Autoimmune Dementia

Abstract

Dementia refers to an acquired syndrome of intraindividual cognitive decline that ultimately interferes with an individual's ability to manage their usual duties at work or home. As experience with the diagnosis and management of patients with autoimmune and paraneoplastic encephalitis (AE) has expanded, it has become increasingly apparent that dementia may arise as a subacute or chronic complication of immune-mediated injury to the central nervous system. Progressive memory and thinking problems may represent the first (or only) sign of an underlying autoimmune or paraneoplastic disease. Accordingly, there is a need to routinely consider the diagnosis of AE in patients with dementia, and to evaluate patients recovering from AE for clinically meaningful cognitive impairment. We review and summarize the available evidence concerning the diagnosis and care of AE patients with associated cognitive impairment, herein referred to as autoimmune dementia (AiD). Relevant information is used to propose a novel diagnostic framework that may be applied to improve recognition, and facilitate the expedited evaluation and treatment of patients with AiD.

Sleep disturbances are common in patients with autoimmune encephalitis

“…Disruptions in sleep architecture were apparent in AE patients who underwent PSG in our cohort, with prominent decreases in sleep efficiency, loss of stage III and REM sleep, and sleep fragmentation compared to age-similar healthy adults. This finding raises the possibility that sleep disturbances may contribute to the impairments in memory and attention that are increasingly reported in recovering AE patients [18,26,31,41,44].…”

“…Autoimmune encephalitis (AE) is an important cause of subacute cognitive decline, seizures, and encephalopathy, with rising prevalence and a high potential for treatment-responsiveness [9,11,16]. As understanding of the clinical phenotype has expanded [30], so too has appreciation of the cognitive sequelae that persist in subsets of AE patients [12,14,18,26,37,41]. The factors that contribute to persistent impairment are largely unknown, challenging efforts to develop efficacious treatments that improve long-term outcomes.…”

The Road to Recovery: A Pilot Study of Driving Behaviors Following Antibody-Mediated Encephalitis

“…The interpretation of study findings is limited by the small number of patients enrolled in this pilot study conducted at a single academic medical center. Findings need to be validated in larger numbers of patients with AME associated with autoantibodies against NMDAR, LGI1, and other antigens, acknowledging the broad variability in the clinical phenotype and long-term outcomes in AME ( 1 – 6 , 9 ) and the low likelihood of detecting rare events (i.e., motor vehicle accidents) in small cohorts of patients. Future studies would also benefit from recruitment of age-matched comparison cohorts.…”

“…AME commonly presents with changes in behavior, psychosis, seizures, memory and cognitive deficits, abnormal movements, dysautonomia, and changes in consciousness (1). Although the potential for meaningful recovery is high in patients who receive early treatment with immunosuppressant agents (1)(2)(3)(4)(5), impairments in memory and executive function are well-recognized complications of AME (4,(6)(7)(8)(9). How these deficits influence the return to meaningful function in recovering patients is largely unknown, as is the time course and extent of recovery of higher-order function.…”

The sum of us. Implementing a Person Centred Care Bundle - A narrative inquiry

“…Implementing the PCC bundle as a small set of evidence-based interventions was to ensure patient safety through a series of brief opportunities for meaningful interactions and reflection during a shift (Provost, 2015). The PCC extends on the nursing process of assessment, diagnosis, planning, implementation and evaluation a systematic approach to individualised patient care ( Long & Day, 2018 ) as it includes an intuitive aspects of nursing care and requires a team response. The PCC bundle also builds on task-based nursing care that involves a top down approach where the nurse in charge allocates duties associated with experience.…”