Hashimoto encephalopathy: a literature review and case report with comprehensive neuropsychological evaluation

Objective: Hashimoto's encephalopathy (HE), a rare immune-mediated disorder, manifests as altered mental state, cognitive and psychological dysfunction, seizures, and myoclonus. Little is known, however, about the neuropsychological profiles of individuals with HE due to the sparse amount of research. This report overviews HE, summarizes findings from available published neuropsychological evaluations, and details neuropsychological examinations of a 57-year-old White woman with a confirmed HE diagnosis evidencing persistent neuropsychological impairment at two discrete timepoints. Method: An extensive literature search was conducted on PubMed and Google Scholar for studies including neuropsychological evaluations of HE cases. Our neuropsychological evaluation included chart review, diagnostic clinical interview, performance-based neurocognitive assessment, and measures of personality and psychopathology. Results: Our assessment revealed a largely subcortical pattern of neurocognitive impairment and impactful neuropsychiatric symptoms that, together, significantly impacted the patient's quality of life and functional status. The patient's performance improved during a six-month re-evaluation within the domains of cognition, psychological functioning, and functional independence. Conclusions: This article highlights the complexity and possible long-term sequela of HE. Complex medical history (including autoimmune disorders) and psychiatric presentation at onset may be factors related to longer-term cognitive dysfunction. Neuropsychology and psychology can serve important and unique roles in assessing long-term functioning and response to treatment in such cases.