And do those patterns differ by disease phenotype or serology? Are there established links there?

When we look at the prevalence of cognitive dysfunction or cognitive impairment overall, it's around, it can range from anything between 30, 35, up to 45%, and sometimes a little bit more.

but you can say as well, I've read in some of the paper, even lower or higher.

And I'm not surprised because the current difficulty that we have is at this level is how we're defining the concept that we're referring to.

As long as we don't have agreement and standardized instrument and definition, this is gonna continue to generate heterogeneity in the prevalence of cognitive impairment.

But what we have been doing lately is in the clinic here over the last 10 years, when the patient comes to the clinic, we administered the American College of Rheumatology cognitive battery, neuropsychiatric battery.

And this takes around, we have a large team working on this.

What patterns have you found and have you identified distinct or predictive subgroups?

Mm-hmm.

Usually this refers to when the patient are, uh, develop acute manifestation that we attribute to the lupus activity.

And we know NPSLE particularly the cog- I'm talking about organic brain syndrome, psychosis, they cluster around the diagnosis of lupus, or at least within the first five years, and it, they become the s- the, then the incidence of these manifestation become lower over time, right? Uh, and again, this is when the patient manifest with symptoms as confusion, um, they don't know where they are, they don't know the time, and we refer to this as organic brain syndrome.

And this should be treated with, uh, aggressively.

Until now, we use a lot of steroid and other immunosuppressant.

So this is different than cognitive impairment.

Uh, cognitive impairment is you don't, you don't have to have organic brain syndrome or psychosis, and you don't have to have active, uh, neuropsychiatric manifestation that we know all of us within the SLEDAI activity to have cognitive impairment.

Mm-hmm