The following is a summary of “Longitudinal Disability, Cognitive Impairment, and Mood Symptoms in Patients With Anti-NMDA Receptor Encephalitis,” published in the January 2024 issue of Neurology by Morgan et al.

Researchers started a retrospective study to investigate the limitations of the modified Rankin Scale (mRS) in capturing longitudinal outcomes in anti-NMDA receptor encephalitis (anti-NMDARe) by employing multiple outcome measures.

They conducted an observational study investigating outcome measures (mRS and Clinical Assessment Scale in Autoimmune Encephalitis [CASE]) in adults with NMDA receptor-IgG in CSF. They utilized linear and logistic regression modeling for short- and long-term follow-ups. Patients with assessments for cognitive impairment (Montreal Cognitive Assessment/Mini-Mental State Examination), depression (Patient Health Questionnaire-9), and anxiety (General Anxiety Disorder-7) beyond 6 months from symptom onset were correlated with final CASE scores.

The results showed 38 individuals, 76% females, and a median disease onset age of 28 years (range = 1–75 years). Most received first-line immunosuppressants (97%) at a median of 3.9 weeks (IQR = 2.1–9.7) from symptom onset, and 68% received second-line therapies. At baseline, the median/mean mRS and CASE were 4 (IQR = 3–5) and 12.9 (SD = 7.2), respectively. At short-term follow-up (median = 10 weeks, IQR = 6–17), dysautonomia, coma/lethargy, seizures/status epilepticus, and intensive care unit admission were associated with higher CASE and mRS (P<0.05). At long-term follow-up (median = 70 weeks, IQR = 51–174), the median/mean mRS and CASE were 2 (IQR = 1–3) and 4.4 (SD = 4.2), respectively. Weakness at symptom onset predicted higher mRS scores (OR = 5.6, 95% confidence interval 1.02–30.9, P=0.047). Despite improvements from baseline (P<0.001), only 31% of patients returned to their premorbid function. Among those with cognitive and mood evaluations >6 months from onset, moderate-severe cognitive impairment (42%), depression (28%), and anxiety (30%) were frequent. Cognitive and depression measures were associated with final CASE subscores, including memory, language, weakness, and psychiatric.

They concluded that motor improvements masked wider long-term impacts in anti-NMDARe, urging broader outcome measures.

Source: neurology.org/doi/10.1212/WNL.0000000000208019