Cognitive impairment in adults with autoimmune encephalitis: experience from the Peruvian National Institute of Neurological Sciences

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"apellidos" => "Guevara-Silva" "email" => array:1 [ 0 => "erikguevara@hotmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "af0005" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cr0005" ] ] ] 1 => array:3 [ "nombre" => "S." "apellidos" => "Castro-Suarez" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "af0005" ] 1 => array:2 [ "etiqueta" => "b" "identificador" => "af0010" ] ] ] 2 => array:3 [ "nombre" => "C." "apellidos" => "Caparó-Zamalloa" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "af0005" ] ] ] 3 => array:3 [ "nombre" => "J." "apellidos" => "Cortez-Escalante" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "af0005" ] ] ] 4 => array:3 [ "nombre" => "M." "apellidos" => "Meza-Vega" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "af0005" ] 1 => array:2 [ "etiqueta" => "c" "identificador" => "af0015" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Centro de Investigación Básica en Demencias y Enfermedades Desmielinizantes del Sistema Nervioso Central, Departamento de Investigación, Docencia y Atención Especializada en Neurología de la Conducta, Instituto Nacional de Ciencias Neurológicas, Lima, Peru" "etiqueta" => "a" "identificador" => "af0005" ] 1 => array:3 [ "entidad" => "Global Brain Health Institute, University of California, San Francisco, CA, United States" "etiqueta" => "b" "identificador" => "af0010" ] 2 => array:3 [ "entidad" => "Facultad de Medicina, Universidad Nacional Mayor de San Marcos, Lima, Peru" "etiqueta" => "c" "identificador" => "af0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cr0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Deterioro cognitivo en pacientes adultos con encefalitis autoinmune: experiencia del Instituto Nacional de Ciencias Neurológicas en Perú" ] ] "textoCompleto" => "IntroductionAutoimmune encephalitis (AE) is inflammation of brain tissue that causes neurological dysfunction and is triggered by immunological factors such as antibodies or cell immunity against antigens present in the brain parenchyma.<a class="elsevierStyleCrossRef" href="#bb0005">1</a> The most frequent form in paediatric patients is acute disseminated encephalomyelitis (ADEM); in adults, however, anti–N-methyl-D-aspartate receptor (NMDAR) encephalitis is the leading cause of antineuronal antibody-mediated encephalitis and, according to some studies, is more frequent than any type of viral encephalitis.<a class="elsevierStyleCrossRef" href="#bb0010">2</a> Presentation is subacute, mainly affecting young adults, predominantly women, and is associated with certain tumours.<a class="elsevierStyleCrossRef" href="#bb0005">1</a> It typically presents with behavioural and cognitive alterations, seizures, psychotic symptoms, abnormal movements, and autonomic and respiratory dysfunction, and is included in the differential diagnosis of acute psychosis and rapidly progressive dementia.<a class="elsevierStyleCrossRef" href="#bb0005">1</a>,<a class="elsevierStyleCrossRef" href="#bb0015">3</a> Cognitive impairment is mainly characterized by memory complaints and executive dysfunction.<a class="elsevierStyleCrossRef" href="#bb0020">4</a>,<a class="elsevierStyleCrossRef" href="#bb0025">5</a>In 30%–90% of cases, AE causes focal alterations on brain MRI, inflammatory changes in the cerebrospinal fluid (CSF), or focal or diffuse epileptic activity in electroencephalography studies (EEG).<a class="elsevierStyleCrossRef" href="#bb0025">5</a>,<a class="elsevierStyleCrossRef" href="#bb0030">6</a> Diagnosis of autoimmune encephalitis is classified as probable or definite according to whether autoantibodies are detected.<a class="elsevierStyleCrossRef" href="#bb0035">7</a> Treatment is based on evidence from observational studies and expert opinion, and is classified as first-line (corticosteroids, plasmapheresis, human immunoglobulins) or second-line treatment (rituximab, cyclophosphamide). Treatment should be started as soon as probable autoimmune encephalitis is diagnosed, and must be combined with an active search for and resection of the tumour. Over 90% of patients respond to first-line therapy, with 50% improving within 4 weeks; the mortality risk is very low if the disease is detected early and treated aggressively, although rates may reach 10%.<a class="elsevierStyleCrossRef" href="#bb0020">4</a>,<a class="elsevierStyleCrossRef" href="#bb0040">8</a>The cognitive alterations described in the literature vary according to the time of assessment, type of antibody detected, and neuropsychological tool used.<a class="elsevierStyleCrossRef" href="#bb0040">8</a> The purpose of this study is to analyse cognitive impairment in adult patients with AE attended at a national reference centre for neurological diseases in Peru.Patients and methodsWe conducted a descriptive, cross-sectional study of the clinical records of patients hospitalised at the Peruvian National Institute of Neurological Sciences between January 2015 and December 2019 with a diagnosis of probable or definite AE according to the criteria proposed by Graus et al.<a class="elsevierStyleCrossRef" href="#bb0035">7</a> In order for patients to be included in our study, they had to be over 18 years of age and have completed a neuropsychological evaluation during hospitalisation. One patient was excluded due to a lack of laboratory data supporting the diagnosis.All patients admitted to our centre with encephalitis undergo MRI, CSF analysis, EEG, and chest, abdomen, and pelvis CT (to rule out occult neoplasia), although it is not always possible to perform all complementary tests. Diagnosis of definite AE was established when the antibody was detected or when MRI findings were highly suggestive (limbic encephalitis and ADEM) and CSF analysis ruled out infection. When no antibody was detected but MRI studies and CSF and blood analyses ruled out other aetiologies, we established a diagnosis of probable AE.Cognitive assessments were performed by neuropsychologists from our centre’s behavioural neurology department. The neuropsychological test battery included: (1) the Wechsler Adult Intelligence Scale (WAIS-III), which has previously been validated in a Chilean population and whose scores have been standardised according to age and education level<a class="elsevierStyleCrossRef" href="#bb0045">9</a>; (2) the NEUROPSI battery, created in Mexico, which evaluates orientation, attention, memory, language, visuospatial ability, executive function, and reading, writing, and mathematics<a class="elsevierStyleCrossRef" href="#bb0050">10</a>; (3) the Rey-Osterrieth Complex Figure test (copy condition only) to evaluate attention, concentration, planning, fine motor coordination, and constructional praxis<a class="elsevierStyleCrossRef" href="#bb0055">11</a>; and (4) the Rey Auditory Verbal Learning Test (RAVLT), an auditory memory test that evaluates verbal learning and immediate recall of a list of 15 words.<a class="elsevierStyleCrossRef" href="#bb0060">12</a> We also used the Zung Self-Rating Anxiety Scale and the Zung Self-Rating Depression Scale.<a class="elsevierStyleCrossRef" href="#bb0065">13</a> In order to compare full-scale, verbal, and performance IQ scores of the Wechsler Intelligence Scale, scores were converted to T-scores; the average score was set at 100, with scores below 70 considered to indicate intellectual disability. The NEUROPSI battery has a maximum score of 130; normative values were adjusted for age and education level. The maximum score on the Rey-Osterrieth Complex Figure is 18; scores <16 points indicate poor performance. The RAVLT has a maximum score of 15, with cut-off scores ranging from 11 to 14 depending on age and education level, according to normative data from a Chilean population.<a class="elsevierStyleCrossRef" href="#bb0070">14</a> Patients were considered to present cognitive impairment if they performed poorly in at least one neuropsychological test.We analysed the following variables: sex, age, education level, disease progression time, epileptic seizures, psychotic symptoms, cognitive impairment, type of encephalitis, CSF findings, EEG results, and brain MRI findings.Data were anonymised and analysed with the Stata software, version 16. Categorical variables are expressed as frequencies and percentages. Continuous variables were tested for normality with the Shapiro–Wilk test; normally distributed variables are expressed as means and standard deviations (SDs), and non-normally distributed variables as medians and interquartile ranges.We also explored the associations between the dependent variable (cognitive impairment) and independent variables (age, sex, disease progression time, CSF alterations) using the t-test, Pearson correlation coefficient, chi-square test, and Fisher exact test. Statistical significance was set at P < .05. This study complies with the ethical principles of the Declaration of Helsinki (2013 revision) and was approved by our centre’s research ethics committee.ResultsWe gathered data from 39 patients with a mean age (SD) of 39.23 (17.55) years; 58.97% (n = 23) of patients were men. Twenty-nine patients had probable AE and 10 had definite AE (5 with limbic encephalitis, 4 with anti-NMDAR encephalitis, and 1 with ADEM). Most patients underwent at least one complementary test to rule out occult neoplasia (teratoma in 1, seminoma in 1, lymphoproliferative disease in 1). Clinical data are summarised in <a class="elsevierStyleCrossRef" href="#t0005">Table 1</a>.