{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,5,16]],"date-time":"2025-05-16T04:11:48Z","timestamp":1747368708949,"version":"3.40.5"},"reference-count":17,"publisher":"American Academy of Insurance Medicine","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2016]]},"abstract":"<jats:p>This case report describes a 52-year-old, female applicant for long term-care insurance with a history of an autoimmune connective tissue disease initially diagnosed as systemic lupus erythematosus (SLE). Over several years, the signs and symptoms evolved into a clear diagnosis of primary Sj\u00f6gren\u2019s syndrome (PSS). The specific criteria for this diagnosis are reviewed including the symptoms, antinuclear antibodies (ANA), extractable nuclear antigen antibodies (ENA), abnormal salivary scintigraphy and positive Schirmer test. Symptoms of neuropathy and the possibility of a cognitive dysfunction are discussed as part of PSS. The association of white matter lesions (WML) with PSS is significant for underwriting consideration.<\/jats:p>","DOI":"10.17849\/0743-6661-46.1.27","type":"journal-article","created":{"date-parts":[[2016,4,13]],"date-time":"2016-04-13T16:24:00Z","timestamp":1460564640000},"page":"27-33","source":"Crossref","is-referenced-by-count":0,"title":["Primary Sj\u00f6gren\u2019s Syndrome White Matter Changes and Cognitive Dysfunction"],"prefix":"10.17849","volume":"46","author":[{"given":"Mary","family":"Dess","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wayne F.","family":"Heidenreich","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"7324","reference":[{"issue":"6","key":"i0743-6661-46-1-27-r1","series-title":"Annals of the Rheumatic Diseases","doi-asserted-by":"publisher","first-page":"554","DOI":"10.1136\/ard.61.6.554","article-title":"Classification criteria for Sj\u00f6gren's syndrome: a revised version of the European criteria proposed by the American-European Consensus Group","volume":"61","author":"Vitali\n              C,","year":"2002","unstructured":"Vitali\n              C, \n            \n              Bombardieri\n              S, \n            \n              Jonsson\n              R, \n          \n          et al. Classification criteria for Sj\u00f6gren's syndrome: a revised version of the European criteria proposed by the American-European Consensus Group. Annals of the Rheumatic Diseases. 2002;61(6):554\u2013558. doi: 10.1136\/ard.61.6.554."},{"key":"i0743-6661-46-1-27-r2","unstructured":"Sj\u00f6gren syndrome Clinical Presentation. Accessed at: http:\/\/emedicine.medscape.com\/article\/332125-clinical Accessed on November 10, 2015."},{"key":"i0743-6661-46-1-27-r3","series-title":"Rheumatology secrets","author":"West\n              S.","year":"2002","unstructured":"West\n              S.\n            \n          \n          Rheumatology secrets. Philadelphia, PA: Hanley & Belfus, Inc., 2002."},{"issue":"1","key":"i0743-6661-46-1-27-r4","series-title":"PLoS One","doi-asserted-by":"publisher","first-page":"e84605","DOI":"10.1371\/journal.pone.0084605","article-title":"Neurological involvement in primary Sj\u00f6gren syndrome","volume":"9","author":"Morreale\n              M,","year":"2014","unstructured":"Morreale\n              M, \n            \n              Marchione\n              P, \n            \n              Giacomini\n              P, \n          \n          et al. Neurological involvement in primary Sj\u00f6gren syndrome. PLoS One. 2014;9(1):e84605. doi: 10.1371\/journal.pone.0084605, 2014."},{"key":"i0743-6661-46-1-27-r5","series-title":"Retinal Toxicity of Systemic Drugs in Principles and Practice of Ophthlmology","author":"Weinberg\n              D,","year":"2000","unstructured":"Weinberg\n              D, \n            \n              Jones\n              BE.\n            \n          \n          Retinal Toxicity of Systemic Drugs in Principles and Practice of Ophthlmology. 2nd ed.Philadelphia, PA: W.B. Saunders Company, 2000."