Cognitive Impairment in Autoimmune Encephalitis: Characterization and Predicting Long-term Outcomes

Area of Science:

• Neurology
• Neuroimmunology
• Cognitive Science

Background:

• Autoimmune encephalitis (AE) is increasingly recognized as a significant cause of reversible cognitive impairment.
• Understanding the specific cognitive deficits and recovery patterns in AE is crucial for patient management.

Purpose of the Study:

• To investigate cognitive domains affected in various AE subtypes.
• To assess cognitive profile changes over time and identify predictors of residual impairment.

Main Methods:

• Cognitive assessments were age-stratified (Vineland, MoCA, ACE-III).
• Psychiatric manifestations were screened using the Neuropsychiatric Inventory.
• Assessments were repeated after a 6-month follow-up period.

Main Results:

• Cognitive impairment was universal in late-onset AE (100%) and prevalent in adults (85%) and children (58%).
• Late-onset AE and anti-LGI-1 positivity were associated with common cognitive impairment.
• Predictors of poor cognitive outcomes included advanced age, mutism, hallucinations, incontinence, altered consciousness, psychiatric issues, high mRS scores, and abnormal EEG.

Conclusions:

• Cognitive impairment is a hallmark of autoimmune encephalitis, with new learning, memory, and fluency domains being severely affected.
• Late-onset AE, abnormal EEG, high mRS scores, and psychiatric comorbidities are significant predictors of poor cognitive outcomes.