Abstract
Objective: To observe the dynamic characteristics of cognitive function following early application of immunotherapy in adult patients with severe anti N-methyl D-aspartate receptor (anti-NMDAR) encephalitis.Methods: Serial neuropsychological assessments were performed at three sequential time points in five adult patients with severe anti-NMDAR encephalitis following early-initiated immunotherapy. The three sequential points were 1–2, 6, and 11–12 months after treatment. Five normal subjects without psychological or neurological diseases were assessed as a control group.Results: Following early-initiated immunotherapy, all five patients demonstrated a gradual improvement of overall cognitive function over the 1-year follow-up period. All patients had suffered from a comprehensive cognitive function disorder from the early stages of the illness. Six months after the immunotherapy, the treatment group showed no significant differences in verbal episodic memory function compared with the control group. One year after the immunotherapy, non-verbal episodic memory function in the treatment group had normalized. The results of other tests related to frontoparietal cognitive function revealed damage of varying degrees during these three phases.Conclusion: The results of this sequential observation study indicated a three-phase recovery pattern of cognitive function in adult patients with severe anti-NMDAR encephalitis following early initiated immunotherapy. These findings extend current understanding of the recovery mechanisms of cognitive function impairment in this disease.
Highlights
Comprehensive cognitive function impairment is one of the major symptoms in the early stages of anti N-methyl D-aspartate receptor encephalitis [1]
At T1, the patients exhibited significant impairments in Mini-Mental State Examination (MMSE) (t = 4.00, p = 0.002) and Montreal Cognitive Assessment (MoCA) (t = 4.40, p = 0.007) scores compared with healthy controls (HCs)
At T2, the patients only demonstrated a significant impairment in the MoCA (t = −3.54, p = 0.008), whereas at T3, there were no significant differences between patients and HCs in MMSE and MoCA scores (Table 3, Figure 1)
Summary
Comprehensive cognitive function impairment is one of the major symptoms in the early stages of anti N-methyl D-aspartate receptor (anti-NMDAR) encephalitis [1]. Approximately 80% of patients receiving timely immunotherapy present with modified Rankin Scores (mRS) in the lower range [1], many patients are left with persistent cognitive deficits, predominantly in the domains of episodic memory, attention, and executive control, which can eventually become long-term consequences of the disease [2, 3]. The study concluded that over 75% of the patients had cognitive deficits, and the rates of performance impairments on tests of executive functioning, episodic memory, and processing speed were unrelated to assessment timing [6]. Most attention has been paid to the characteristics of cognitive function impairment in the chronic stages of the disease, regarding the assessment of verbal episodic memory and executive control. Few studies have focused on nonverbal episodic memory and the dynamic characteristics of the progress of cognitive function recovery
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