The ACR 1999 nomenclature defined CD as including a significant deficit in any or all of the following cognitive domains: simple or complex attention, reasoning, executive skills, memory, visual-spatial processing, language and psychomotor speed [
17]. Among these, in SLE, language and working memory domains are most commonly affected, followed by simple attention and psychomotor speed [
3]. Rayes et al. [
3] presented a comprehensive meta-analysis evaluating different neurocognitive testing tools used to assess CD in SLE. While the 4-h, complete battery of neurocognitive testing is the most comprehensive, it is not feasible for routine assessments of patients in the clinical setting. A number of alternative modalities have been utilised with varying degrees of agreements with the complete neurocognitive testing battery, including the ACR-SLE battery [
17], a 1-h battery of tests that focus on SLE-specific domains that show good agreement with the complete battery in healthy controls and SLE patients without NPSLE (96% and 95% agreement, respectively, with 100% sensitivity in both groups, and 96% specificity in controls and 94% in SLE without NPSLE), but only moderate agreement in patients with NPSLE (81% agreement, with 80% sensitivity and 81% specificity) [
31]. While the ACR-SLE battery has been shown to be a relatively good CD evaluating tool in SLE patients, its main barrier is the significant time and resources it requires for administration, making it challenging for routine use. The Automated Neuropsychological Assessment Metric (ANAM) is a 40-min, self-administered computerised test that has been validated in multi-ethnic populations and is less influenced by age, education, English language proficiency and depression than other forms of neurocognitive testing [
32,
33]. When compared to the ACR-SLE battery, the ANAM was found to have a sensitivity of 78–80% and specificity of 70% [
32,
33], demonstrating promise as a possible CD screening method. The ANAM, however, needs further analysis of its capacity to monitor changes in CD over time and is thought to lack the ability to identify specific domain impairments [
3]. Finally, the MoCA test, already mentioned above, is a brief, 15-min administered test that showed acceptable agreement with the ANAM (sensitivity 83% and specificity 73%) but requires more extensive validation prior to clinical and investigational use [
34]. Identifying and validating a reliable screening and monitoring tool for CD that is both sensitive and specific, as well as technically feasible in the clinical setting, are of the utmost importance. Relying on patients’ self-reporting is clearly inadequate, especially as studies comparing patient self-reporting to objective findings of CD found no association between the two, most probably because self-perception of CD is often closely associated with depression and anxiety [
35]. It is also important to emphasise that these tests may be useful for the identification and quantification of CD, but are not specific for NPSLE, and do not allow the discerning of primary SLE-related CD from any other confounding causes.