<elsevierMultimedia ident="t0005"></elsevierMultimedia>Only 22 patients underwent neuropsychological assessment, which was conducted 1–2 weeks after the final bolus of methylprednisolone; therefore, the following analyses refer only to this subgroup.Mean age (SD) in the subgroup of patients undergoing neuropsychological assessment was 39.31 (17.20) years; 59.09% were men (13/22). By education level, 3 patients (13.64%) had completed primary education only, 9 (40.91%) had completed secondary education only, and 10 (45.45%) had higher studies. The median disease progression time at admission was 20.5 days. Epileptic seizures were reported in 81.82% of patients (18/22) and psychotic symptoms in 18.18% (4/22). Only two patients presented depression and another presented anxiety. Fifteen patients (68.18%) were diagnosed with probable AE and 7 (31.82%) with definite AE (4 with limbic encephalitis, 2 with anti-NMDAR encephalitis, and 1 with ADEM). All patients but one presented impairment of at least one cognitive domain; this was considered sufficient to establish a diagnosis of cognitive impairment. <a class="elsevierStyleCrossRef" href="#t0010">Table 2</a> presents the cognitive domains affected in our sample.<elsevierMultimedia ident="t0010"></elsevierMultimedia>The Mann–Whitney U test revealed that the median IQ was significantly higher in patients aged ≤38 years than in those older than 38 (P = .027). However, IQ scores were similar in patients with disease progression times above and below 3 weeks (P = .843). Likewise, no association was found between IQ score and education level.The Spearman correlation coefficient showed no correlation between IQ and disease progression time (rho = –0.002; P = .991), IQ and CSF protein level (rho = –0.142; P = .527), or IQ and CSF cell count (rho = –0.065; P = .773). We only found a moderate, inverse correlation between IQ and age (rho = –0.383; P = .078), although it did not reach the threshold for statistical significance.CSF analysis revealed alterations in 17 patients (77.27%): 8 patients presented high protein levels, 2 presented high protein levels plus pleocytosis, and 7 presented pleocytosis only. Twenty-two patients underwent neuroimaging studies, 11 of whom (50%) presented focal alterations compatible with encephalitis. EEG studies were performed in 19 patients, 11 of whom (57.89%) displayed alterations suggestive of diffuse encephalopathy or epileptiform activity.DiscussionAutoimmune encephalitis is more frequent among women and may present between the ages of 2 and 67 years.<a class="elsevierStyleCrossRef" href="#bb0005">1</a>,<a class="elsevierStyleCrossRef" href="#bb0075">15</a> However, below the age of 12 years, the condition predominantly affects boys.<a class="elsevierStyleCrossRef" href="#bb0020">4</a> Interestingly, our sample included a slightly higher percentage of men; mean age was within the range reported in the literature.Cognitive alterations appear from the early stage of AE and continue to develop as the disease progresses. The pathophysiology of cognitive impairment has been widely studied, mainly in patients with anti-NMDAR antibodies. NMDAR modulates excitatory synaptic transmission in the CNS and is essential for long-term potentiation, the neural basis of learning and memory. In encephalitis, IgG antibodies target the NR1 subunit of the receptor, causing receptor internalisation and decreasing NMDA-mediated current amplitudes.<a class="elsevierStyleCrossRef" href="#bb0080">16</a> NMDAR is abundantly expressed in the frontal and hippocampal cortex, which explains why the disease is predominantly associated with alterations in memory and executive function.<a class="elsevierStyleCrossRef" href="#bb0085">17</a> For a more in-depth description of the pathophysiological substrate of cognitive impairment according to the type of autoantibody involved, we recommend the study by Gibson et al.<a class="elsevierStyleCrossRef" href="#bb0090">18</a> The course of AE begins with a prodromal phase, followed by a psychotic phase, characterised by neuropsychiatric symptoms<a class="elsevierStyleCrossRef" href="#bb0095">19</a>; in this phase, 32%–50% of patients present cognitive symptoms.<a class="elsevierStyleCrossRefs" href="#bb0100">20–22</a> In our sample, all patients but one presented cognitive impairment, whereas a study of 86 Chinese patients does not mention cognitive impairment among the clinical manifestations of AE (except for allomnesia, among the psychiatric symptoms).<a class="elsevierStyleCrossRef" href="#bb0115">23</a> This may be explained by three factors. Firstly, differences in the time when the neuropsychological battery was administered, which is not indicated in most studies.<a class="elsevierStyleCrossRef" href="#bb0005">1</a>,<a class="elsevierStyleCrossRef" href="#bb0095">19</a>,<a class="elsevierStyleCrossRef" href="#bb0100">20</a>,<a class="elsevierStyleCrossRefs" href="#bb0110">22–24</a> Cognitive function is difficult to evaluate during the first days of hospitalisation due to agitation, sensory alterations, and recurrent seizures.<a class="elsevierStyleCrossRef" href="#bb0005">1</a>,<a class="elsevierStyleCrossRef" href="#bb0120">24</a>,<a class="elsevierStyleCrossRef" href="#bb0125">25</a> In our sample, the psychometric assessment was performed 1–2 weeks after administration of the final bolus of methylprednisolone, despite which nearly all patients displayed cognitive alterations. Secondly, different studies use different neuropsychological test batteries, and these are not always mentioned in the articles.<a class="elsevierStyleCrossRef" href="#bb0095">19</a>,<a class="elsevierStyleCrossRef" href="#bb0100">20</a>,<a class="elsevierStyleCrossRef" href="#bb0110">22</a>,<a class="elsevierStyleCrossRef" href="#bb0120">24</a> Our battery included several tests validated in Latin American populations,<a class="elsevierStyleCrossRefs" href="#bb0045">9–12</a> such as the WAIS-III and RAVLT; these tests were also used by Flanagan et al.<a class="elsevierStyleCrossRef" href="#bb0025">5</a> Finally, studies differ in the type and severity of encephalitis reported: while we included patients diagnosed both with probable and with definite AE, most publications only include patients with definite AE, and describe cognitive impairment according to the type of antibody detected,<a class="elsevierStyleCrossRef" href="#bb0005">1</a>,<a class="elsevierStyleCrossRef" href="#bb0075">15</a>,<a class="elsevierStyleCrossRef" href="#bb0110">22</a>,<a class="elsevierStyleCrossRef" href="#bb0115">23</a>,<a class="elsevierStyleCrossRef" href="#bb0125">25</a> which hinders comparison against our results.The cognitive profile of AE is characterised mainly by memory impairment (affecting working, short-term, and anterograde memory), and also involves executive dysfunction.<a class="elsevierStyleCrossRef" href="#bb0005">1</a>,<a class="elsevierStyleCrossRef" href="#bb0025">5</a>,<a class="elsevierStyleCrossRef" href="#bb0110">22</a>,<a class="elsevierStyleCrossRef" href="#bb0130">26</a> However, a review including patients with anti-NMDAR encephalitis found impaired concentration, apraxia, aphasia, and anterograde and retrograde amnesia.<a class="elsevierStyleCrossRef" href="#bb0095">19</a> Another review including 383 patients with AE from Latin America reports similar results.<a class="elsevierStyleCrossRef" href="#bb0105">21</a> These findings are consistent with our own results: in our sample, memory was the most frequently affected cognitive domain, followed by attention, language, constructional praxis, executive function, and visuospatial ability. However, studies including adolescents most frequently report language disorders, characterised by decreased verbal output progressing to mutism.<a class="elsevierStyleCrossRef" href="#bb0125">25</a> Regarding IQ, Flanagan et al.<a class="elsevierStyleCrossRef" href="#bb0025">5</a> report a mean score of 89 in 51 patients with autoimmune dementia; this score is higher than that observed in our sample.Epileptic seizures are observed in up to 48% of patients with AE presenting cognitive impairment.