Nearly one-third of patients diagnosed with anti-N-methyl-D-aspartate receptor encephalitis struggle to return to work or education due to persistent cognitive and emotional challenges even years after diagnosis, according to a recent cross-sectional and prospective cohort study.

The research assessed long-term outcomes in 92 patients (mean age 29 years) with anti-NMDAR encephalitis, a condition predominantly affecting young adults. The study cohort represented less severe cases compared to the complete nationwide cohort, with lower rates of intensive care unit admission (32% vs 58%, p < 0.001). Eighty-five patients completed cognitive assessments, while 87 completed patient-reported outcome measures. Twelve patients were assessed prospectively with multiple evaluations.

Cognitive recovery continued for up to 36 months, with significant improvements in the first six months after diagnosis. However, persistent cognitive impairments, particularly in memory (mean z-score -0.67 ± 0.89 SD) and language (mean z-score -0.75 ± 1.06 SD), were noted beyond this period. By 36 months, 34% of patients had cognitive impairments in one or more domains, and 65% scored below average in at least one cognitive area. Self-reported difficulties, particularly in emotional well-being, social functioning, and energy levels, remained significantly lower than population norms (emotional well-being score of 72 vs. 82, p < 0.001).

Despite a favorable functional outcome (91% of patients scored ≤2 on the modified Rankin Scale), 30% of patients had not resumed work or education, and 18% returned at a reduced capacity. Patients with better cognitive processing speed were more likely to return to work or school, with those showing faster processing speeds (mean z-score −0.14) more often resuming activities compared to those with slower speeds (mean z-score −0.84, p = 0.039). Treatment with intravenous immunoglobulin showed a positive relationship with quality of life (EQ-5D-5L median 0.90 vs 0.72, p = 0.02).

Published in Neurology, this study underscores the importance of comprehensive, long-term assessments to capture the full scope of recovery in anti-NMDAR encephalitis. The study also highlights the importance of addressing persistent cognitive and emotional challenges in these patients.

Full disclosures can be found in the published study.