Diagnosis and Management of Autoimmune Dementia

Sechi, Elia; Flanagan, Eoin P.

doi:10.1007/s11940-019-0550-9

Cited by 16 publications

(18 citation statements)

References 111 publications

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“…8 Onset is typically acute/ subacute within days to weeks, but slowly progressive presentations are possible and may mimic neurodegenerative disorders. 50 Isolated paraneoplastic myelopathy may also occur. 8,51 Overall, associated neural-specific autoantibodies have been described in up to 54% of the cases with CNS involvement by tissue immunofluorescence and generally accompanied by their classic neurologic syndromes (Tables).…”

Section: Autoimmune Encephalitis and Other Cns Manifestationsmentioning

confidence: 99%

“…8,22,62 Exclusion of other more likely diagnoses is essential given the relative rarity of nirAE, especially cancer dissemination to the nervous system. 1,50 Other common causes of encephalopathy/delirium in patients with cancer are drugs (especially opioid), metabolic, and infections, with most patients having multiple recognizable etiologies. 63 Finally, identification of patients with preexisting neurologic autoimmunity before ICI initiation is fundamental because these patients may experience worsening of their condition.…”

Section: Autoimmune Encephalitis and Other Cns Manifestationsmentioning

confidence: 99%

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Neurologic Complications of Immune Checkpoint Inhibitors in Thoracic Malignancies

Sechi

Ζεκερίδου

2021

Journal of Thoracic Oncology

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Section: Autoimmune Encephalitis and Other Cns Manifestationsmentioning

confidence: 99%

Section: Autoimmune Encephalitis and Other Cns Manifestationsmentioning

confidence: 99%

Neurologic Complications of Immune Checkpoint Inhibitors in Thoracic Malignancies

Sechi

Ζεκερίδου

2021

Journal of Thoracic Oncology

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“…Autoantibody-based clinical neurological and psychiatric syndromes are a rapidly growing field in clinical neuropsychiatry and geriatric psychiatry as they often present with cognitive decline as the first or concomitant symptoms (Gibson et al 2020 ; Bartels et al 2019 ; Arino et al 2016 ; Loane et al 2019 ; Sechi and Flanagan 2019 ). A recent study focusing on the increasing frequency of N -methyl- d -aspartate receptor antibodies (NMDAR)-mediated atypical dementia (Gibson et al 2020 ).…”

Section: Introductionmentioning

confidence: 99%

Neural cell-surface and intracellular autoantibodies in patients with cognitive impairment from a memory clinic cohort

et al. 2021

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Autoantibody-associated cognitive impairment is an expanding field in geriatric psychiatry. We aim to assess the association between the presence of specific neural autoantibodies and cognitive performance in a memory clinic cohort. 154 patients with cognitive impairment were included between 2019 and 2020 presenting initially in a memory clinic. We evaluated their patient files retrospectively applying epidemiologic parameters, psychopathology, neuropsychology, intracellular and membrane-surface autoantibodies in serum and cerebrospinal fluid (CSF) and markers of neurodegeneration in CSF. In 26 of 154 patients, we searched for neural autoantibodies due to indicators for autoimmunity. In 15/26 (58%) of patients we detected serum and/or CSF autoantibodies. We identified autoantibodies against intracellular or cell-surface antigens in 7 of all 26 (27%) patients with cognitive dysfunction, although we cannot exclude patients with potential specific autoantibodies lacking autoimmune indicators. There were no significant differences between psychopathological and neuropsychological profiles in groups of patients with cognitive impairment comprising patients with autoantibodies (ABS + COG), no autoantibodies (ABS − COG), and Alzheimer’s disease (ADCOG). Concerning our CSF parameters, we detected intrathecal IgG synthesis in 14% of ABS + COG and in 13% of ABS − COG patients, whereas no intrathecal IgG synthesis was found in ADCOG patients. Furthermore, CSF Aß42 was significantly diminished in the ADCOG compared to the ABS + COG group (p < 0.05). In addition, the Aß42/40 ratio was lower in ADCOG patients than in the ABS + COG or ABS − COG group (p < 0.05). Our findings reveal the underestimated occurrence and autoantibodies’ potential role in patients presenting cognitive impairment. Furthermore, the patients with possible Alzheimer’s disease might be differentiated from autoantibody-positive patients via a reduced Aß42 and Aß42/40 ratio in the CSF. The antibody-type varies between patients to a relevant degree, thus demonstrating the need for more research to identify subgroup-specific phenotypes. These pilot study results open an avenue for improving diagnosis and treatment in a memory clinic.

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“…Although prion diseases are the prototypical etiology of RPD, recent studies showed that a large proportion of RPDs are treatable, especially immune-mediated etiologies. [2][3][4][5] In autoimmune dementia, patients with seropositivity of a cation channel complex autoantibody including VGCC are more likely to response to immunotherapy than seronegative patients with an odds ratio of 8.0 (95% confidence interval 1.6-39.2). 6 Therefore, it is important to carefully investigate any treatable causes, including autoimmune encephalopathy, in patients with RPDs.…”

Section: Discussionmentioning

confidence: 99%

“…RPD secondary to autoimmune encephalopathies are treatable. 2 Moreover, voltage-gated calcium channel (VGCC) antibody is not a common autoantibody causing autoimmune encephalopathy. Herein, we present a case of RPD with positive serum Ntype VGCC antibody, which presented with prominent psychiatric symptoms followed by rapidly progressive cognitive decline and significantly improved after immunotherapy.…”

mentioning

confidence: 99%

Rapidly progressive dementia–associated N-type voltage-gated calcium channel antibody encephalopathy

Thakolwiboon

Sohn

Duarte-Celada

et al. 2020

Baylor University Medical Center Proceedings

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Autoimmune encephalopathy is one of the treatable causes of rapidly progressive dementia; however, it is often underdiagnosed. Autoantibodies against voltage-gated calcium channel (VGCC) have been linked to several neurological disorders, including Lambert-Eaton syndrome, but VGCC antibody-associated encephalopathy is uncommon. Herein, we present a case of a 74-year-old woman with prominent neuropsychiatric symptoms followed by rapid cognitive decline. Extensive initial studies were nondiagnostic. Subsequently, serum N-type VGCC antibody was positive. After treatment with intravenous immunoglobulin, the patient's cognition and neuropsychiatric symptoms significantly improved.

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Diagnosis and Management of Autoimmune Dementia

Cited by 16 publications

References 111 publications

Neurologic Complications of Immune Checkpoint Inhibitors in Thoracic Malignancies

Neurologic Complications of Immune Checkpoint Inhibitors in Thoracic Malignancies

Neural cell-surface and intracellular autoantibodies in patients with cognitive impairment from a memory clinic cohort

Rapidly progressive dementia–associated N-type voltage-gated calcium channel antibody encephalopathy

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