Psychometric deficits in autoimmune encephalitis: A retrospective study from the Australian Autoimmune Encephalitis Consortium.
autoimmune diseases
autoimmune encephalitis
cognitive outcomes
neuropsychology
Journal
European journal of neurology
ISSN: 1468-1331
Titre abrégé: Eur J Neurol
Pays: England
ID NLM: 9506311
Informations de publication
Date de publication:
08 2022
08 2022
Historique:
received:
21
03
2022
accepted:
13
04
2022
pubmed:
24
4
2022
medline:
19
7
2022
entrez:
23
4
2022
Statut:
ppublish
Résumé
Despite the rapid increase in research examining outcomes in autoimmune encephalitis (AE) patients, there are few cohort studies examining cognitive outcomes in this population. The current study aimed to characterise psychometric outcomes in this population, and explore variables that may predict psychometric outcomes. This retrospective observational study collected psychometric data from 59 patients across six secondary and tertiary referral centres in metropolitan hospitals in Victoria, Australia between January 2008 and July 2019. Frequency and pattern analysis were employed to define and characterize psychometric outcomes. Univariable logistic regression was performed to examine predictors of intact and pathological psychometric outcomes. Deficits in psychometric markers of executive dysfunction were the most common finding in this cohort, followed by deficits on tasks sensitive to memory. A total of 54.2% of patients were classified as having psychometric impairments across at least two cognitive domains. Twenty-nine patterns were observed, suggesting outcomes in AE are complex. None of the demographic data, clinical features or auxiliary examination variables were predictors of psychometric outcome. Cognitive outcomes in AE are complex. Further detailed and standardized cognitive testing, in combination with magnetic resonance imaging volumetrics and serum/cerebrospinal fluid biomarkers, is required to provide rigorous assessments of disease outcomes.
Sections du résumé
BACKGROUND AND PURPOSE
Despite the rapid increase in research examining outcomes in autoimmune encephalitis (AE) patients, there are few cohort studies examining cognitive outcomes in this population. The current study aimed to characterise psychometric outcomes in this population, and explore variables that may predict psychometric outcomes.
METHODS
This retrospective observational study collected psychometric data from 59 patients across six secondary and tertiary referral centres in metropolitan hospitals in Victoria, Australia between January 2008 and July 2019. Frequency and pattern analysis were employed to define and characterize psychometric outcomes. Univariable logistic regression was performed to examine predictors of intact and pathological psychometric outcomes.
RESULTS
Deficits in psychometric markers of executive dysfunction were the most common finding in this cohort, followed by deficits on tasks sensitive to memory. A total of 54.2% of patients were classified as having psychometric impairments across at least two cognitive domains. Twenty-nine patterns were observed, suggesting outcomes in AE are complex. None of the demographic data, clinical features or auxiliary examination variables were predictors of psychometric outcome.
CONCLUSIONS
Cognitive outcomes in AE are complex. Further detailed and standardized cognitive testing, in combination with magnetic resonance imaging volumetrics and serum/cerebrospinal fluid biomarkers, is required to provide rigorous assessments of disease outcomes.
Types de publication
Journal Article
Observational Study
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
2355-2366Informations de copyright
© 2022 European Academy of Neurology.
Références
Graus F, Titulaer MJ, Balu R, et al. A clinical approach to diagnosis of autoimmune encephalitis. Lancet Neurol. 2016;15(4):391-404.
Sechi E, Flanagan EP. Antibody-mediated autoimmune diseases of the CNS: challenges and approaches to diagnosis and management. Front Neurol. 2021;7(12):673339.
Graus F, Escudero D, Oleaga L, et al. Syndrome and outcome of antibody-negative limbic encephalitis. Eur J Neurol. 2018;25(8):1011-1016.
Shin Y-W, Lee S-T, Park K-I, et al. Treatment strategies for autoimmune encephalitis. Ther Adv Neurol Disord. 2018;11:1756285617722347.
Broadley J, Seneviratne U, Beech P, et al. Prognosticating autoimmune encephalitis: a systematic review. J Autoimmun. 2018;2019(96):24-34.
Broderick JP, Adeoye O, Elm J. Evolution of the modified Rankin scale and its use in future stroke trials. Stroke. 2017;48(7):2007-2012.
Heine J, Kopp UA, Klag J, Ploner CJ, Prüss H, Finke C. Long-term cognitive outcome in anti-NMDA receptor encephalitis. Ann Neurol. 2021;90:949-961.
Griffith SP, Malpas CB, Kyndt C, Alpitsis R, O'Brien TJ, Monif M. Cognition and psychopathology in autoimmune encephalitides-a focus on risk factors and patient outcomes. Clin Exp Neuroimmunol. 2021;12(3):182-191.
Broadley J, Wesselingh R, Seneviratne U, et al. Peripheral immune cell ratios and clinical outcomes in seropositive autoimmune encephalitis: a study by the Australian Autoimmune Encephalitis Consortium. Front Immunol. 2020;11:597858.
Fisher RS, Cross JH, French JA, et al. Operational classification of seizure types by the international league against epilepsy: position paper of the ILAE commission for classification and terminology. Epilepsia. 2017;58(4):522-530.
Trinka E, Cock H, Hesdorffer D, et al. A definition and classification of status epilepticus-Report of the ILAE task force on classification of status epilepticus. Epilepsia. 2015;56(10):1515-1523.
