Cognitive deficits following anti-NMDA receptor encephalitis

• Published in: Journal of neurology, neurosurgery and psychiatry Vol. 83; no. 2; pp. 195 - 198
• Main Authors: Finke, Carsten, Kopp, Ute A, Prüss, Harald, Dalmau, Josep, Wandinger, Klaus-Peter, Ploner, Christoph J
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group Ltd 01.02.2012; BMJ Publishing Group; BMJ Publishing Group LTD
• Subjects: Adult; Anti-N-Methyl-D-Aspartate Receptor Encephalitis - etiology; Anti-N-Methyl-D-Aspartate Receptor Encephalitis - psychology; Autoantibodies - analysis; Autoantibodies - blood; Autoantibodies - cerebrospinal fluid; Autoimmune Diseases - complications; Autoimmune Diseases - psychology; Biological and medical sciences; Brain - pathology; Brain damage; Cerebrospinal fluid; clinical neurology; cognition; Cognition Disorders - etiology; Cognition Disorders - psychology; cognitive neuropsychology; Color Perception - physiology; dementia; Encephalitis; Executive function; eye movements; Female; Hippocampus - physiopathology; Humans; Immunoglobulins; immunology; Immunotherapy; Injuries of the nervous system and the skull. Diseases due to physical agents; Intensive care; Learning Disabilities - etiology; Learning Disabilities - psychology; limbic system; Magnetic Resonance Imaging; Male; Medical sciences; Memory; Memory Disorders - etiology; Memory Disorders - psychology; neuroanatomy; Neurology; neurooncology; Neuropsychological Tests; Neuropsychology; NMDA; Ovaries; paraneoplastic syndrome; Patients; Psychomotor Performance - physiology; Receptors, N-Methyl-D-Aspartate - immunology; Traumas. Diseases due to physical agents; Whipple's disease; Young Adult; Encephalitis; Nervous system diseases; Cognitive disorder; Central nervous system disease; Glutamate receptor; NMDA receptor; Cerebral disorder
• ISSN: 0022-3050; 1468-330X
• DOI: 10.1136/jnnp-2011-300411

BackgroundAnti-NMDA receptor (NMDAR) encephalitis is a recently characterised autoimmune disorder mainly affecting young women. Although the clinical features of the acute disease are well characterised, cognitive long-term outcome has not been examined in detail.MethodsThe authors investigated cognitive performance in nine patients with proven anti-NMDAR encephalitis after recovery from the acute disease period (median 43 months after disease onset, range 23 to 69). Patients underwent a comprehensive neuropsychological assessment, including memory tasks that have previously been shown to be sensitive for hippocampal dysfunction.ResultsSubstantial persistent cognitive impairments were observed in eight out of nine patients that mainly consisted of deficits in executive functions and memory. The severity of these deficits varied inter-individually. Patients with early immunotherapy performed significantly better. The most severe deficits were observed with inefficient or delayed initial treatment.ConclusionOur results suggest that cognitive deficits constitute a major long-term morbidity of anti-NMDAR encephalitis. These deficits relate to the distribution of NMDARs in the human brain and their functional role in normal cognition. Good cognitive long-term outcome may depend on early and aggressive treatment.