Department of Neurology, West China Hospital, Sichuan University, Chengdu, China.
Department of Pathology, University of Washington School of Medicine, Seattle, WA, USA.
Acta Neurol Scand. 2019 Dec;140(6):414-421. doi: 10.1111/ane.13160. Epub 2019 Oct 10.
To evaluate the long-term cognitive or neuropsychiatric outcomes and potential risk factors associated with prolonged cognitive deficits or neuropsychiatric symptoms in patients with anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis.
In this cohort follow-up study, patients with a definitive diagnosis of anti-NMDAR encephalitis from the inpatient of West China Hospital between June 2012 and December 2017 were included and underwent a prospective cognitive and neuropsychiatric assessment every 3 months by cognitive impairment rating scale, Neuropsychiatric Inventory (NPI) and/or Montreal Cognitive Assessment.
Up to 97.5% patients had severe cognitive deficits and neuropsychiatric symptoms in acute phase. Decreasing proportion of patients with prolonged cognitive deficits was observed and time dependent. At 2 years' follow-up, 7.8% of patients with cognitive deficits were unable to complete some previous activities or return to work. The risk factors associated with persistent cognitive deficits included age of disease onset over 40 years old (HR, 1.77; 95% CI, 1.11-2.82; P = .01) and with clinical relapses (HR, 2.22; 95% CI, 1.21-4.09; P = .02). The predictors of prolonged neuropsychiatric symptoms included clinical relapses (HR, 2.79; 95% CI, 1.21-6.43; P = .02). Among the 12 neuropsychiatric symptoms of NPI, irritability was shown as the most prevalent and persistent.
Combined cognitive and neuropsychiatric assessment and intervention are essential elements of comprehensive care of anti-NMDAR encephalitis.
评估抗 N-甲基-D-天冬氨酸受体（抗 NMDAR）脑炎患者长期认知或神经精神结局，以及与认知功能障碍或神经精神症状持续相关的潜在危险因素。
本队列随访研究纳入了 2012 年 6 月至 2017 年 12 月期间在华西医院住院的明确诊断为抗 NMDAR 脑炎的患者，并通过认知障碍评定量表、神经精神问卷（NPI）和/或蒙特利尔认知评估，每 3 个月进行一次前瞻性认知和神经精神评估。
急性期，97.5%的患者有严重的认知功能障碍和神经精神症状。观察到持续存在认知功能障碍的患者比例随时间减少。在 2 年随访时，有认知功能障碍的患者中，7.8%无法完成之前的一些活动或恢复工作。与持续认知功能障碍相关的危险因素包括起病年龄>40 岁（HR，1.77；95%CI，1.11-2.82；P=0.01）和临床复发（HR，2.22；95%CI，1.21-4.09；P=0.02）。持续神经精神症状的预测因素包括临床复发（HR，2.79；95%CI，1.21-6.43；P=0.02）。在 NPI 的 12 种神经精神症状中，易激惹是最常见和持续存在的。
综合认知和神经精神评估及干预是抗 NMDAR 脑炎全面治疗的重要组成部分。
