Episode 64: Cognitive Neuropsychiatric Symptoms in Lupus with Dr. Zahi Touma

“Lupus is a disease of a thousand faces”—and some of its most difficult symptoms are the ones clinicians cannot see."In this episode, hosts Dr. Daniel Ennis and Dr. Janet Pope are joined by Dr. Zahi Touma to explore cognitive neuropsychiatric symptoms in patients with systemic lupus erythematosus (SLE). They examine the difference between patient-reported “brain fog” and objectively measured cognitive impairment, the cognitive domains most commonly affected, and why symptoms can be so difficult to attribute to the disease itself.Dr. Touma discusses what long-term research reveals about cognitive trajectories in patients with SLE, including why some patients remain stable, some experience persistent impairment, and others fluctuate over time. The conversation also considers the influence of depression, chronic pain, and sleep disorders; the limitations of current blood tests and brain imaging; and emerging research into functional imaging; and potential biomarkers such as calprotectin.Most pertinently, the episode asks what rheumatologists can do now. While better screening tools and targeted treatments are still being developed, the first step is listening to patients, taking their cognitive concerns seriously, and offering appropriate reassurance that impairment does not necessarily mean continued decline.Dr. Zahi Touma is an Associate Professor of Medicine and Clinician-Scientist with the University of Toronto, the Krembil Research Institute, and Schroeder Arthritis Institute. He is also the director of the Lupus Program at Toronto’s University Health Network (UHN). His research is focused on patients with systemic lupus and also measurement science, with a particular interest in the assessment of disease activity, patient-reported outcomes, and cognitive function.Dr. Daniel Ennis is a rheumatologist and clinical faculty member in the Division of Rheumatology at the University of British Columbia.Dr. Janet Pope is a professor of medicine at Western University and division head of rheumatology at St. Joseph’s Health Care London. Her research focuses on systemic sclerosis, lupus and rheumatoid arthritis.Around The Rheum is produced by the CRA Communications Committee. A special thank you to the podcast team, Dr. Dax G. Rumsey (CRA Communications Committee Chair), Dr. Daniel Ennis (Host), Dr. Janet Pope (Host), David McGuffin of ExploreProductions.ca and Erin Stewart (CRA) for leading production.Our theme music was composed by Aaron Fontwell.For more on the work of the Canadian Rheumatology Association, visit rheum.ca