Neuropsychological and psychiatric outcomes in encephalitis:A multi-centre case-control study

Harris, Lara and Griem, Julia and Gummery, Alison and Marsh, Laura and Defres, Sylviane and Bhojak, Maneesh and Das, Kumar and Easton, Ava and Solomon, Tom and Kopelman, Michael and Barlow, Gavin and Beeching, Nick and Blanchard, Thomas and Body, Richard and Boyd, Gavin and Cebria-Prejan, Lucia and Chadwick, David and Cooke, Richard and Crawford, Pamela and Davies, Brendan and Davies, Nick and Douthwaite, Sam and Emsley, Hedley and Goldenberg, Simon and Graham, Clive and Green, Steve and Hawkins, Clive and Irish, Dianne and Jeffrey, Kate and Jones, Matt and Keating, Liza and Keep, Jeff and Kopelman, Michael and Larkin, Susan and Leita, Maria and Macallan, Derek and Minton, Jane and Mohandas, Kavya and Moran, Ed and Muir, David and Pasztor, Monicka and Reed, Matthew and Solomon, Tom and Stanley, Philip and Sutton, Julian and Thomas, Peter and Weir, John and Brown, David and Tharmaratnam, Kukatharmini and Thornton, Maria (2020) Neuropsychological and psychiatric outcomes in encephalitis:A multi-centre case-control study. PLoS ONE, 15 (3). ISSN 1932-6203

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Objectives Our 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). Methods Patients 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. Results Patients 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. Conclusions Neuropsychological 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.

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03 Sep 2020 11:15
Last Modified:
28 Sep 2020 02:02