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Wang X, Yin Y, Wang X, Xu G, Tian J, Ma X. White matter microstructural alterations in patients with anti-N-methyl-D-aspartate receptor encephalitis: A tract-based spatial statistics study. Mult Scler Relat Disord 2024; 84:105500. [PMID: 38368748 DOI: 10.1016/j.msard.2024.105500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 02/05/2024] [Accepted: 02/11/2024] [Indexed: 02/20/2024]
Abstract
BACKGROUND Cognitive impairment is common in patients with anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis; however, neural mechanisms underlying this impairment remain unclear. Diffusion tensor imaging (DTI) is a potential method for studying the condition of white matter fibers in patients with anti-NMDAR encephalitis, allowing for an analysis of the neuroimaging mechanisms of cognitive impairment in conjunction with cognitive scales. This study aimed to explore white matter microstructural alterations and their correlation with cognitive function in patients with anti-NMDAR encephalitis. METHODS DTI data were collected from 22 patients with anti-NMDAR encephalitis (aged 29.00(19.75, 39.50) years; 12 males, 10 females) and 20 healthy controls (HCs) (aged 24.50(21.25, 32.00); 12 males, 8 females) matched for age, sex, and educational level. Changes in the white matter microstructure were analyzed using tract-based spatial statistics. Pearson correlation analysis was used to explore the correlation between white matter integrity and neuropsychological scores. RESULTS Compared with HCs, patients with anti-NMDAR encephalitis showed decreased fractional anisotropy and increased mean diffusivity values in extensive white matter regions, which were associated with disease severity, memory, and executive and visuospatial functions. CONCLUSION Widespread impairment of the structural integrity of the white matter in the brain is significantly associated with cognitive dysfunction in patients with anti-NMDAR encephalitis, providing neuroimaging evidence for studying the underlying mechanisms.
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Affiliation(s)
- Xiaoxuan Wang
- Department of Nuclear Medicine, The Affiliated Guangdong Second Provincial General Hospital of Jinan University, Guangzhou 510317, PR China
| | - Yi Yin
- Department of Medical imaging, The Affiliated Guangdong Second Provincial General Hospital of Jinan University, Guangzhou, PR China
| | - Xinzhi Wang
- Department of Medical imaging, The Affiliated Guangdong Second Provincial General Hospital of Jinan University, Guangzhou, PR China
| | - Guang Xu
- Department of Neurology, The Affiliated Guangdong Second Provincial General Hospital of Jinan University, Guangzhou, PR China
| | - Junzhang Tian
- Department of Nuclear Medicine, The Affiliated Guangdong Second Provincial General Hospital of Jinan University, Guangzhou 510317, PR China; The Second School of Clinical Medicine, Southern Medial University, Guangzhou, PR China
| | - Xiaofen Ma
- Department of Nuclear Medicine, The Affiliated Guangdong Second Provincial General Hospital of Jinan University, Guangzhou 510317, PR China; The Second School of Clinical Medicine, Southern Medial University, Guangzhou, PR China.
