SLE linked to 53% higher odds of cognitive impairment in meta-analysis of 7 million

Systemic lupus erythematosus (SLE) is a chronic autoimmune disease that can affect multiple organs, with neuropsychiatric manifestations, particularly cognitive impairment, being common and debilitating. However, the risk of cognitive decline and dementia in SLE patients remains debated due to methodological differences across studies. This meta-analysis aims to quantify the association between neurocognitive impairment and dementia in SLE patients by integrating data from observational studies. We systematically searched PubMed, Embase, and the Cochrane Library from inception to September 2025 for observational studies investigating the association between SLE and all-cause dementia or cognitive impairment. Study quality was assessed using the Newcastle-Ottawa Scale and the Agency for Healthcare Research and Quality checklist. Pooled effect estimates were computed using random-effects models. Heterogeneity was assessed with the I² statistic, and pre-specified subgroup analyses were performed. Seven studies involving over 7 million participants were included. The meta-analysis showed a significant association between SLE and cognitive impairment, with a pooled OR (Odds Ratio) of 1.53 (95% CI: 1.26–1.85, p < 0.001), indicating a 53% higher odds. Subgroup analyses found this association in cohort studies (OR = 1.50, 95% CI: 1.20–1.88), as well as in both Asian (OR = 1.56, 95% CI: 1.08–2.26) and non-Asian populations (OR = 1.49, 95% CI: 1.36–1.64), and in both men (OR = 1.43, 95% CI: 1.13–1.80) and women (OR = 1.98, 95% CI: 1.25–3.15). Sensitivity analyses confirmed the robustness of these findings. SLE is associated with significantly higher odds of neurocognitive impairment, underscoring the need for integrated cognitive screening and proactive management in clinical practice. https://www.crd.york.ac.uk/PROSPERO/, identifier CRD420251148236.