<a class="elsevierStyleCrossRef" href="#bb0135">27</a> In our sample, over 80% of patients presented this complication. The importance of this finding lies in its association with the development of cognitive impairment,<a class="elsevierStyleCrossRef" href="#bb0140">28</a> particularly when the pathophysiological substrate of seizures is found in the temporal lobe; the main cognitive domains affected in these cases are memory and executive function.<a class="elsevierStyleCrossRef" href="#bb0145">29</a> Furthermore, the percentage of patients with psychotic symptoms in our sample was considerably lower than reported in the literature, considering that these symptoms are reported in up to two-thirds of patients.<a class="elsevierStyleCrossRef" href="#bb0005">1</a>,<a class="elsevierStyleCrossRef" href="#bb0020">4</a>The systematic review by Blinder and Lewerenz<a class="elsevierStyleCrossRef" href="#bb0030">6</a> reports CSF pleocytosis in up to 50% of patients, with a mean count of 20 cells/μL, high CSF protein levels in up to 53% of patients, and pleocytosis plus high protein levels in 25%–100% of cases. These findings stand in contrast with our results, as two-thirds of our patients presented CSF alterations, but only two patients presented both pleocytosis and high protein levels. Furthermore, five patients presented no CSF inflammatory changes, which seems to be frequent according to the literature.<a class="elsevierStyleCrossRef" href="#bb0150">30</a>,<a class="elsevierStyleCrossRef" href="#bb0155">31</a> Flanagan et al.<a class="elsevierStyleCrossRef" href="#bb0025">5</a> report brain MRI alterations in 29% of patients and epileptiform activity in the EEG study in 18%, whereas Titulaer et al.<a class="elsevierStyleCrossRef" href="#bb0020">4</a> report MRI alterations in 33% and EEG alterations in 90%. In our sample, half of the patients undergoing MRI and EEG studies displayed alterations.The studies conducted to date with patients with AE do not describe an association between presence of cognitive impairment and such factors as age, sex, or disease progression time.<a class="elsevierStyleCrossRef" href="#bb0005">1</a>,<a class="elsevierStyleCrossRef" href="#bb0020">4</a>,<a class="elsevierStyleCrossRef" href="#bb0025">5</a> Our study only found a correlation between lower IQ and age above 38 years; this is not surprising, however, since age is a recognised risk factor for cognitive impairment in other diseases.<a class="elsevierStyleCrossRef" href="#bb0160">32</a> We found no significant correlations with the remaining factors analysed; future prospective studies with larger samples may provide valuable information on this topic.Our study has several limitations, including the small sample size and the fact that patients were selected by convenience sampling, which prevents us from extrapolating our results or identifying associated factors. The design of our study prevents us from providing a detailed description of the progression of cognitive impairment. Furthermore, antibody studies were not performed for all patients; therefore, the percentage of patients with definite AE may be underestimated. Neuropsychological test performance may be influenced by treatment with methylprednisolone. In any case, this is the first study of cognitive impairment in a representative sample of patients with AE from a national-level reference centre in Peru. Few studies have provided detailed descriptions of the neuropsychological tools used to evaluate cognitive performance in the acute phase of AE.<a class="elsevierStyleCrossRef" href="#bb0005">1</a>,<a class="elsevierStyleCrossRef" href="#bb0025">5</a> Neuropsychological assessment during the acute phase represents a major challenge due to the severity of the associated symptoms; a qualitative description of cognitive function is frequently performed in this stage, with standardised tests being more feasible in the subacute and chronic phases of AE.<a class="elsevierStyleCrossRef" href="#bb0090">18</a>In conclusion, our study shows that AE affects not only memory but also executive function, language, attention, and praxis. Therefore, a comprehensive neuropsychological assessment of these patients, including tests for all cognitive domains, should be performed starting in the acute phase, and repeated periodically. Future studies should aim to describe the peculiarities of cognitive impairment in each type of AE, explore associated factors, and measure treatment response.Conflicts of interestThe authors have no conflicts of interest to declare.FundingThis study has received no specific funding from any public, commercial, or non-profit organisation." "textoCompletoSecciones" => array:1 [ "secciones" => array:11 [ 0 => array:3 [ "identificador" => "xres2071325" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "as0025" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "as0030" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "as0035" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "as0040" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1767051" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres2071326" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "as0005" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "as0010" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "as0015" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "as0020" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1767050" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "s0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "s0010" "titulo" => "Patients and methods" ] 6 => array:2 [ "identificador" => "s0015" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "s0020" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "s0025" "titulo" => "Conflicts of interest" ] 9 => array:2 [ "identificador" => "s0030" "titulo" => "Funding" ] 10 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2021-08-11" "fechaAceptado" => "2022-01-04" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1767051" "palabras" => array:4 [ 0 => "Cognitive impairment" 1 => "Autoimmune encephalitis" 2 => "Anti-NMDAR encephalitis" 3 => "Peru" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1767050" "palabras" => array:4 [ 0 => "Deterioro cognitivo" 1 => "Encefalitis autoinmune" 2 => "Encefalitis R-NMDA" 3 => "Perú" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "IntroductionCognitive impairment, usually associated with seizures and psychosis, is one of the main symptoms of autoimmune encephalitis. The objective of our study is to analyse cognitive impairment in patients with autoimmune encephalitis. MethodsWe conducted a descriptive cross-sectional study of clinical data from 39 patients older than 18 years diagnosed with autoimmune encephalitis. Twenty-two patients underwent neuropsychological assessment. ResultsAll but one of the patients presented cognitive impairment. Memory was the most frequently affected domain (90.91%), followed by language (50%), attention (45.45%), executive function (40.91%), praxis (40.91%), and visuospatial skills (9.09%). No association was found with disease progression time, age, sex, or education level. Results from cerebrospinal fluid analysis, electroencephalography, and brain magnetic resonance imaging studies revealed alterations in 77.27%, 57.89%, and 55% of cases, respectively. ConclusionsMemory is the most frequently affected cognitive domain; however, other cognitive domains were also altered in our patients. Neuropsychological assessment is crucial to determine which cognitive domains are impaired in patients with autoimmune encephalitis." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "as0025" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "as0030" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "as0035" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "as0040" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "IntroducciónEl deterioro cognitivo, usualmente asociado a crisis epilépticas y psicosis, es uno de los principales síntomas de la encefalitis autoinmune. El objetivo de nuestro estudio fue describir las alteraciones cognitivas en pacientes con encefalitis autoinmune. MétodosTrabajo descriptivo transversal. Se revisaron 39 registros de pacientes mayores de 18 años con diagnóstico de encefalitis autoinmune, 22 de los cuales tuvieron evaluación neuropsicológica. Resultadosde los 22 pacientes sólo uno no presentó deterioro cognitivo. El dominio más comprometido fue la memoria (90,91%), seguido del lenguaje (50%), atención (45,45%), funciones ejecutivas (40,91%), apraxia (40,91%) y habilidades visuoespaciales (9,09%). No se encontró asociación con el tiempo de enfermedad, grado de instrucción, sexo o edad. Los análisis de líquido cefalorraquídeo, encefalograma y resonancia magnética estuvieron alterados en 77,27%, 57,89% y 55% de los casos respectivamente. ConclusionesEl trastorno de memoria es el compromiso más frecuente; sin embargo, nosotros encontramos que nuestros pacientes presentaban alteraciones de otras áreas cognitivas. La evaluación neuropsicológica es fundamental para determinar qué dominios están comprometidos en los pacientes con encefalitis autoinmune." