Cognitive disorders in patients with neuroimmunological disease

Autoimmune diseases such as systemic lupus erythematosus (SLE), multiple sclerosis (MS), and autoimmune encephalitis can directly and indirectly affect brain function, leading to cognitive dysfunction or well characterized neurocognitive syndromes. However, these are often poorly characterized in the literature. Here, we review evidence on clinical manifestations, risk factors, their assessment and outcomes, and evidence for underlying mechanisms and associated biomarkers, if available.

Significant advances have been made in neurocognitive disorders associated with four categories of autoimmune disease: neurocognitive disorders due to autoimmune connective tissue diseases, neurocognitive disorders due to autoimmune demyelinating diseases of the CNS, neurocognitive disorders due to autoimmune encephalitis, and neurocognitive disorders due to cerebrovascular disease of autoimmune origin.

Autoimmune diseases should be considered as critical causal factors underlying new cases of neurocognitive disorder, especially in young patients. These diseases are mediated by immune system reactions involving antibody production, T-cell-mediated damage, and demyelination. Although the prognosis seems favourable in most conditions after immunotherapy, the magnitude of the therapeutic effect of immunotherapy on cognitive functioning remains unclear.