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Galioto R, Grezmak T, Swetlik C, Abbatemarco JR, Titulaer MJ, Finke C, Kunchok A. Neuropsychological Testing in Autoimmune Encephalitis: A Scoping Review. NEUROLOGY(R) NEUROIMMUNOLOGY & NEUROINFLAMMATION 2024; 11:e200179. [PMID: 37949665 PMCID: PMC10691228 DOI: 10.1212/nxi.0000000000200179] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 09/11/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND AND OBJECTIVES Identifying optimal methods for evaluation and monitoring of cognitive outcomes in AE is important for clinical care and research. This scoping review aimed to evaluate neuropsychological tests (NPT) that are most frequently impaired in AE cohorts to provide recommendations for a standardized NPT battery for AE outcome. METHODS PubMed search for studies examining NPT in patients with AE was conducted on June 9, 2023. Studies were screened for inclusion/exclusion criteria as follows: at least 1 NPT, individual NPT test scores with comparison with healthy controls or normative data and neural-IgG status, total sample size ≥5, and English manuscript available. RESULTS The search yielded 5,393 studies, of which 3,359 were screened, 107 were full text reviewed, and 32 met inclusion/exclusion criteria, anti-NMDA-R (k = 18), anti-LGI1 (k = 10), anti-GABAB-R (k = 2), anti-GAD-65 (k = 4), and anti-CASPR2 (k = 3). The cognitive domains most frequently impaired were visual and verbal episodic memory, attention/working memory, processing speed, and aspects of executive functions. DISCUSSION Given the dearth of literature examining NPT in AE in combination with small sample sizes and methodological differences, more research in this area is needed. However, we provide recommendations for a test battery to be used in future studies, with the aim of standardizing research in this area. Based on the available literature, we recommend the use of comprehensive NPT batteries, spanning all cognitive domains. The highest yield measures may include the tests of (1) visual and verbal learning/memory, (2) basic and sustained attention, (3) processing speed, and (4) executive functions.
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Affiliation(s)
- Rachel Galioto
- From the Cleveland Clinic Mellen Center for MS (R.G., J.R.A., A.K.); Department of Neurology (T.G., C.S.), Cleveland Clinic, OH; Neurology (M.J.T.), Erasmus University Medical Center, Rotterdam, Netherlands; Department of Neurology (C.F.), Charité - Universitätsmedizin Berlin, Germany.
| | - Tiffany Grezmak
- From the Cleveland Clinic Mellen Center for MS (R.G., J.R.A., A.K.); Department of Neurology (T.G., C.S.), Cleveland Clinic, OH; Neurology (M.J.T.), Erasmus University Medical Center, Rotterdam, Netherlands; Department of Neurology (C.F.), Charité - Universitätsmedizin Berlin, Germany
| | - Carol Swetlik
- From the Cleveland Clinic Mellen Center for MS (R.G., J.R.A., A.K.); Department of Neurology (T.G., C.S.), Cleveland Clinic, OH; Neurology (M.J.T.), Erasmus University Medical Center, Rotterdam, Netherlands; Department of Neurology (C.F.), Charité - Universitätsmedizin Berlin, Germany
| | - Justin R Abbatemarco
- From the Cleveland Clinic Mellen Center for MS (R.G., J.R.A., A.K.); Department of Neurology (T.G., C.S.), Cleveland Clinic, OH; Neurology (M.J.T.), Erasmus University Medical Center, Rotterdam, Netherlands; Department of Neurology (C.F.), Charité - Universitätsmedizin Berlin, Germany
| | - Maarten J Titulaer
- From the Cleveland Clinic Mellen Center for MS (R.G., J.R.A., A.K.); Department of Neurology (T.G., C.S.), Cleveland Clinic, OH; Neurology (M.J.T.), Erasmus University Medical Center, Rotterdam, Netherlands; Department of Neurology (C.F.), Charité - Universitätsmedizin Berlin, Germany
| | - Carsten Finke
- From the Cleveland Clinic Mellen Center for MS (R.G., J.R.A., A.K.); Department of Neurology (T.G., C.S.), Cleveland Clinic, OH; Neurology (M.J.T.), Erasmus University Medical Center, Rotterdam, Netherlands; Department of Neurology (C.F.), Charité - Universitätsmedizin Berlin, Germany
| | - Amy Kunchok
- From the Cleveland Clinic Mellen Center for MS (R.G., J.R.A., A.K.); Department of Neurology (T.G., C.S.), Cleveland Clinic, OH; Neurology (M.J.T.), Erasmus University Medical Center, Rotterdam, Netherlands; Department of Neurology (C.F.), Charité - Universitätsmedizin Berlin, Germany
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Wen S, Zhang H, Huang K, Wei X, Yang K, Wang Q, Feng L. Impaired orienting function detected through eye movements in patients with temporal lobe epilepsy. Front Neurosci 2023; 17:1290959. [PMID: 38188032 PMCID: PMC10770870 DOI: 10.3389/fnins.2023.1290959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 12/04/2023] [Indexed: 01/09/2024] Open
