Cognition and psychopathology in autoimmune encephalitides: A focus on risk factors and patient outcomes

Abstract

Neurocognitive compromise, neuropsychiatric symptoms and psychopathology are all evident in the acute stages of autoimmune encephalitides. These factors considerably affect functional independence after discharge. Drawing on psychometric assessments and qualitative descriptions, this review explores the nature, extent and diagnosis of cognitive disorder in autoimmune encephalitides. Potential pathophysiological and neuroanatomical architecture related to neurocognitive compromise in the acute and chronic stages of this illness is examined. In regard to outcomes, the review highlights clinicodemographic factors currently known to be associated with poorer cognitive outcome. Finally, the review delves into neuropsychiatric symptomology and psychological concerns that should be considered at diagnosis and during follow up of these patients.

Psychometric deficits in autoimmune encephalitis: A retrospective study from the Australian Autoimmune Encephalitis Consortium

“…Finally, the psychometric data did not incorporate psychopathology data, nor did they include clinical or qualitative data pertaining to behavioural dysexecutive syndromes. As these aspects of neuropsychological outcomes are reported to be evident in AE populations [8] and may be related to impacted cognitive networks, consideration should be given to incorporating these measures into the psychometric battery of tests to allow for a true representation of outcomes in these populations.…”

“…Where psychometric impairments were present, three patterns were observed: (i) psychometrics deficits in only memory; (ii) psychometric deficits in both executive functioning and memory; and (iii) psychometric deficits in visuospatial/visuoconstructional abilities. While memory and dysexecutive profiles have been commonly reported in the literature [7,8], the final profile of visuospatial/visuoconstructional impairment is one of interest. While these findings may indicate constructional apraxia, they may also possibly reflect dysexecutive profiles and future prospective studies should further examine these findings.…”

“…Cognitive deficits are wide-ranging in their severity and type, and are known to affect daily functioning and quality of life [8]. While memory impairments and executive dysfunction are commonly reported [7,8], it is unclear whether these deficits are all primary in nature or occur secondary to other cognitive impairments (e.g., whether memory deficits are secondary to executive dysfunction).…”

“…Cognitive deficits are wide-ranging in their severity and type, and are known to affect daily functioning and quality of life [8]. While memory impairments and executive dysfunction are commonly reported [7,8], it is unclear whether these deficits are all primary in nature or occur secondary to other cognitive impairments (e.g., whether memory deficits are secondary to executive dysfunction). This knowledge gap is further confounded by lack of comprehensive studies on neuropathological correlates and pathophysiological mechanisms of disease that could provide theoretical underpinnings of the cognitive sequelae.…”

Minding the gut: extending embodied cognition and perception to the gut complex

“…Whether or not we want to ascribe cognitive capacities to the immune system, there can be no do doubt that cognition and immune responses are intimately connected and influence in each other's functioning (Dantzer, 2018). The connection here might be readily illustrated by the case of autoimmune diseases impairing cognitive abilities (Lim et al, 2013;Griffith et al, 2021). The relevance and shared chemical signals of these systems, however, is not limited to pathology.…”