},{"key":"i0743-6661-46-1-27-r6","series-title":"UptoDate Medicine","article-title":"Clinical manifestations of Sj\u00f6gren\u2019s syndrome: Extraglandular disease","author":"Fox\n              R,","unstructured":"Fox\n              R, \n            \n              Moschella\n              S.\n            \n          \n          Clinical manifestations of Sj\u00f6gren\u2019s syndrome: Extraglandular disease, UptoDate Medicinewww.uptodate.com Updated on June 5, 2015. 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Medicine. 2004;83 (5):280\u2013291."},{"key":"i0743-6661-46-1-27-r8","series-title":"Journal of Neurology","first-page":"577","article-title":"Neurological complications of primary Sj\u00f6gren's syndrome","volume":"248","author":"Lafitte\n              C,","year":"2001","unstructured":"Lafitte\n              C, \n            \n              Amoura\n              Z, \n            \n              Cacoub\n              P, \n          \n          et al. Neurological complications of primary Sj\u00f6gren's syndrome. Journal of Neurology. 2001;248:577\u2013584."},{"key":"i0743-6661-46-1-27-r9","series-title":"The Neurologist","doi-asserted-by":"publisher","first-page":"287","DOI":"10.1097\/nrl.0b013e3181ebe59f","article-title":"Peripheral nervous system manifestations of Sj\u00f6gren syndrome","volume":"16","author":"Birnbaum\n              J.","year":"2010","unstructured":"Birnbaum\n              J.\n            \n          \n          Peripheral nervous system manifestations of Sj\u00f6gren syndrome. The Neurologist. 2010;16:287\u2013297. doi: 10.1097\/nrl.0b013e3181ebe59f."},{"key":"i0743-6661-46-1-27-r10","series-title":"Annals of the Rheumatic Diseases","first-page":"616","article-title":"Central nervous system involvement in Sj\u00f6gren\u2019s syndrome","volume":"63","author":"Soliotis\n              FC,","year":"2004","unstructured":"Soliotis\n              FC, \n            \n              Mavragani\n              CP, \n            \n              Moutsopoulos\n              HM.\n            \n          \n          Central nervous system involvement in Sj\u00f6gren\u2019s syndrome. Annals of the Rheumatic Diseases. 2004;63:616\u2013620."},{"key":"i0743-6661-46-1-27-r11","series-title":"ISRN Neurology","doi-asserted-by":"publisher","DOI":"10.1155\/2013\/501327","article-title":"Cognitive dysfunction and dementia in primary Sj\u00f6gren\u2019s syndrome","author":"Blanc\n              F,","year":"2013","unstructured":"Blanc\n              F, \n            \n              Longato\n              N, \n            \n              Jung\n              B, \n          \n          et al. Cognitive dysfunction and dementia in primary Sj\u00f6gren\u2019s syndrome. ISRN Neurology. 2013. doi:10.1155\/2013\/501327."},{"key":"i0743-6661-46-1-27-r12","series-title":"Acta Neurologica Scandinavica","first-page":"272","article-title":"Primary Sj\u00f6gren's syndrome: cognitive symptoms, mood, and cognitive performance","volume":"125","author":"Segal\n              BM,","year":"2012","unstructured":"Segal\n              BM, \n            \n              Pogatchnik\n              B, \n            \n              Holker\n              E, \n          \n          et al. Primary Sj\u00f6gren's syndrome: cognitive symptoms, mood, and cognitive performance. 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Doi 10.1007\/s00415-003-0153-x."},{"issue":"1","key":"i0743-6661-46-1-27-r15","series-title":"Annals of the Rheumatic Disease.","first-page":"132","article-title":"Cognitive function and 99mTc-ECD brain SPECT are significantly correlated in patients with primary Sj\u00f6gren syndrome: a case-control study","volume":"69","author":"Le Guern\n              V,","year":"2010","unstructured":"Le Guern\n              V, \n            \n              Belin, C, \n            \n              Henegar\n              C, \n          \n          et al. Cognitive function and 99mTc-ECD brain SPECT are significantly correlated in patients with primary Sj\u00f6gren syndrome: a case-control study. 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