Abstract
Objective Patients with temporal lobe epilepsy (TLE) often exhibit attention function impairment. The orienting network is the subsystem of the attention network that has not been fully studied. In this study, we used eye-tracking technology with an attention network test (ANT)-based task to assess the orienting function of TLE patients, aiming to characterize their eye movement patterns. Methods A total of 37 TLE patients and 29 healthy controls (HCs) completed the ANT task based on eye-tracking technology. Orienting function damage was mainly assessed by the ANT orienting effect. Eye movement metrics, such as mean first goal-directed saccade latency (MGSL), total saccades, and saccade amplitudes, were compared between groups. Results The TLE patients had a significantly lower ANT orienting effect (HC, 54.05 ± 34.05; TLE, 32.29 ± 39.54) and lower eye-tracking orienting effect (HC, 116.98 ± 56.59; TLE, 86.72 ± 59.10) than those of the HCs. The larger orienting effects indicate that orienting responses are faster when receiving a spatial cue compared with a center cue. In the spatial cue condition, compared with HCs, the TLE group showed a longer first goal-directed saccade latency (HC, 76.77 ± 58.87 ms; TLE, 115.14 ± 59.15 ms), more total saccades (HC, 28.46 ± 12.30; TLE, 36.69 ± 15.13), and larger saccade amplitudes (HC, 0.75° ± 0.60°; TLE, 1.36° ± 0.89°). Furthermore, there was a positive correlation of the orienting-effect score between the ANT task and eye-tracking metrics (r = 0.58, p < 0.05). Conclusion We innovatively developed a new detection method using eye-tracking technology in combination with an ANT-based task to detect the orienting function in TLE patients. The current research demonstrated that TLE patients had a significant orienting dysfunction with a specific saccade pattern characterized by a longer first goal-directed saccade latency, more total saccades, and larger saccade amplitudes. These oculomotor metrics are likely to be a better indicator of orienting function and may potentially be used for behavioral-based interventions and long-term cognition monitoring in TLE patients.
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Affiliation(s)
- Shirui Wen
- Department of Neurology, Zhongshan Hospital, Fudan University, Shanghai, China
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Huangyemin Zhang
- Key Laboratory of Spectral Imaging Technology, Xi'an Institute of Optics and Precision Mechanics of Chinese Academy of Sciences, Xi'an, China
- University of Chinese Academy of Sciences, Beijing, China
- Key Laboratory of Biomedical Spectroscopy of Xi'an, Xi'an Institute of Optics and Precision Mechanics of Chinese Academy of Sciences, Xi'an, China
| | - Kailing Huang
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Xiaojie Wei
- Key Laboratory of Spectral Imaging Technology, Xi'an Institute of Optics and Precision Mechanics of Chinese Academy of Sciences, Xi'an, China
- University of Chinese Academy of Sciences, Beijing, China
- Key Laboratory of Biomedical Spectroscopy of Xi'an, Xi'an Institute of Optics and Precision Mechanics of Chinese Academy of Sciences, Xi'an, China
| | - Ke Yang
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Quan Wang
- Key Laboratory of Spectral Imaging Technology, Xi'an Institute of Optics and Precision Mechanics of Chinese Academy of Sciences, Xi'an, China
- Key Laboratory of Biomedical Spectroscopy of Xi'an, Xi'an Institute of Optics and Precision Mechanics of Chinese Academy of Sciences, Xi'an, China
| | - Li Feng
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
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Zhang C, Hao Y, Huang G, Xin M, Bai S, Guan Y, Liu J. Hypometabolism of the left middle/medial frontal lobe on FDG-PET in anti-NMDA receptor encephalitis: Comparison with MRI and EEG findings. CNS Neurosci Ther 2023; 29:1624-1635. [PMID: 36815303 PMCID: PMC10173717 DOI: 10.1111/cns.14125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 02/02/2023] [Accepted: 02/05/2023] [Indexed: 02/24/2023] Open
Abstract
