Screening for Cognitive Dysfunction in Systemic Lupus Erythematosus: a Systematic Review

Background: Screening instruments are brief and simple tools designed to identify alterations in cognitive functioning, as well as to rule out or confirm the presence of cognitive dysfunction. Systemic lupus erythematosus (SLE) is an inflammatory disease that affects multiple organs of the human body, including the nervous system, which can cause neuropsychiatric symptoms such as cognitive dysfunction. Objective: To analyze the scientific evidence on cognitive screening tests used in SLE and the cutoff points suggested in academic literature. Methodology: A systematic review was conducted from 2014 to the second half of 2024, in databases such as PubMed, Scopus, Web of Science, ScienceDirect, Redalyc and SciELO, based on combinations of keywords and Boolean operators: "cognitive dysfunction", "cognitive impairment", "cognitive decline", "lupus", "systemic lupus erythematosus", "SLE", "Montreal Cognitive Assessment", "MoCA", “MMSE”, “Mini-Mental State Examination”, “INECO Frontal Screening", "INECO", "Addenbrooke's Cognitive Examination", and "ACE-R III". Results: The search yielded a total of 564 works, of which 31 documents met the inclusion criteria and were analyzed. The results show that the MoCA is the preferred tool by physicians and specialists worldwide for cognitive screening in patients with SLE, both in patients with and without clear neuropsychiatric symptoms. Conclusion: The literature consistently supports a cutoff score of <26 on the MoCA as the most widely used threshold for identifying cognitive dysfunction in individuals with systemic lupus erythematosus, with this criterion receiving the strongest empirical validation across published studies. However, some studies have explored lower cutoff scores to improve the instrument's specificity and sensitivity, especially in the SLE population.