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "as0005" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "as0010" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "as0015" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "as0020" "titulo" => "Conclusiones" ] ] ] ] "apendice" => array:1 [ 0 => array:1 [ "seccion" => array:1 [ 0 => array:4 [ "apendice" => "<elsevierMultimedia ident="ec0005"></elsevierMultimedia>" "etiqueta" => "Appendix A" "titulo" => "Supplementary data" "identificador" => "s0035" ] ] ] ] "multimedia" => array:3 [ 0 => array:8 [ "identificador" => "t0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "al0005" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:3 [ "leyenda" => "CT: computed tomography; EEG: electroencephalography; F: female; IQR: interquartile range; M: male; MRI: magnetic resonance imaging." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td-with-role" title="\n \t\t\t\t\ttable-head\n \t\t\t\t ; entry_with_role_colgroup " colspan="2" align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Neuropsychological assessment</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Yes (n = 22) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">No (n = 17) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">P \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Age, median (IQR) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">36.5 (35) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">38 (34) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.701<a class="elsevierStyleCrossRef" href="#tf0005">a</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Sex (M/F) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">13/9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10/7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.987<a class="elsevierStyleCrossRef" href="#tf0010">b</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Disease progression time (days), median (IQR) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">20.5 (52) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">15 (34) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.532<a class="elsevierStyleCrossRef" href="#tf0005">a</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Abnormal chest-abdomen-pelvis CT \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 (9.09%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 (5.88%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.00<a class="elsevierStyleCrossRef" href="#tf0015">c</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Abnormal MRI \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">11 (50%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6 (35.29%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.380<a class="elsevierStyleCrossRef" href="#tf0010">b</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Abnormal EEG \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">15 (68.18%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9 (52.94%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.229<a class="elsevierStyleCrossRef" href="#tf0010">b</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3430423.png" ] ] ] "notaPie" => array:3 [ 0 => array:3 [ "identificador" => "tf0005" "etiqueta" => "a" "nota" => "Mann–Whitney U test." ] 1 => array:3 [ "identificador" => "tf0010" "etiqueta" => "b" "nota" => "Chi-square test." ] 2 => array:3 [ "identificador" => "tf0015" "etiqueta" => "c" "nota" => "Fisher exact test." ] ] ] "descripcion" => array:1 [ "en" => "Clinical characteristics of our sample of patients with autoimmune encephalitis." ] ] 1 => array:8 [ "identificador" => "t0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "al0010" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:3 [ "leyenda" => "IQ: Wechsler Adult Intelligence Scale intelligence quotient; SD: standard deviation." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Total (n = 22) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Men (n = 13) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Women (n = 9) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">P \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">IQ, mean (SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">57.45 (17.91) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">61.84 (18.82) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">51.11 (15.30) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.172<a class="elsevierStyleCrossRef" href="#tf0020">a</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Memory \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">20 (90.91%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12 (60%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8 (40%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.00<a class="elsevierStyleCrossRef" href="#tf0025">b</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Language \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">11 (50%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7 (63.64%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 (36.36%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.00<a class="elsevierStyleCrossRef" href="#tf0025">b</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Attention \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10 (45.45%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7 (70%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 (30%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.415<a class="elsevierStyleCrossRef" href="#tf0025">b</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Executive function \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9 (40.91%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 (55.56%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 (44.44%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.00<a class="elsevierStyleCrossRef" href="#tf0025">b</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Constructional praxis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9 (40.91%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 (55.56%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 (44.44%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.00<a class="elsevierStyleCrossRef" href="#tf0025">b</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Visuospatial ability \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 (9.09%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 (50%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 (50%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.00<a class="elsevierStyleCrossRef" href="#tf0025">b</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3430424.png" ] ] ] "notaPie" => array:2 [ 0 => array:3 [ "identificador" => "tf0020" "etiqueta" => "a" "nota" => "t test." ] 1 => array:3 [ "identificador" => "tf0025" "etiqueta" => "b" "nota" => "Fisher exact test." ] ] ] "descripcion" => array:1 [ "en" => "Cognitive domains presenting impairment in the subgroup of patients with autoimmune encephalitis who underwent neuropsychological assessment." ] ] 2 => array:7 [ "identificador" => "ec0005" "tipo" => "MULTIMEDIAECOMPONENTE" "mostrarFloat" => false "mostrarDisplay" => true "detalles" => array:1 [ 0 => array:3 [ "identificador" => "al0015" "detalle" => "Image " "rol" => "short" ] ] "Ecomponente" => array:2 [ "fichero" => "mmc1.pdf" "ficheroTamanyo" => 248218 ] "descripcion" => array:1 [ "en" => "Supplementary material" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bs0005" "bibliografiaReferencia" => array:32 [ 0 => array:3 [ "identificador" => "bb0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Anti-NMDA-receptor encephalitis: case series and analysis of the effects of antibodies" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J. Dalmau" 1 => "A. Gleichman" 2 => "E. Hughes" 3 => "J. Rossi" 4 => "X. Peng" 5 => "M. Lai" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S1474-4422(08)70224-2" "Revista" => array:6 [ "tituloSerie" => "Lancet Neurol." "fecha" => "2008" "volumen" => "7" "paginaInicial" => "1091" "paginaFinal" => "1098" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18851928" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bb0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The frequency of autoimmune N-Methyl-D-aspartate receptor encephalitis surpasses that of individual viral etiologies in young individuals enrolled in the California Encephalitis Project" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "M.S. Gable" 1 => "H. Sheriff" 2 => "J. Dalmau" 3 => "D.H. Tilley" 4 => "C.A. Glaser" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/cid/cir1038" "Revista" => array:6 [ "tituloSerie" => "Clin Infect