Department of Old Age Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
School of Clinical Medicine, Addenbrooke's Hospital, University of Cambridge, Hills Rd, Cambridge, CB2 0SP, UK.
J Neurol. 2021 Aug;268(8):2769-2779. doi: 10.1007/s00415-020-09825-0. Epub 2020 Apr 18.
Neuronal antibodies can cause encephalopathy syndromes often presenting with subacute cognitive impairment, sometimes resembling neurodegenerative dementias.
We searched Medline and Embase for studies reporting associations between neuronal surface antibodies in all-cause dementia versus controls. Random-effects meta-analysis was used to pool adjusted estimates across studies.
Six studies were included, all reporting frequency of serum NMDAR antibodies in dementia with four also reporting frequency in atypical dementias. Both IgG [OR = 8.09 (1.51; 56.85), p = 0.036] and IgA/IgM NMDAR antibodies [OR = 42.48 (11.39; 158.52), p < 0.001] were associated with atypical dementia, but neither were associated with all-cause dementia.
In the first meta-analysis to explore this literature, serum IgG and IgA/IgM NMDAR antibodies were significantly more common in atypical dementias. However, methodological issues and small-sample sizes necessitate caution interpreting this result. Further studies measuring both serum and CSF antibodies are needed to investigate the role of neuronal antibodies in dementia, since evidence of pathogenicity in even a subset of patients could pave the way for novel treatment options.
神经元抗体可引起脑病综合征，常表现为亚急性认知障碍，有时类似于神经退行性痴呆。
我们在 Medline 和 Embase 中搜索了所有原因导致的痴呆症与对照组之间神经元表面抗体相关的研究。使用随机效应荟萃分析来汇总研究间的调整估计值。
共纳入 6 项研究，均报告了血清 NMDAR 抗体在痴呆症中的频率，其中 4 项还报告了血清 NMDAR 抗体在非典型性痴呆症中的频率。无论是 IgG [OR=8.09 (1.51; 56.85)，p=0.036] 还是 IgA/IgM NMDAR 抗体 [OR=42.48 (11.39; 158.52)，p<0.001]，均与非典型性痴呆症相关，但与所有原因导致的痴呆症均无关。
这是首次探索该文献的荟萃分析，血清 IgG 和 IgA/IgM NMDAR 抗体在非典型性痴呆症中更为常见。然而，方法学问题和样本量小限制了对该结果的解释。需要进一步研究测量血清和 CSF 抗体，以研究神经元抗体在痴呆症中的作用，因为即使在部分患者中存在致病性证据，也可能为新的治疗选择铺平道路。