OBJECTIVES To investigate changes in brain-glucose metabolism in anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis, and compare results with MRI and electroencephalography (EEG) findings at different disease stages. METHODS The clinical data of 18 patients (median age, 35 years; 11 men) were retrospectively collected. Patients were divided into groups based on the time of symptom onset to examination, (≤1 month, >1 but ≤3 months, >3 months). Two-sample t-test results were compared with age and sex-paired healthy controls using statistical parametric mapping and verified using a NeuroQ software normal database with a discriminating z-score of 2. RESULTS Abnormal patterns on FDG-PET differed over time (T = 3.21-8.74, Z = 2.68-4.23, p < 0.005). Regional analysis showed hypometabolic left middle or medial frontal cortex in 4/5, 5/7, and 5/6 patients, respectively. Time-subgroup analysis revealed hypermetabolic supertemporal cortex in 4/5, 5/7, and 2/6, patients, respectively. MRI and EEG abnormalities in any region and stage occurred in 10/18 and 10/16 patients, respectively. MRI and EEG time-subgroup analysis showed abnormalities in 5/9, 4/5, and 1/4, and 1/3, 6/7, and 3/6 patients, respectively. Abnormal temporal lobes were detected most frequently in MRI analyses and occurred in 3/10 patients. CONCLUSIONS Decreased left middle/medial frontal metabolism could be common to all stages. Metabolism in other regions, MRI, and EEG results were associated with the progression of anti-NMDAR encephalitis. The sensitivity rate of FDG-PET was superior to that of MRI and EEG.
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Affiliation(s)
- Chenpeng Zhang
- Department of Nuclear Medicine, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yong Hao
- Department of Neurology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Gan Huang
- Department of Nuclear Medicine, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Mei Xin
- Department of Nuclear Medicine, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shuwei Bai
- Department of Neurology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yangtai Guan
- Department of Neurology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jianjun Liu
- Department of Nuclear Medicine, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Vandiver MS, Roy B, Mahmud F, Lavretsky H, Kumar R. Functional comorbidities and brain tissue changes before and after lung transplant in adults. Front Cell Neurosci 2022; 16:1015568. [DOI: 10.3389/fncel.2022.1015568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 11/17/2022] [Indexed: 12/03/2022] Open
Abstract
BackgroundAdults undergoing lung transplant, as a lifesaving treatment for end stage lung disease, exhibit high levels of peri-operative neurocognitive dysfunction in multiple domains, including delirium, cognition, and autonomic deficits. These complications impact healthcare costs, quality of life, and patient outcomes. Post-operative symptoms likely result from loss of brain tissue integrity in sites mediating such regulatory functions. Our aim in this study was to examine peri-operative neurocognitive dysfunction and brain tissue changes after lung transplant in adults.MethodsWe retrospectively examined the UCLA lung transplant database to identify 114 lung transplant patients with pre-operative clinical and neurocognitive data. Of 114 patients, 9 lung transplant patients had pre- and post-transplant brain magnetic resonance imaging. Clinical and neurocognitive data were summarized for all subjects, and brain tissue volume changes, using T1-weighted images, before and after transplant were examined. T1-weighted images were partitioned into gray matter (GM)-tissue type, normalized to a common space, smoothed, and the smoothed GM-volume maps were compared between pre- and post-transplant (paired t-tests; covariate, age; SPM12, p < 0.005).ResultsIncreased comorbidities, including the diabetes mellitus (DM), hypertension, kidney disease, and sleep disordered breathing, as well as higher rates of neurocognitive dysfunction were observed in the lung transplant patients, with 41% experiencing post-operative delirium, 49% diagnosed with a mood disorder, and 25% of patients diagnosed with cognitive deficits, despite incomplete documentation. Similarly, high levels of delirium, cognitive dysfunction, and mood disorder were noted in a subset of patients used for brain MRI evaluation. Significantly decreased GM volumes emerged in multiple brain regions, including the frontal and prefrontal, parietal, temporal, bilateral anterior cingulate and insula, putamen, and cerebellar cortices.ConclusionAdults undergoing lung transplant often show significant pre-operative comorbidities, including diabetes mellitus, hypertension, and chronic kidney disease, as well as neurocognitive dysfunction. In addition, patients with lung transplant show significant brain tissue changes in regions that mediate cognition, autonomic, and mood functions. The findings indicate a brain structural basis for many enhanced post-operative symptoms and suggest a need for brain tissue protection in adults undergoing lung transplant to improve health outcomes.