Dis." "fecha" => "2012" "volumen" => "54" "paginaInicial" => "899" "paginaFinal" => "904" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22281844" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bb0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Rapidly progressive dementia" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "M.D. Geschwind" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1212/CON.0000000000000319" "Revista" => array:5 [ "tituloSerie" => "Contin Lifelong Learn Neurol" "fecha" => "2016" "volumen" => "22" "paginaInicial" => "510" "paginaFinal" => "537" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bb0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Treatment and prognostic factors for long-term outcome in patients with anti-NMDA receptor encephalitis: an observational cohort study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M.J. Titulaer" 1 => "L. McCracken" 2 => "I. Gabilondo" 3 => "T. Armangue" 4 => "C. Glaser" 5 => "T. Iizuka" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S1474-4422(12)70310-1" "Revista" => array:6 [ "tituloSerie" => "Lancet Neurol." "fecha" => "2013" "volumen" => "12" "paginaInicial" => "157" "paginaFinal" => "165" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23290630" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bb0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Autoimmune dementia: clinical course and predictors of immunotherapy response" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "E. Flanagan" 1 => "A. McKeon" 2 => "V. Lennon" 3 => "B. Boeve" 4 => "M. Trenerry" 5 => "M. Tan" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.4065/mcp.2010.0326" "Revista" => array:6 [ "tituloSerie" => "Mayo Clin Proc." "fecha" => "2010" "volumen" => "85" "paginaInicial" => "881" "paginaFinal" => "897" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20884824" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bb0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cerebrospinal fluid findings in patients with autoimmune encephalitis-a systematic analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "T. Blinder" 1 => "J. Lewerenz" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3389/fneur.2019.00804" "Revista" => array:6 [ "tituloSerie" => "Front Neurol." "fecha" => "2019" "volumen" => "10" "paginaInicial" => "1" "paginaFinal" => "13" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30761061" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bb0035" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A clinical approach to diagnosis of autoimmune encephalitis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "F. Graus" 1 => "M.J. Titulaer" 2 => "R. Balu" 3 => "S. Benseler" 4 => "C.G. Bien" 5 => "T. Cellucci" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S1474-4422(15)00401-9" "Revista" => array:6 [ "tituloSerie" => "Lancet Neurol." "fecha" => "2016" "volumen" => "15" "paginaInicial" => "391" "paginaFinal" => "404" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26906964" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bb0040" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Auto-immune encephalitis as differential diagnosis of infectious encephalitis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "T. Armangue" 1 => "F. Leypoldt" 2 => "J. Dalmau" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/WCO.0000000000000087" "Revista" => array:6 [ "tituloSerie" => "Curr Opin Neurol." "fecha" => "2014" "volumen" => "27" "paginaInicial" => "361" "paginaFinal" => "368" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24792345" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bb0045" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Escala de Inteligencia de Wechsler para adultos (WAIS): Manual" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "H. La Marta" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:3 [ "fecha" => "1982" "editorial" => "Pontificia Universidad Católica de Chile, Escuela de Psicología" "editorialLocalizacion" => "Chile" ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bb0050" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "NEUROPSI: Evaluación Neuropsicológica Breve en Español" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "S. Ostrosky" 1 => "A. Ardila" 2 => "M. Rosselli" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "LibroEditado" => array:2 [ "titulo" => "Manual, Instructivo y Protocolo de Aplicación" "serieFecha" => "1997" ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bb0055" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Spanish normative studies in young adults (NEURONORMA young adults project): norms for the Rey-Osterrieth Complex Figure (copy and memory) and Free and Cued Selective Reminding Test" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "R. Palomo" 1 => "M. Casals-Coll" 2 => "G. Sánchez-Benavides" 3 => "M. Quintana" 4 => "R.M. Manero" 5 => "T. Rognoti" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.nrl.2012.03.008" "Revista" => array:6 [ "tituloSerie" => "Neurología." "fecha" => "2013" "volumen" => "28" "paginaInicial" => "226" "paginaFinal" => "235" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22652140" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bb0060" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Rey Auditory-Verbal Learning Test: the effects of age and gender, and norms for delayed recall and story recognition trials" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "R.M. Savage" 1 => "W.D. Gouvier" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Arch Clin Neuropsychol." "fecha" => "1992" "volumen" => "7" "paginaInicial" => "407" "paginaFinal" => "414" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14591275" "web" => "Medline" ] ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bb0065" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Validez de la escala breve de Zung para tamizaje del episodio depresivo mayor en la población general de Bucaramanga" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "A. Campo" 1 => "L.A. Díaz" 2 => "G.E. Rueda" ] ] ] ] ] "host" => array:2 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Colombia. Biomédica." "fecha" => "2006" "volumen" => "26" "paginaInicial" => "415" "paginaFinal" => "423" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17176005" "web" => "Medline" ] ] ] ] 1 => array:1 [ "WWW" => array:1 [ "link" => "http://www.scielo.org.co/scielo.php?script=sci_arttextπd=S0120-41572006000300011&lng=en" ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bb0070" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Gonzáles-Hernandez, J. Batería neuropsicológica “memoriza”. Pontificia Universidad Católica de Chile, Departamento de Neurología. Página web: <a target="_blank" href="http://www.memoriza.com">http://www.memoriza.com</a>" ] ] ] 14 => array:3 [ "identificador" => "bb0075" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cognitive outcomes following anti-N-methylD-aspartate receptor encephalitis: a systematic review" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "G.L. McKeon" 1 => "G.A. Robinson" 2 => "A.E. Ryan" 3 => "S. Blum" 4 => "D. Gillis" 5 => "C. Finke" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1080/13803395.2017.1329408" "Revista" => array:6 [ "tituloSerie" => "J Clin Exp Neuropsychol." "fecha" => "2017" "volumen" => "40" "paginaInicial" => "234" "paginaFinal" => "252" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28585453" "web" => "Medline" ] ] ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bb0080" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Acute mechanisms underlying antibody effects in anti-N-methyl-D-aspartate receptor encephalitis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "E.H. Moscato" 1 => "X. Peng" 2 => "A. Jain" 3 => "T.D. Parsons" 4 => "J. Dalmau" 5 => "R.J. Balice-Gordon" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/ana.24195" "Revista" => array:6 [ "tituloSerie" => "Ann Neurol." 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"fecha" => "2018" "volumen" => "59" "paginaInicial" => "215" "paginaFinal" => "225" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29205291" "web" => "Medline" ] ] ] ] ] ] ] ] 28 => array:3 [ "identificador" => "bb0145" "etiqueta" => "29" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Network connectivity separate from the hypothesized irritative zone correlates with impaired cognition and higher rates of seizure recurrence" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "E.G. Neal" 1 => "L. Di" 2 => "A. Reale-Caldwell" 3 => "S. Maciver" 4 => "M.R. Schoenberg" 5 => "F.L. Vale" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.yebeh.2019.106585" "Revista" => array:4 [ "tituloSerie" => "Epilepsy Behav." 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Deterioro cognitivo en pacientes adultos con encefalitis autoinmune: experiencia del Instituto Nacional de Ciencias Neurológicas en Perú

E. Guevara-Silvaa,

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erikguevara@hotmail.com

Corresponding author.

