Sy Alfeo Julius R, Anlacan Veeda Michelle M, Yu Adrian B, Jamora Roland Dominic G
Section of Neurology, Department of Internal Medicine, Cardinal Santos Medical Center, San Juan City, Philippines.
Department of Clinical Neurosciences, University of the East Ramon Magsaysay Memorial Medical Center, Quezon City, Philippines.
Neurol Sci. 2025 May 5. doi: 10.1007/s10072-025-08223-6.
Hashimoto's encephalopathy (HE) is a rare autoimmune disorder which can mimic late-life neuropsychiatric symptoms as part of a dementia syndrome. Our objective was to review the clinical profile and management outcomes of new onset HE in older adults based on available literature.
We conducted a comprehensive search for studies on patients aged 65 years and older with newly diagnosed HE across multiple databases, including Medline, Web of Science, Wiley Online Library, and The Cochrane Library, covering publications up to January 2024. Clinical information was extracted and analyzed using Descriptive statistics.
Out of 608 articles screened, 45 articles detailing 51 patients were included. Majority of older patients (n = 48, 94.1%) were initially treated with steroids. Methylprednisolone 1 g/day was given in 37.2% (n = 19) for a minimum of 3 days before tapering. Some initiated a reduced dose of 500 mg/ day (n = 5, 9.8%) with similar outcomes. Response is favorable, with 56.8% (n = 29) returning to near baseline functional status, while 29.4% (n = 15) showed partial improvement.
Evidence from 51 cases highlight the disorder's variable course in the older population; often mimicking other age-related conditions leading to diagnostic challenges and delays in management. A tailored approach is required, balancing the benefits of immunomodulatory therapies with potential risks. Further research is essential to understand the mechanism of HE in the older population and enhance patient outcomes by developing standardized treatment protocols tailored to this vulnerable population.
桥本脑病（HE）是一种罕见的自身免疫性疾病，可模拟作为痴呆综合征一部分的晚年神经精神症状。我们的目的是根据现有文献回顾老年人新发HE的临床特征和治疗结果。
我们在多个数据库中全面检索了关于65岁及以上新诊断为HE的患者的研究，包括Medline、Web of Science、Wiley Online Library和Cochrane图书馆，涵盖截至2024年1月的出版物。使用描述性统计方法提取和分析临床信息。
在筛选的608篇文章中，纳入了45篇详细描述51例患者的文章。大多数老年患者（n = 48，94.1%）最初接受了类固醇治疗。37.2%（n = 19）的患者给予甲泼尼龙1 g/天，至少3天，然后逐渐减量。一些患者开始使用500 mg/天的减量剂量（n = 5，9.8%），结果相似。反应良好，56.8%（n = 29）的患者恢复到接近基线的功能状态，而29.4%（n = 15）的患者显示部分改善。
51例病例的证据突出了该疾病在老年人群中的可变病程；常常模拟其他与年龄相关的疾病，导致诊断挑战和治疗延迟。需要一种量身定制的方法，平衡免疫调节疗法的益处与潜在风险。进一步的研究对于了解老年人群中HE的机制以及通过制定针对这一脆弱人群的标准化治疗方案来改善患者预后至关重要。
