与精神分裂症患者和健康对照相比，经诊断和治疗的N-甲基-D-天冬氨酸受体抗体介导（NMDAR）脑炎患者的认知结果和表现。
Cognitive outcomes and performance of patients diagnosed and treated for N-Methyl-D-Aspartate receptor antibody-mediated (NMDAR) encephalitis compared with patients with schizophrenia and healthy controls.
作者信息
Kelleher Eric, Mothersill David, Hargreaves April, Barry Helen, Smyth Shane, Chaila Elijah, Boers Peter, McCabe Dominick Jh, Sweeney Brian, Costello Daniel, Murphy Kieran C, Cotter David, Doherty Colin P, Donohoe Gary, Corvin Aiden
机构信息
Department of Psychiatry, Trinity College Dublin, Dublin, Ireland; Department of Psychiatry and Neurobehavioral Science, School of Medicine and Health, University College Cork, Ireland; Liaison Psychiatry Service, Cork University Hospital, Cork, Ireland.
Department of Psychiatry, Trinity College Dublin, Dublin, Ireland; Department of Psychology, School of Business, National College of Ireland, Dublin, Ireland.
出版信息
Psychiatry Res Neuroimaging. 2025 Jun;349:111983. doi: 10.1016/j.pscychresns.2025.111983. Epub 2025 Mar 17.
BACKGROUND
Cognitive dysfunction may be a sequelae of N-Methyl-D-Aspartate receptor encephalitis (NMDAR encephalitis) with working memory commonly affected. This study examined cognitive outcomes in patients treated for NMDAR encephalitis using a neurocognitive test battery and a working memory paradigm, compared with healthy controls & patients with schizophrenia.
METHODS
Adult patients previously treated for NMDAR encephalitis were assessed using the Cambridge Automated Neuropsychological Test Battery (CANTAB) for working memory & episodic memory. Patients completed the N-back task during functional MRI (fMRI) scanning. Results were compared to patients with schizophrenia and healthy controls from a prior study.
RESULTS
Twelve patients were recruited [11 women; mean (SD) age 37(12) years; Mean (SD) duration until immunotherapy treatment 7.09 (2.43) weeks]. Data were compared to 14 patients with schizophrenia [10 women; mean (SD) age 39 (12) years] and 14 healthy controls [7 women; mean (SD) age 30 (6) years]. Significant differences in letter number sequencing, spatial working memory, logical memory I, 1-back, and 2-back performance were observed (Cohen's d = 0.766 to 1.254, p< 0.05), driven by poorer performance by patients with schizophrenia. While patients with NMDAR encephalitis exhibited slightly lower performance compared with healthy controls, none of these differences were statistically significant. No significant differences in neural activation during 1-back or 2-back performance were observed.
CONCLUSIONS
Study findings suggest cognitive performance in patients treated for NMDAR encephalitis approaches normal over time. Prompt treatment with immunotherapy is associated with improved cognitive outcomes. Psychiatric services should be aware of the clinical features of autoimmune encephalitis.
背景
认知功能障碍可能是N-甲基-D-天冬氨酸受体脑炎（NMDAR脑炎）的后遗症，工作记忆通常会受到影响。本研究使用神经认知测试组合和工作记忆范式，对接受NMDAR脑炎治疗的患者的认知结果进行了检查，并与健康对照组和精神分裂症患者进行了比较。
方法
使用剑桥自动化神经心理测试组合（CANTAB）对先前接受过NMDAR脑炎治疗的成年患者进行工作记忆和情景记忆评估。患者在功能磁共振成像（fMRI）扫描期间完成N-back任务。将结果与先前研究中的精神分裂症患者和健康对照组进行比较。
结果
招募了12名患者[11名女性；平均（标准差）年龄37（12）岁；免疫治疗前的平均（标准差）病程为7.09（2.43）周]。将数据与14名精神分裂症患者[10名女性；平均（标准差）年龄39（12）岁]和14名健康对照组[7名女性；平均（标准差）年龄30（6）岁]进行比较。观察到字母数字排序、空间工作记忆、逻辑记忆I、1-back和2-back表现存在显著差异（Cohen's d = 0.766至1.254，p < 0.05），这是由精神分裂症患者表现较差所致。虽然NMDAR脑炎患者的表现与健康对照组相比略低，但这些差异均无统计学意义。在1-back或2-back表现期间未观察到神经激活的显著差异。
结论
研究结果表明，接受NMDAR脑炎治疗的患者的认知表现会随着时间的推移接近正常水平。免疫治疗的及时应用与改善认知结果相关。精神科服务机构应了解自身免疫性脑炎的临床特征。
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