, S. Castro-Suareza,b, C. Caparó-Zamalloaa, J. Cortez-Escalantea, M. Meza-Vegaa,c

a Centro de Investigación Básica en Demencias y Enfermedades Desmielinizantes del Sistema Nervioso Central, Departamento de Investigación, Docencia y Atención Especializada en Neurología de la Conducta, Instituto Nacional de Ciencias Neurológicas, Lima, Peru

b Global Brain Health Institute, University of California, San Francisco, CA, United States

c Facultad de Medicina, Universidad Nacional Mayor de San Marcos, Lima, Peru

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    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "Deterioro cognitivo en pacientes adultos con encefalitis autoinmune&#58; experiencia del Instituto Nacional de Ciencias Neurol&#243;gicas en Per&#250;"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="s0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0065">Introduction</span><p id="p0005" class="elsevierStylePara elsevierViewall">Autoimmune encephalitis &#40;AE&#41; is inflammation of brain tissue that causes neurological dysfunction and is triggered by immunological factors such as antibodies or cell immunity against antigens present in the brain parenchyma&#46;<a class="elsevierStyleCrossRef" href="#bb0005"><span class="elsevierStyleSup">1</span></a> The most frequent form in paediatric patients is acute disseminated encephalomyelitis &#40;ADEM&#41;&#59; in adults&#44; however&#44; anti&#8211;N-methyl-D-aspartate receptor &#40;NMDAR&#41; encephalitis is the leading cause of antineuronal antibody-mediated encephalitis and&#44; according to some studies&#44; is more frequent than any type of viral encephalitis&#46;<a class="elsevierStyleCrossRef" href="#bb0010"><span class="elsevierStyleSup">2</span></a> Presentation is subacute&#44; mainly affecting young adults&#44; predominantly women&#44; and is associated with certain tumours&#46;<a class="elsevierStyleCrossRef" href="#bb0005"><span class="elsevierStyleSup">1</span></a> It typically presents with behavioural and cognitive alterations&#44; seizures&#44; psychotic symptoms&#44; abnormal movements&#44; and autonomic and respiratory dysfunction&#44; and is included in the differential diagnosis of acute psychosis and rapidly progressive dementia&#46;<a class="elsevierStyleCrossRef" href="#bb0005"><span class="elsevierStyleSup">1</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bb0015"><span class="elsevierStyleSup">3</span></a> Cognitive impairment is mainly characterized by memory complaints and executive dysfunction&#46;<a class="elsevierStyleCrossRef" href="#bb0020"><span class="elsevierStyleSup">4</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bb0025"><span class="elsevierStyleSup">5</span></a></p><p id="p0010" class="elsevierStylePara elsevierViewall">In 30&#37;&#8211;90&#37; of cases&#44; AE causes focal alterations on brain MRI&#44; inflammatory changes in the cerebrospinal fluid &#40;CSF&#41;&#44; or focal or diffuse epileptic activity in electroencephalography studies &#40;EEG&#41;&#46;<a class="elsevierStyleCrossRef" href="#bb0025"><span class="elsevierStyleSup">5</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bb0030"><span class="elsevierStyleSup">6</span></a> Diagnosis of autoimmune encephalitis is classified as probable or definite according to whether autoantibodies are detected&#46;<a class="elsevierStyleCrossRef" href="#bb0035"><span class="elsevierStyleSup">7</span></a> Treatment is based on evidence from observational studies and expert opinion&#44; and is classified as first-line &#40;corticosteroids&#44; plasmapheresis&#44; human immunoglobulins&#41; or second-line treatment &#40;rituximab&#44; cyclophosphamide&#41;&#46; Treatment should be started as soon as probable autoimmune encephalitis is diagnosed&#44; and must be combined with an active search for and resection of the tumour&#46; Over 90&#37; of patients respond to first-line therapy&#44; with 50&#37; improving within 4 weeks&#59; the mortality risk is very low if the disease is detected early and treated aggressively&#44; although rates may reach 10&#37;&#46;<a class="elsevierStyleCrossRef" href="#bb0020"><span class="elsevierStyleSup">4</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bb0040"><span class="elsevierStyleSup">8</span></a></p><p id="p0015" class="elsevierStylePara elsevierViewall">The cognitive alterations described in the literature vary according to the time of assessment&#44; type of antibody detected&#44; and neuropsychological tool used&#46;<a class="elsevierStyleCrossRef" href="#bb0040"><span class="elsevierStyleSup">8</span></a> The purpose of this study is to analyse cognitive impairment in adult patients with AE attended at a national reference centre for neurological diseases in Peru&#46;</p></span><span id="s0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0070">Patients and methods</span><p id="p0020" class="elsevierStylePara elsevierViewall">We conducted a descriptive&#44; cross-sectional study of the clinical records of patients hospitalised at the Peruvian National Institute of Neurological Sciences between January 2015 and December 2019 with a diagnosis of probable or definite AE according to the criteria proposed by Graus et al&#46;<a class="elsevierStyleCrossRef" href="#bb0035"><span class="elsevierStyleSup">7</span></a> In order for patients to be included in our study&#44; they had to be over 18 years of age and have completed a neuropsychological evaluation during hospitalisation&#46; One patient was excluded due to a lack of laboratory data supporting the diagnosis&#46;</p><p id="p0025" class="elsevierStylePara elsevierViewall">All patients admitted to our centre with encephalitis undergo MRI&#44; CSF analysis&#44; EEG&#44; and chest&#44; abdomen&#44; and pelvis CT &#40;to rule out occult neoplasia&#41;&#44; although it is not always possible to perform all complementary tests&#46; Diagnosis of definite AE was established when the antibody was detected or when MRI findings were highly suggestive &#40;limbic encephalitis and ADEM&#41; and CSF analysis ruled out infection&#46; When no antibody was detected but MRI studies and CSF and blood analyses ruled out other aetiologies&#44; we established a diagnosis of probable AE&#46;</p><p id="p0030" class="elsevierStylePara elsevierViewall">Cognitive assessments were performed by neuropsychologists from our centre&#8217;s behavioural neurology department&#46; The neuropsychological test battery included&#58; &#40;1&#41; the Wechsler Adult Intelligence Scale &#40;WAIS-III&#41;&#44; which has previously been validated in a Chilean population and whose scores have been standardised according to age and education level<a class="elsevierStyleCrossRef" href="#bb0045"><span class="elsevierStyleSup">9</span></a>&#59; &#40;2&#41; the NEUROPSI battery&#44; created in Mexico&#44; which evaluates orientation&#44; attention&#44; memory&#44; language&#44; visuospatial ability&#44; executive function&#44; and reading&#44; writing&#44; and mathematics<a class="elsevierStyleCrossRef" href="#bb0050"><span class="elsevierStyleSup">10</span></a>&#59; &#40;3&#41; the Rey-Osterrieth Complex Figure test &#40;copy condition only&#41; to evaluate attention&#44; concentration&#44; planning&#44; fine motor coordination&#44; and constructional praxis<a class="elsevierStyleCrossRef" href="#bb0055"><span class="elsevierStyleSup">11</span></a>&#59; and &#40;4&#41; the Rey Auditory Verbal Learning Test &#40;RAVLT&#41;&#44; an auditory memory test that evaluates verbal learning and immediate recall of a list of 15 words&#46;<a class="elsevierStyleCrossRef" href="#bb0060"><span class="elsevierStyleSup">12</span></a> We also used the Zung Self-Rating Anxiety Scale and the Zung Self-Rating Depression Scale&#46;<a class="elsevierStyleCrossRef" href="#bb0065"><span class="elsevierStyleSup">13</span></a> In order to compare full-scale&#44; verbal&#44; and performance IQ scores of the Wechsler Intelligence Scale&#44; scores were converted to T-scores&#59; the average score was set at 100&#44; with scores below 70 considered to indicate intellectual disability&#46; The NEUROPSI battery has a maximum score of 130&#59; normative values were adjusted for age and education level&#46; The maximum score on the Rey-Osterrieth Complex Figure is 18&#59; scores &#60;<span class="elsevierStyleHsp" style=""></span>16 points indicate poor performance&#46; The RAVLT has a maximum score of 15&#44; with cut-off scores ranging from 11 to 14 depending on age and education level&#44; according to normative data