Longitudinal clinical outcomes, cognitive impairment, and mood symptoms in anti-NMDAR encephalitis (P5-5.006)

Abstract

<h3>Objective:</h3> To characterize longitudinal outcomes in anti-NMDA receptor (anti-NMDAR) encephalitis. <h3>Background:</h3> Outcomes in anti-NMDAR encephalitis are poorly understood but may be influenced by factors not adequately captured using the modified Rankin Scale (mRS). <h3>Design/Methods:</h3> This retrospective, observational cohort study examined outcome measures (mRS and clinical assessment scale in autoimmune encephalitis, CASE) in adults with anti-NMDAR-IgG in CSF at hospital discharge and long-term follow-up. Linear and logistic regression modeled outcomes. Mixed models examined predictor effects by time. Subgroups with evaluations for cognitive impairment (CI) (Montreal Cognitive Assessment or Mini-Mental State Examination) &gt;6 months from symptom onset and depression (Patient Health Questionnaire-9) and anxiety (General Anxiety Disorder-7) within 1 year of long-term follow-up were reported. Spearman correlations were examined between mood and final CASE scores. <h3>Results:</h3> Thirty-eight patients (76.3% female, median disease onset age=28 years, IQR=22–36) were included. The majority received first-(97.4%) and second-line (68.4%) immunosuppressants at a median of 3.9 weeks (IQR=2.1–9.7). Median/mean mRS and CASE were 4 (IQR=3–5) and 12.7 (SD=7) at baseline and 2 (IQR=1–3) and 4 (SD=4.1) at long-term follow-up (median=70 weeks, IQR=51–174). Both improved from baseline (p&lt;0.001). At hospital discharge (median=10 weeks, IQR=6–17), predictors of higher CASE and mRS scores included: dysautonomia, coma/lethargy, seizures/status epilepticus, and intensive care unit admission (p&lt;0.05). At long-term follow-up, only onset weakness predicted higher mRS scores (OR=5.62, CI 1.02–30.90, p=0.047). Seizures were uncommon (3%). Psychiatric morbidity was the main contributor to final CASE scores (mean=1.3, SD=0.94). In subgroup analyses, moderate-severe CI (50%), depression (29.5%), and anxiety (41.6%) were frequent. There was a correlation between depression (r=0.65, p&lt;0.01) and anxiety (r=0.79, p&lt;0.01) measures with final CASE memory sub-scores. <h3>Conclusions:</h3> Different clinical factors predict early versus long-term outcomes in anti-NMDAR encephalitis. Only onset weakness predicts long-term disability by mRS. Long-term CI and mood symptoms were frequently noted. Highlighting a complex interplay, mood symptoms correlated with CASE memory sub-scores. <b>Disclosure:</b> Dr. Morgan has nothing to disclose. Ms. Li has nothing to disclose. Nicholas Thompson has nothing to disclose. Dr. Rae-Grant has received publishing royalties from a publication relating to health care. Dr. Rae-Grant has received publishing royalties from a publication relating to health care. Dr. Abbatemarco has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for EMD Serono. Dr. Abbatemarco has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Horizon. Dr. Abbatemarco has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Genentech . The institution of Dr. Abbatemarco has received research support from Horizon. Dr. Punia has nothing to disclose. Dr. Hantus has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Eisai. Dr. Hantus has received personal compensation in the range of $0-$499 for serving as a Consultant for UCB. Rachel Galioto has nothing to disclose. Dr. Kunchok has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Genentech. Dr. Kunchok has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Horizon therapeutics . Dr. Kunchok has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Neurology.