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Cognitive and Social Functioning Deficits after Anti-N-Methyl-D-Aspartate Receptor Encephalitis: An Exploratory Case Series

  • Gemma L. McKeon (a1) (a2) (a3), James G. Scott (a2) (a3) (a4), Donna M. Spooner (a4), Alexander E. Ryan (a2) (a3), Stefan Blum (a2) (a5), David Gillis (a4) (a6), Daman Langguth (a7) and Gail A. Robinson (a1) (a2) (a4)...

Abstract

Background: Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is a recently described life-threatening autoimmune disorder associated with a characteristic multi-stage neuropsychiatric syndrome. Although it is known that the majority of patients experience neuropsychological disturbance post-treatment, some aspects of the cognitive profile remain unclear. Methods: This study sought to investigate patterns of cognitive functioning in a sample of anti-NMDAR encephalitis patients. Seven (6F:1M; mean age, 26.4 years; range, 16–37 years) treated patients completed a comprehensive set of neurocognitive and social functioning measures. Performance was analyzed using normative data (where available), and comparison with matched controls (10F:4M; mean age, 25.8 years; range, 16–38 years). Results: Individual cognitive profiles ranged from within normal limits to extensive dysfunction. Relative to controls, the patient group’s performance was affected in the domains of verbal/ visual memory, working memory, attention, processing speed, executive functioning, and social cognition. The patient group also reported significantly higher levels of anxiety compared to controls. Conclusions: These results add to the accumulating evidence that neurocognitive deficits, consistent with the distribution and functions of the NMDAR system can persist during recovery from anti-NMDAR encephalitis. This is the first study to provide evidence of performance decrements on measures of social cognition, including some involving theory of mind. (JINS, 2016, 22, 828–838)

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Corresponding author

Correspondence and reprint requests to: Gail Robinson, The University of Queensland (UQ), School of Psychology, McElwain Building, UQ, St Lucia, Brisbane, QLD, Australia, 4072. E-mail: g.robinson@psy.uq.edu.au

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