from a Chilean population&#46;<a class="elsevierStyleCrossRef" href="#bb0070"><span class="elsevierStyleSup">14</span></a> Patients were considered to present cognitive impairment if they performed poorly in at least one neuropsychological test&#46;</p><p id="p0035" class="elsevierStylePara elsevierViewall">We analysed the following variables&#58; sex&#44; age&#44; education level&#44; disease progression time&#44; epileptic seizures&#44; psychotic symptoms&#44; cognitive impairment&#44; type of encephalitis&#44; CSF findings&#44; EEG results&#44; and brain MRI findings&#46;</p><p id="p0040" class="elsevierStylePara elsevierViewall">Data were anonymised and analysed with the Stata software&#44; version 16&#46; Categorical variables are expressed as frequencies and percentages&#46; Continuous variables were tested for normality with the Shapiro&#8211;Wilk test&#59; normally distributed variables are expressed as means and standard deviations &#40;SDs&#41;&#44; and non-normally distributed variables as medians and interquartile ranges&#46;</p><p id="p0045" class="elsevierStylePara elsevierViewall">We also explored the associations between the dependent variable &#40;cognitive impairment&#41; and independent variables &#40;age&#44; sex&#44; disease progression time&#44; CSF alterations&#41; using the <span class="elsevierStyleItalic">t</span>-test&#44; Pearson correlation coefficient&#44; chi-square test&#44; and Fisher exact test&#46; Statistical significance was set at <span class="elsevierStyleItalic">P</span> &#60; &#46;05&#46; This study complies with the ethical principles of the Declaration of Helsinki &#40;2013 revision&#41; and was approved by our centre&#8217;s research ethics committee&#46;</p></span><span id="s0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0075">Results</span><p id="p0050" class="elsevierStylePara elsevierViewall">We gathered data from 39 patients with a mean age &#40;SD&#41; of 39&#46;23 &#40;17&#46;55&#41; years&#59; 58&#46;97&#37; &#40;n &#61; 23&#41; of patients were men&#46; Twenty-nine patients had probable AE and 10 had definite AE &#40;5 with limbic encephalitis&#44; 4 with anti-NMDAR encephalitis&#44; and 1 with ADEM&#41;&#46; Most patients underwent at least one complementary test to rule out occult neoplasia &#40;teratoma in 1&#44; seminoma in 1&#44; lymphoproliferative disease in 1&#41;&#46; Clinical data are summarised in <a class="elsevierStyleCrossRef" href="#t0005">Table 1</a>&#46;</p><elsevierMultimedia ident="t0005"></elsevierMultimedia><p id="p0055" class="elsevierStylePara elsevierViewall">Only 22 patients underwent neuropsychological assessment&#44; which was conducted 1&#8211;2 weeks after the final bolus of methylprednisolone&#59; therefore&#44; the following analyses refer only to this subgroup&#46;</p><p id="p0060" class="elsevierStylePara elsevierViewall">Mean age &#40;SD&#41; in the subgroup of patients undergoing neuropsychological assessment was 39&#46;31 &#40;17&#46;20&#41; years&#59; 59&#46;09&#37; were men &#40;13&#47;22&#41;&#46; By education level&#44; 3 patients &#40;13&#46;64&#37;&#41; had completed primary education only&#44; 9 &#40;40&#46;91&#37;&#41; had completed secondary education only&#44; and 10 &#40;45&#46;45&#37;&#41; had higher studies&#46; The median disease progression time at admission was 20&#46;5 days&#46; Epileptic seizures were reported in 81&#46;82&#37; of patients &#40;18&#47;22&#41; and psychotic symptoms in 18&#46;18&#37; &#40;4&#47;22&#41;&#46; Only two patients presented depression and another presented anxiety&#46; Fifteen patients &#40;68&#46;18&#37;&#41; were diagnosed with probable AE and 7 &#40;31&#46;82&#37;&#41; with definite AE &#40;4 with limbic encephalitis&#44; 2 with anti-NMDAR encephalitis&#44; and 1 with ADEM&#41;&#46; All patients but one presented impairment of at least one cognitive domain&#59; this was considered sufficient to establish a diagnosis of cognitive impairment&#46; <a class="elsevierStyleCrossRef" href="#t0010">Table 2</a> presents the cognitive domains affected in our sample&#46;</p><elsevierMultimedia ident="t0010"></elsevierMultimedia><p id="p0065" class="elsevierStylePara elsevierViewall">The Mann&#8211;Whitney <span class="elsevierStyleItalic">U</span> test revealed that the median IQ was significantly higher in patients aged &#8804;<span class="elsevierStyleHsp" style=""></span>38 years than in those older than 38 &#40;<span class="elsevierStyleItalic">P</span> &#61; &#46;027&#41;&#46; However&#44; IQ scores were similar in patients with disease progression times above and below 3 weeks &#40;<span class="elsevierStyleItalic">P</span> &#61; &#46;843&#41;&#46; Likewise&#44; no association was found between IQ score and education level&#46;</p><p id="p0070" class="elsevierStylePara elsevierViewall">The Spearman correlation coefficient showed no correlation between IQ and disease progression time &#40;rho &#61; &#8211;0&#46;002&#59; <span class="elsevierStyleItalic">P</span> &#61; &#46;991&#41;&#44; IQ and CSF protein level &#40;rho &#61; &#8211;0&#46;142&#59; <span class="elsevierStyleItalic">P</span> &#61; &#46;527&#41;&#44; or IQ and CSF cell count &#40;rho &#61; &#8211;0&#46;065&#59; <span class="elsevierStyleItalic">P</span> &#61; &#46;773&#41;&#46; We only found a moderate&#44; inverse correlation between IQ and age &#40;rho &#61; &#8211;0&#46;383&#59; <span class="elsevierStyleItalic">P</span> &#61; &#46;078&#41;&#44; although it did not reach the threshold for statistical significance&#46;</p><p id="p0075" class="elsevierStylePara elsevierViewall">CSF analysis revealed alterations in 17 patients &#40;77&#46;27&#37;&#41;&#58; 8 patients presented high protein levels&#44; 2 presented high protein levels plus pleocytosis&#44; and 7 presented pleocytosis only&#46; Twenty-two patients underwent neuroimaging studies&#44; 11 of whom &#40;50&#37;&#41; presented focal alterations compatible with encephalitis&#46; EEG studies were performed in 19 patients&#44; 11 of whom &#40;57&#46;89&#37;&#41; displayed alterations suggestive of diffuse encephalopathy or epileptiform activity&#46;</p></span><span id="s0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0080">Discussion</span><p id="p0080" class="elsevierStylePara elsevierViewall">Autoimmune encephalitis is more frequent among women and may present between the ages of 2 and 67 years&#46;<a class="elsevierStyleCrossRef" href="#bb0005"><span class="elsevierStyleSup">1</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bb0075"><span class="elsevierStyleSup">15</span></a> However&#44; below the age of 12 years&#44; the condition predominantly affects boys&#46;<a class="elsevierStyleCrossRef" href="#bb0020"><span class="elsevierStyleSup">4</span></a> Interestingly&#44; our sample included a slightly higher percentage of men&#59; mean age was within the range reported in the literature&#46;</p><p id="p0085" class="elsevierStylePara elsevierViewall">Cognitive alterations appear from the early stage of AE and continue to develop as the disease progresses&#46; The pathophysiology of cognitive impairment has been widely studied&#44; mainly in patients with anti-NMDAR antibodies&#46; NMDAR modulates excitatory synaptic transmission in the CNS and is essential for long-term potentiation&#44; the neural basis of learning and memory&#46; In encephalitis&#44; IgG antibodies target the NR1 subunit of the receptor&#44; causing receptor internalisation and decreasing NMDA-mediated current amplitudes&#46;<a class="elsevierStyleCrossRef" href="#bb0080"><span class="elsevierStyleSup">16</span></a> NMDAR is abundantly expressed in the frontal and hippocampal cortex&#44; which explains why the disease is predominantly associated with alterations in memory and executive function&#46;<a class="elsevierStyleCrossRef" href="#bb0085"><span class="elsevierStyleSup">17</span></a> For a more in-depth description of the pathophysiological substrate of cognitive impairment according to the type of autoantibody involved&#44; we recommend the study by Gibson et al&#46;<a class="elsevierStyleCrossRef" href="#bb0090"><span class="elsevierStyleSup">18</span></a> The course of AE begins with a prodromal phase&#44; followed by a psychotic phase&#44; characterised by neuropsychiatric symptoms<a class="elsevierStyleCrossRef" href="#bb0095"><span class="elsevierStyleSup">19</span></a>&#59; in this phase&#44; 32&#37;&#8211;50&#37; of patients present cognitive symptoms&#46;<a class="elsevierStyleCrossRefs" href="#bb0100"><span class="elsevierStyleSup">20&#8211;22</span></a> In