Eloi Giné-Servén1, Jordi Serra-Mestres2, Maria Martinez-Ramirez3, Ester Boix-Quintana3, Eva Davi-Loscos3, Nicolau Guanyabens4, Virginia Casado4, Desiree Muriana4, Cristina Torres-Rivas3, Jorge Cuevas-Esteban5, Javier Labad6. 1. Department of Psychiatry, Hospital de Mataró, Consorci Sanitari del Maresme, Mataró, Spain. Electronic address: egine@csdm.cat. 2. Old Age Psychiatry Service, Cardinal Clinic, Windsor SL5 4EL, UK. 3. Department of Psychiatry, Hospital de Mataró, Consorci Sanitari del Maresme, Mataró, Spain. 4. Department of Neurology, Hospital de Mataró, Consorci Sanitari del Maresme, Mataró, Spain. 5. Department of Psychiatry, Hospital Universitari Germans Trias i Pujol, Badalona, Spain. 6. Department of Psychiatry, Hospital de Mataró, Consorci Sanitari del Maresme, Mataró, Spain; Centro de Investigación en Red de Salud Mental (CIBERSAM), Madrid, Spain; Translational Neuroscience Research Unit I3PT-INc-UAB, Institut de Innovació i Investigació Parc Taulí (I3PT), Institut de Neurociències, Universitat Autònoma de Barcelona, Barcelona, Spain.
Abstract
OBJECTIVE: To ascertain the clinical characteristics of anti-NMDA receptor encephalitis (NMDARE) in older patients. METHOD: A systematic literature review using PubMed and Scopus of all published case reports of NMDARE was undertaken, from database inception to June 2020. From this, cases reporting on patients older than 65 years of age and whose diagnosis was confirmed by the presence of anti-NMDAR antibodies in CSF were selected. RESULTS: 23 case reports fulfilling the study's criteria were found. Median age was 70.1 years (range 65-84), fourteen were female (60.9%), and mostly presented with acute behavioral and cognitive changes (95.7%). Atypical psychosis occurred in eleven patients (47.8%) with a sudden onset and fluctuating clinical pattern of delusions (39.1%), hallucinations (30.4%), and motility disturbances (34.8%) including catatonia (17.4%). Nine patients presented with seizures (39.1%). Pleocytosis in CSF (>5 WBC) was described in twelve cases (52.2%). Eleven cases (47.8%) had abnormal brain magnetic resonance imaging (MRI) scans with limbic inflammatory lesions. Thirteen patients had an abnormal EEG (56.5%). CONCLUSION: NMDARE should be included in the differential diagnosis of older patients who present with new psychiatric episodes, especially when characterized by sudden onset psychotic polymorphic symptomatology, fluctuating course with marked cognitive decline, and with catatonic features.
OBJECTIVE: To ascertain the clinical characteristics of anti-NMDA receptor encephalitis (NMDARE) in older patients. METHOD: A systematic literature review using PubMed and Scopus of all published case reports of NMDARE was undertaken, from database inception to June 2020. From this, cases reporting on patients older than 65 years of age and whose diagnosis was confirmed by the presence of anti-NMDAR antibodies in CSF were selected. RESULTS: 23 case reports fulfilling the study's criteria were found. Median age was 70.1 years (range 65-84), fourteen were female (60.9%), and mostly presented with acute behavioral and cognitive changes (95.7%). Atypical psychosis occurred in eleven patients (47.8%) with a sudden onset and fluctuating clinical pattern of delusions (39.1%), hallucinations (30.4%), and motility disturbances (34.8%) including catatonia (17.4%). Nine patients presented with seizures (39.1%). Pleocytosis in CSF (>5 WBC) was described in twelve cases (52.2%). Eleven cases (47.8%) had abnormal brain magnetic resonance imaging (MRI) scans with limbic inflammatory lesions. Thirteen patients had an abnormal EEG (56.5%). CONCLUSION: NMDARE should be included in the differential diagnosis of older patients who present with new psychiatric episodes, especially when characterized by sudden onset psychotic polymorphic symptomatology, fluctuating course with marked cognitive decline, and with catatonic features.
Authors: James Luccarelli; Mark Kalinich; Thomas H McCoy; Carlos Fernandez-Robles; Gregory Fricchione; Felicia Smith; Scott R Beach Journal: Gen Hosp Psychiatry Date: 2022-05-24 Impact factor: 7.587