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Objectives To characterize patient-reported cognitive difficulties using the Perceived Deficits Questionnaire-20 (PDQ-20) in systemic lupus erythematosus (SLE), and to assess its relationship with objective cognitive impairment (CI) measured by the American College of Rheumatology Neuropsychological Battery (ACR-NB).Methods This cross-sectional study included adult SLE patients from a single-center cohort who completed both the PDQ-20 and ACR-NB at the time. Subjective cognitive symptoms were analyzed by individual PDQ-20 items and grouped into four cognitive domains. Objective CI was defined using established ACR-NB thresholds across six cognitive domains. Concurrent construct validity and known-group validity of the PDQ-20 and ACR-NB were studied.Results Among 214 participants, the most frequently patient-reported cognitive difficulties from the PDQ-20 items involved attention, working memory, and planning (e.g., mind wandering, forgetting names or tasks). Correlations between PDQ-20 and ACR-NB scores were generally weak. The strongest association was between PDQ-20 items related to working memory and ACR-NB test 6.5 (Auditory Consonant Trigrams; r ~= -0.29). Patients with objective CI had slightly higher PDQ-20 scores than non-CI patients (33.4 vs. 29.3, respectively; p=0.15), though both groups reported high cognitive symptom burden. No statistically significant differences were observed between the PDQ-20 CI and non-CI groups as determined by ACR-NB.Abstract PO:07:181 Figure 1Breakdown of scores per individual PDQ-20 item by question number stratified by CI vs. non-CI as determined by the ACR-NB, where 0 = never, 1 = rarely, 2 = sometimes, 3 = often, and 4 = almost always. Those with indeterminate CI were excluded from this analysis.Conclusions SLE patients frequently report subjective cognitive difficulties, particularly in attention and working memory, which weakly correlate with objective cognitive testing. The PDQ-20 helped identifying patients experiencing and the severity of CI symptoms. The lack of association between objective and subjective CI supports the assessment of both objective and subjective cognitive function to ensure a breadth and depth approach to cognitive function in SLE.