Neuropsychological and psychiatric outcomes in encephalitis: A multi-centre case-control study
Neuropsychological and psychiatric outcomes in encephalitis: A multi-centre case-control study
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DOI：
10.1371/journal.pone.0230436
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发表时间：
2020-03-25
期刊：
影响因子：
3.7
通讯作者：
Kopelman, Michael
中科院分区：
文献类型：
--
作者：
Harris, Lara;Griem, Julia;Kopelman, Michael
我们的目的是比较单纯疱疹病毒(HSV)、其他感染或自身免疫性原因(Other)和不明原因脑炎(不明原因)三种脑炎病因组的神经心理和精神结果。方法从NHS医院招募患者进行短期(出院后4个月)、中期(首次评估后9-12个月)和长期(1年)的神经心理和精神状况评估。结果单纯疱疹病毒感染者在顺行和逆行记忆任务中受损最严重。在短期内，他们还表现出执行力、智商和命名方面的缺陷，这些缺陷在长期内得到了解决。患有其他或不明原因脑炎的患者表现出中度记忆障碍，但在执行测试中没有明显障碍。记忆障碍与磁共振成像(MRI)上的海马/内侧颞叶损害有关，命名障碍与左侧颞叶和左额叶异常有关。患者报告的主观认知症状比健康对照组更多，疲劳是一个显著的问题，HSV组和其他脑炎组的抑郁和焦虑发生率很高。即使在客观测量的神经心理表现得到改善后，这些主观的、自我报告的抱怨、抑郁和焦虑仍然存在。结论脑炎后的神经心理和精神结局因病因而异。记忆和命名在单纯疱疹病毒中受到严重影响，在其他形式中影响较小。随着时间的推移，神经心理功能会有所改善，特别是那些有更严重的短期损伤的人，但主观认知抱怨、抑郁和焦虑仍然存在，应该在康复计划中加以解决。
ObjectivesOur aim was to compare neuropsychological and psychiatric outcomes across three encephalitis aetiological groups: Herpes simplex virus (HSV), other infections or autoimmune causes (Other), and encephalitis of unknown cause (Unknown).MethodsPatients recruited from NHS hospitals underwent neuropsychological and psychiatric assessment in the short-term (4 months post-discharge), medium-term (9-12 months after the first assessment), and long-term (>1-year). Healthy control subjects were recruited from the general population and completed the same assessments.ResultsPatients with HSV were most severely impaired on anterograde and retrograde memory tasks. In the short-term, they also showed executive, IQ, and naming deficits, which resolved in the long-term. Patients with Other or Unknown causes of encephalitis showed moderate memory impairments, but no significant impairment on executive tests. Memory impairment was associated with hippocampal/medial temporal damage on magnetic resonance imaging (MRI), and naming impairment with left temporal and left frontal abnormalities. Patients reported more subjective cognitive complaints than healthy controls, with tiredness a significant problem, and there were high rates of depression and anxiety in the HSV and the Other encephalitis groups. These subjective, self-reported complaints, depression, and anxiety persisted even after objectively measured neuropsychological performance had improved.ConclusionsNeuropsychological and psychiatric outcomes after encephalitis vary according to aetiology. Memory and naming are severely affected in HSV, and less so in other forms. Neuropsychological functioning improves over time, particularly in those with more severe short-term impairments, but subjective cognitive complaints, depression, and anxiety persist, and should be addressed in rehabilitation programmes.