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Effects of Lupus on the Brain

A study to understand what causes cognitive impairment in people with lupus.

The Problem

Lupus can affect many parts of the body, including the brain, causing a wide range of neurologic and psychiatric symptoms. A common one is mild cognitive impairment that comes and goes, often referred to as “lupus brain fog”. We need a better understanding of what causes cognitive impairment in lupus and how it evolves over time, so that we can identify better treatment options.

The Solution

A better understanding of what causes cognitive impairment in lupus and how it evolves is needed to identify adequate treatment options.

 

What the Study will do

This study will use state-of-the-art MRI scans of the brain to measure the leakiness of the blood-brain barrier, to see how it changes over time and how it corresponds to fluctuations in cognitive function.

The Research Study

Using a state of the art MRI brain scan, we can measure the leakiness of the blood-brain barrier. In general, we found in previous studies that lupus patients had more blood-brain barrier leakage than expected. We also found that the lupus patients with leakier blood-brain barriers on MRI had lower cognitive test scores when compared to those with less blood-brain barrier leakage.

Based on these findings, we believe that dysfunction of the blood-brain barrier may be a major contributor to lupus-related cognitive impairment, often referred to as “lupus brain fog”. However, we do not know what happens to the blood-brain barrier over time in lupus. Our study aims to determine whether the degree of blood-brain barrier leakage changes over time in people with lupus and whether changes in blood-brain barrier leakage will predict changes in cognitive performance.

Lupus patients who participated in a previous study will be invited to repeat their MRI scans and cognitive testing approximately five years after their initial assessment. We will then compare the MRI findings and cognitive test results between the two visits and expect that if there is an increase in blood-brain barrier leakage from the original scan, this will also be coupled with a decline in cognitive test performance. For individuals with less blood-brain barrier leakage compared to the original scan, it is anticipated they will have an improvement in their cognitive test scores over time.

Research Scientist

Alexandra Legge Rheumatology, MD, MSc, FRCPC

Alexandra Legge Rheumatology, MD, MSc, FRCPC

Research Scientist

Alexandra Legge received her medical degree from Dalhousie University in 2014. Following graduation, she remained in Halifax for her Core Internal Medicine and Adult Rheumatology subspecialty residency training, which she completed in June 2021.

During her residency, Alex also completed a Master of Science (MSc) degree in Community Health & Epidemiology through the Dalhousie University Clinician-Investigator Program (CIP). Her thesis project focused on the construction and validation of a frailty index as a novel health measure in systemic lupus erythematosus (SLE).

Following her residency training, Alex completed a one-year research fellowship at Arthritis Research Canada in Vancouver under the supervision of Dr. Diane Lacaille. This fellowship focused on using population-based administrative health data to construct and evaluate a frailty index that can be applied to estimate susceptibility to adverse health outcomes among individuals living with rheumatoid arthritis.

Alex joined the Division of Rheumatology at Dalhousie University in July 2022 as an Assistant Professor. She is a practicing rheumatologist at the Queen Elizabeth II Health Sciences Centre in Halifax, Nova Scotia and is currently the Director of the Dalhousie Lupus Clinic. Her recent publications and current research projects focus on investigating the impact of frailty among individuals living with rheumatic diseases, as well as improving long-term clinical outcomes in SLE, with a special interest in neuropsychiatric lupus. She also collaborates with international SLE researchers as a provisional member of the Systemic Lupus International Collaborating Clinics (SLICC).

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