Ryan JJ, Lopez SJ. Wechsler Adult Intelligence Scale-III BT - Understanding Psychological Assessment. In: Dorfman WI, Hersen M, editors. Springer US; 2001:19-42. 10.1007/978-1-4615-1185-4_2
Wechsler D. Wechsler Adult Intelligence Scale-Fourth Edition (WAIS- IV). Pearson; 2008.
Wechsler D. Wechsler Memory Scale-Fourth Edition (WMS-IV) technical and interpretive manual. Pearson; 2009.
Randolph C, Tierney MC, Mohr E, Chase TN. The repeatable battery for the assessment of neuropsychological status (RBANS): preliminary clinical validity. J Clin Exp Neuropsychol. 1998;20(3):310-319.
Tombaugh TN. Trail making test A and B: normative data stratified by age and education. Arch Clin Neuropsychol. 2004;19(2):203-214.
Delis DC, Kaplan E, Kramer JH. Delis-Kaplan Executive Function System®(D-KEFS®): Examiner's Manual: Flexibility of Thinking, Concept Formation, Problem Solving, Planning, Creativity, Impluse Control, Inhibition. Pearson; 2001.
D'Elia L, Satz P, Uchiyama CL, White T. Color trails test. PAR; 1996.
Kaplan E, Goodglass H, Weintraub S. Boston naming test; 2001.
Strauss E, Sherman EM, Spreen O. A Compendium of Neuropsychological Tests: Administration, Norms, and Commentary. American Chemical Society; 2006.
Delis DC, Kaplan E, Kramer JH. Delis-Kaplan executive function system; 2001.
Meyers JE, Meyers KR. Rey Complex Figure Test and Recognition Trial. Psychological Assessment Resources; 1995.
Lezak MD, Howieson DB, Loring DW, Hannay JH, Fischer JS. Neuropsychological Assessment. Oxford University Press; 2004.
Wechsler D. A standardized memory scale for clinical use. J Psychol. 1945;19(1):87-95.
Elwood RW. The Wechsler memory scale-revised: psychometric characteristics and clinical application. Neuropsychol Rev. 1991;2(2):179-201.
Millis SR, Malina AC, Bowers DA, Ricker JH. Confirmatory factor analysis of the Wechsler Memory Scale-III. J Clin Exp Neuropsychol. 1999;21(1):87-93.
Woods SP, Delis DC, Scott JC, Kramer JH, Holdnack JA. The California verbal learning test-second edition: test-retest reliability, practice effects, and reliable change indices for the standard and alternate forms. Arch Clin Neuropsychol. 2006;21(5):413-420.
Benedict RHB, Schretlen D, Groninger L, Brandt J. Hopkins verbal learning test-revised: normative data and analysis of inter-form and test-retest reliability. Clin Neuropsychol. 1998;12(1):43-55.
Schmidt M. Rey auditory verbal learning test: A handbook. Western Psychological Services; 1996.
Bucks RS. Trail-Making Test BT - Encyclopedia of Behavioral Medicine. In: Gellman MD, Turner JR, editors. Springer New York; 2013:1986-1987. 10.1007/978-1-4419-1005-9_1538
Burgess PW, Shallice T. The Hayling and Brixton Tests. UK Thames Val Test Co; 1997.
Gibson LL, McKeever A, Coutinho E, Finke C, Pollak TA. Cognitive impact of neuronal antibodies: encephalitis and beyond. Transl Psychiatr. 2020;10:304. doi:10.1038/s41398-020-00989-x
Dalmau J, Gleichman AJ, Hughes EG, et al. Anti-NMDA-receptor encephalitis: case series and analysis of the effects of antibodies. Lancet Neurol. 2008;7(12):1091-1098.
Hughes EG, Peng X, Gleichman AJ, et al. Cellular and synaptic mechanisms of anti-NMDA receptor encephalitis. J Neurosci. 2010;30(17):5866-5875. 10.1523/JNEUROSCI.0167-10.2010
Zrzavy T, Endmayr V, Bauer J, et al. Neuropathological variability within a spectrum of NMDAR-encephalitis. Ann Neurol. 2021;90:725-737.
Helmstaedter C, Hansen N, Leelaarporn P, et al. Specific B- and T-cell populations are associated with cognition in patients with epilepsy and antibody positive and negative suspected limbic encephalitis. J Neurol. 2021;268(2):455-466.
Heine J, Pruss H, Kopp UA, et al. Beyond the limbic system: disruption and functional compensation of large-scale brain networks in patients with anti-LGI1 encephalitis. J Neurol Neurosurg Psychiatry. 2018;89(11):1191-1199.
Mueller C, Langenbruch LM, Rau JMH, et al. Determinants of cognition in autoimmune limbic encephalitis-A retrospective cohort study. Hippocampus. 2021;31(10):1092-1103.
De Meo E, Portaccio E, Giorgio A, et al. Identifying the distinct cognitive phenotypes in multiple sclerosis. JAMA Neurol. 2021;78(4):414-425.
McKeon GL, Scott JG, Spooner DM, et al. Cognitive and social functioning deficits after Anti-N-Methyl-D-aspartate receptor encephalitis: an exploratory case series. J Int Neuropsychol Soc. 2016;22(8):828-838.
Finke C, Prüss H, Heine J, et al. Evaluation of cognitive deficits and structural hippocampal damage in encephalitis with leucine-rich, glioma-inactivated 1 antibodies. JAMA Neurol. 2017;74(1):50-59.