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Šiško Markoš I, Blažeković I, Peitl V, Jukić T, Supanc V, Karlović D, Fröbe A. Psychiatric Illness or Immune Dysfunction-Brain Perfusion Imaging Providing the Answer in a Case of Anti-NMDAR Encephalitis. Diagnostics (Basel) 2022; 12:diagnostics12102377. [PMID: 36292066 PMCID: PMC9600880 DOI: 10.3390/diagnostics12102377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 09/21/2022] [Accepted: 09/28/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND We investigated the potential use of SPECT quantification in addition to qualitative brain perfusion analysis for the detection of anti-NMDAR encephalitis. The question is how to normalize brain activity to be able to quantitatively detect perfusion patterns. Usually, brain activity is normalized to a structure considered unaffected by the disease. METHODS Brain [99mTc]-HMPAO SPECT was performed as a method to detect brain perfusion patterns. The patterns of abnormal brain perfusion cannot always be reliably and qualitatively assessed when dealing with rare diseases. Recent advances in SPECT quantification using commercial software have enabled more objective and detailed analysis of brain perfusion. The cerebellum and whole brain were used as the normalization structures and were compared with visual analysis. RESULTS The quantification analysis performed with whole brain normalization confirmed right parietal lobe hypoperfusion while also detecting statistically significant left-to-right perfusion differences between the temporal lobe and thalamus. Whole brain normalization further described bilateral frontal lobe hyperperfusion, predominantly of the left lobe, and was in accordance with visual analysis. CONCLUSION SPECT quantitative brain perfusion analysis, using the whole brain as the normalization structure rather than the cerebellum, in this case, improved confidence in the visual detection of anti-NMDAR encephalitis and provided unexpected solutions to atypical psychiatric dilemmas.
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Affiliation(s)
- Ines Šiško Markoš
- Department of Oncology and Nuclear Medicine, Sestre Milosrdnice University Hospital Center, 10000 Zagreb, Croatia
- School of Medicine, Catholic University of Croatia, 10000 Zagreb, Croatia
- Correspondence: ; Tel.: +385-1-3787-620
| | - Ivan Blažeković
- Department of Oncology and Nuclear Medicine, Sestre Milosrdnice University Hospital Center, 10000 Zagreb, Croatia
| | - Vjekoslav Peitl
- School of Medicine, Catholic University of Croatia, 10000 Zagreb, Croatia
- Department of Psychiatry, Sestre Milosrdnice University Hospital Center, 10000 Zagreb, Croatia
| | - Tomislav Jukić
- Department of Oncology and Nuclear Medicine, Sestre Milosrdnice University Hospital Center, 10000 Zagreb, Croatia
- School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
| | - Višnja Supanc
- Department of Neurology, Sestre Milosrdnice University Hospital Center, 10000 Zagreb, Croatia
| | - Dalibor Karlović
- School of Medicine, Catholic University of Croatia, 10000 Zagreb, Croatia
- Department of Psychiatry, Sestre Milosrdnice University Hospital Center, 10000 Zagreb, Croatia
| | - Ana Fröbe
- Department of Oncology and Nuclear Medicine, Sestre Milosrdnice University Hospital Center, 10000 Zagreb, Croatia
- School of Dental Medicine, University of Zagreb, 10000 Zagreb, Croatia
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