and treatment. As a clinical epidemiologist, he is focused on the measurement of patient outcomes in systemic lupus erythematosus (SLE), For this proposed work, Dr. Touma will be collaborating with Dr. Barraclough. Through this project, we aim to elaborate on our current grants by adding fMRI. This will enable us to better understand the mechanisms involved with cognitive dysfunction, fatigue and the use of compensatory brain mechanisms to maintain cognitive function. Cognitive dysfunction affects up to 75% of SLE patients and significantly impacts their quality of life. By further understanding the mechanisms involved in cognitive dysfunction in SLE we can start to plan future clinical trials and ultimately provide personalized treatment for patients.

Lay Summary

Lupus is a long-term illness caused by problems with the body’s immune system. One of the symptoms of lupus is problems with memory and attention, known as cognitive functions. Also, lupus patients commonly complain of “brain fog” which we believe to be linked to problems with cognition. When these problems occur, they can badly affect quality of life. There are many things that can cause problems with cognition in lupus and so it is hard to know how to treat it.

Our work aims to look at ways of grouping lupus patients according to possible causes of cognitive problems. This will help to develop studies to test new treatments and ultimately help to improve this symptom in those with lupus. We have recently started a large study that is looking at ways to group lupus patients with cognitive problems. One measure that we plan to add to this study is looking at how the brain works when lupus patients are doing cognitive tasks.

We believe that the brains of people with lupus must work harder during cognitive tasks compared to healthy volunteers. This overuse could explain the feelings of “brain fog” (cognitive fatigue) reported by lupus patients. It is then likely that this overuse and fatigue could lead to cognitive problems.

We aim to use a brain imaging technique, known as functional Magnetic Resonance Imaging (fMRI), to collect more information about how the brain works when lupus patients are doing tasks that test their memory and attention. We will also be looking at how fatigued patients get during these tasks.

We will invite 40 patients, that are already in our grouping study, and 20 healthy volunteers to take part in this fMRI study. We will collect information about their lupus, health and personal details. Blood samples will be taken and questionnaires/assessments done to look at disease activity and damage, mood, sleep problems, pain, fatigue, quality of life and cognitive performance. Finally, participants will go into a brain imaging scanner where they will do tasks that look at memory and attention. All this information will then be looked at and added to the information from the grouping study. It will help us to better group lupus patients according to their cognition and will help us to develop studies to test new treatments to improve this symptom.