Cognitive follow-up in anti-N-methyl-D-aspartate receptor encephalitis: Hospital discharge, 4, 8, and 12 months

Bayliss, Leo; Moctezuma Sandoval, Andrea; Nava, Alan; Diaz-Victoria, Ana Ruth; Espinola-Nadurille, Mariana; Ramírez-Bermúdez, Jesús; Gálvez , Víctor

doi:10.1016/j.clineuro.2023.107701

Cognitive follow-up in anti-N-methyl-D-aspartate receptor encephalitis: Hospital discharge, 4, 8, and 12 months

Journal

Clinical Neurology and Neurosurgery

ISSN

0303-8467

Publisher

Elsevier

Date Issued

2023

Author(s)

Bayliss, Leo

Moctezuma Sandoval, Andrea

Facultad de Ciencias de la Salud - CampCM

Nava, Alan

Diaz-Victoria, Ana Ruth

Espinola-Nadurille, Mariana

Ramírez-Bermúdez, Jesús

Gálvez , Víctor

Facultad de Ciencias de la Salud - CampCM

Type

text::journal::journal article

DOI

10.1016/j.clineuro.2023.107701

URL

https://scripta.up.edu.mx/handle/20.500.12552/3614

Abstract

Introduction: Cognitive dysfunction is a core symptom in patients with Anti-N-methyl-D-aspartate (NMDA) receptor encephalitis (ANMDARE). In stark contrast to the good functional (neurological) outcome observed in most ANMDARE patients (81%) after 18 months of hospital discharge, 80% of patients exhibit moderate or severe cognitive impairment even two years after the acute phase. Despite clinical features during the recovery phase having been widely characterized, our understanding of cognitive recovery during the first year remains incomplete since most reports have cross-sectional study designs or small sample sizes in which the administered neuropsychological tests and follow-up times (when available) are heterogeneous. To sum up the main cognitive reports, neuropsychological cross-sectional studies have revealed deficits related to attention, language, visuospatial function, and episodic and working memory. Nevertheless, longitudinal and systematic neuropsychological assessments reveal a wider picture. According to a recent study of 43 ANMDARE patients, moderate or severe cognitive impairments persisted for an average 2.3 years after onset, mainly in memory and executive function domains. Significant improvements were observed in neuropsychological performance after 4.9 years, but 2/3 of patients still had moderate to severe deficits despite favorable neurological outcomes. However, this approach does not provide information on the evolution of cognitive functions until 2 years after the acute stage. Therefore, detailed cognitive outcomes during the first year are still lacking. We aim to describe the cognitive outcomes in ANMDARE patients through a comprehensive neuropsychological assessment at hospital discharge as well as after 4, 8, and 12 months.