Hansen Niels, Hirschel Sina, Rentzsch Kristin, Wiltfang Jens, Malchow Berend, Fitzner Dirk
Department of Psychiatry and Psychotherapy, University Medical Center Göttingen, Göttingen, Germany.
Clinical Immunological Laboratory Prof. Dr. med. Winfried Stöcker, Lübeck, Germany.
Front Aging Neurosci. 2022 Sep 27;14:856876. doi: 10.3389/fnagi.2022.856876. eCollection 2022.
Anti-neural autoantibody-associated cognitive impairment is an increasing phenomenon in memory clinics deserving more attention to applying immunotherapy such as methylprednisolone to improve cognition. Our study aims to investigate the usefulness of intravenous high-dosage corticosteroids in a small cohort of patients suffering from anti-neural autoantibody-associated cognitive impairment.
We included in our retrospective case series seven patients presenting diverse neural autoantibodies and cognitive impairments varying from a mild impairment to dementia. We conducted neuropsychological and psychopathological investigations before and after the application of high intravenous methylprednisolone therapy over a 6-month period. Neuropsychological function was assessed by the CERAD (Consortium to Establish a Registry for Alzheimer's Disease) test battery. Patients were also characterized by assessing their patient files for demographic and clinical data.
The patients' cognitive subdomains did not improve according to CERAD in their z-scores before and after immunotherapy. We noted a non-significant trend toward an improvement in semantic fluency and verbal memory consolidation. Patients did not do worse in 4 of 12 (33%) cognitive subdomains in the CERAD test battery. Furthermore, mood dysfunction lessened as a non-significant trend in specific psychopathological features such as reduced affective symptoms, loss of drive, and ruminations. Affective symptoms, loss of drive and ruminations were reduced by 43% after immunotherapy.
Our small pilot study revealed no relevant alleviation of cognitive dysfunction in patients with neural autoantibodies. However, mood dysfunction became less obvious in specific functions concerning affect, drive, and rumination. However, we do not know whether methylprednisolone affects mood dysfunction, as some patients were taking antidepressant drugs at the same time. Our results might indicate that methylprednisolone immunotherapy is associated with impeding the progression of cognitive dysfunction and reducing mood dysfunction. Further large-scale, placebo-controlled studies in a more homogeneous patient population presenting a uniform pattern of neural autoantibodies should be undertaken.
抗神经自身抗体相关的认知障碍在记忆门诊中日益常见，在应用免疫疗法（如甲泼尼龙）改善认知方面值得更多关注。我们的研究旨在调查静脉注射高剂量皮质类固醇对一小群患有抗神经自身抗体相关认知障碍患者的有效性。
我们纳入了一项回顾性病例系列研究，其中有7名患者，他们存在不同的神经自身抗体和认知障碍，程度从轻度损害到痴呆不等。在为期6个月的高剂量静脉注射甲泼尼龙治疗前后，我们进行了神经心理学和精神病理学调查。神经心理学功能通过CERAD（阿尔茨海默病注册协会）测试组进行评估。还通过查阅患者病历获取人口统计学和临床数据来对患者进行特征描述。
根据CERAD测试组的z分数，患者的认知亚领域在免疫治疗前后没有改善。我们注意到语义流畅性和言语记忆巩固有非显著的改善趋势。在CERAD测试组的12个认知亚领域中，有4个（33%）患者的情况没有变差。此外，在特定的精神病理学特征（如情感症状减轻、动力丧失和反复思考）方面，情绪功能障碍有非显著的减轻趋势。免疫治疗后，情感症状、动力丧失和反复思考减少了43%。
我们的小型试点研究表明，神经自身抗体患者的认知功能障碍没有得到相关缓解。然而，在与情感、动力和反复思考相关的特定功能方面，情绪功能障碍变得不那么明显。然而，我们不知道甲泼尼龙是否影响情绪功能障碍，因为一些患者同时服用了抗抑郁药物。我们的结果可能表明，甲泼尼龙免疫疗法与阻止认知功能障碍的进展和减轻情绪功能障碍有关。应该在呈现统一神经自身抗体模式的更同质患者群体中进行进一步的大规模、安慰剂对照研究。