our sample&#44; all patients but one presented cognitive impairment&#44; whereas a study of 86 Chinese patients does not mention cognitive impairment among the clinical manifestations of AE &#40;except for allomnesia&#44; among the psychiatric symptoms&#41;&#46;<a class="elsevierStyleCrossRef" href="#bb0115"><span class="elsevierStyleSup">23</span></a> This may be explained by three factors&#46; Firstly&#44; differences in the time when the neuropsychological battery was administered&#44; which is not indicated in most studies&#46;<a class="elsevierStyleCrossRef" href="#bb0005"><span class="elsevierStyleSup">1</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bb0095"><span class="elsevierStyleSup">19</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bb0100"><span class="elsevierStyleSup">20</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRefs" href="#bb0110"><span class="elsevierStyleSup">22&#8211;24</span></a> Cognitive function is difficult to evaluate during the first days of hospitalisation due to agitation&#44; sensory alterations&#44; and recurrent seizures&#46;<a class="elsevierStyleCrossRef" href="#bb0005"><span class="elsevierStyleSup">1</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bb0120"><span class="elsevierStyleSup">24</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bb0125"><span class="elsevierStyleSup">25</span></a> In our sample&#44; the psychometric assessment was performed 1&#8211;2 weeks after administration of the final bolus of methylprednisolone&#44; despite which nearly all patients displayed cognitive alterations&#46; Secondly&#44; different studies use different neuropsychological test batteries&#44; and these are not always mentioned in the articles&#46;<a class="elsevierStyleCrossRef" href="#bb0095"><span class="elsevierStyleSup">19</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bb0100"><span class="elsevierStyleSup">20</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bb0110"><span class="elsevierStyleSup">22</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bb0120"><span class="elsevierStyleSup">24</span></a> Our battery included several tests validated in Latin American populations&#44;<a class="elsevierStyleCrossRefs" href="#bb0045"><span class="elsevierStyleSup">9&#8211;12</span></a> such as the WAIS-III and RAVLT&#59; these tests were also used by Flanagan et al&#46;<a class="elsevierStyleCrossRef" href="#bb0025"><span class="elsevierStyleSup">5</span></a> Finally&#44; studies differ in the type and severity of encephalitis reported&#58; while we included patients diagnosed both with probable and with definite AE&#44; most publications only include patients with definite AE&#44; and describe cognitive impairment according to the type of antibody detected&#44;<a class="elsevierStyleCrossRef" href="#bb0005"><span class="elsevierStyleSup">1</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bb0075"><span class="elsevierStyleSup">15</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bb0110"><span class="elsevierStyleSup">22</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bb0115"><span class="elsevierStyleSup">23</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bb0125"><span class="elsevierStyleSup">25</span></a> which hinders comparison against our results&#46;</p><p id="p0090" class="elsevierStylePara elsevierViewall">The cognitive profile of AE is characterised mainly by memory impairment &#40;affecting working&#44; short-term&#44; and anterograde memory&#41;&#44; and also involves executive dysfunction&#46;<a class="elsevierStyleCrossRef" href="#bb0005"><span class="elsevierStyleSup">1</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bb0025"><span class="elsevierStyleSup">5</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bb0110"><span class="elsevierStyleSup">22</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bb0130"><span class="elsevierStyleSup">26</span></a> However&#44; a review including patients with anti-NMDAR encephalitis found impaired concentration&#44; apraxia&#44; aphasia&#44; and anterograde and retrograde amnesia&#46;<a class="elsevierStyleCrossRef" href="#bb0095"><span class="elsevierStyleSup">19</span></a> Another review including 383 patients with AE from Latin America reports similar results&#46;<a class="elsevierStyleCrossRef" href="#bb0105"><span class="elsevierStyleSup">21</span></a> These findings are consistent with our own results&#58; in our sample&#44; memory was the most frequently affected cognitive domain&#44; followed by attention&#44; language&#44; constructional praxis&#44; executive function&#44; and visuospatial ability&#46; However&#44; studies including adolescents most frequently report language disorders&#44; characterised by decreased verbal output progressing to mutism&#46;<a class="elsevierStyleCrossRef" href="#bb0125"><span class="elsevierStyleSup">25</span></a> Regarding IQ&#44; Flanagan et al&#46;<a class="elsevierStyleCrossRef" href="#bb0025"><span class="elsevierStyleSup">5</span></a> report a mean score of 89 in 51 patients with autoimmune dementia&#59; this score is higher than that observed in our sample&#46;</p><p id="p0095" class="elsevierStylePara elsevierViewall">Epileptic seizures are observed in up to 48&#37; of patients with AE presenting cognitive impairment&#46;<a class="elsevierStyleCrossRef" href="#bb0135"><span class="elsevierStyleSup">27</span></a> In our sample&#44; over 80&#37; of patients presented this complication&#46; The importance of this finding lies in its association with the development of cognitive impairment&#44;<a class="elsevierStyleCrossRef" href="#bb0140"><span class="elsevierStyleSup">28</span></a> particularly when the pathophysiological substrate of seizures is found in the temporal lobe&#59; the main cognitive domains affected in these cases are memory and executive function&#46;<a class="elsevierStyleCrossRef" href="#bb0145"><span class="elsevierStyleSup">29</span></a> Furthermore&#44; the percentage of patients with psychotic symptoms in our sample was considerably lower than reported in the literature&#44; considering that these symptoms are reported in up to two-thirds of patients&#46;<a class="elsevierStyleCrossRef" href="#bb0005"><span class="elsevierStyleSup">1</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bb0020"><span class="elsevierStyleSup">4</span></a></p><p id="p0100" class="elsevierStylePara elsevierViewall">The systematic review by Blinder and Lewerenz<a class="elsevierStyleCrossRef" href="#bb0030"><span class="elsevierStyleSup">6</span></a> reports CSF pleocytosis in up to 50&#37; of patients&#44; with a mean count of 20 cells&#47;&#956;L&#44; high CSF protein levels in up to 53&#37; of patients&#44; and pleocytosis plus high protein levels in 25&#37;&#8211;100&#37; of cases&#46; These findings stand in contrast with our results&#44; as two-thirds of our patients presented CSF alterations&#44; but only two patients presented both pleocytosis and high protein levels&#46; Furthermore&#44; five patients presented no CSF inflammatory changes&#44; which seems to be frequent according to the literature&#46;<a class="elsevierStyleCrossRef" href="#bb0150"><span class="elsevierStyleSup">30</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bb0155"><span class="elsevierStyleSup">31</span></a> Flanagan et al&#46;<a class="elsevierStyleCrossRef" href="#bb0025"><span class="elsevierStyleSup">5</span></a> report brain MRI alterations in 29&#37; of patients and epileptiform activity in the EEG study in 18&#37;&#44; whereas Titulaer et al&#46;<a class="elsevierStyleCrossRef" href="#bb0020"><span class="elsevierStyleSup">4</span></a> report MRI alterations in 33&#37; and EEG alterations in 90&#37;&#46; In our sample&#44; half of the patients undergoing MRI and EEG studies displayed alterations&#46;</p><p id="p0105" class="elsevierStylePara elsevierViewall">The studies conducted to date with patients with AE do not describe an association between presence of cognitive impairment and such factors as age&#44; sex&#44; or disease progression time&#46;<a class="elsevierStyleCrossRef" href="#bb0005"><span class="elsevierStyleSup">1</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bb0020"><span class="elsevierStyleSup">4</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bb0025"><span class="elsevierStyleSup">5</span></a> Our study only found a correlation between lower IQ and age above 38 years&#59; this is not surprising&#44; however&#44; since age is a recognised risk factor for cognitive impairment in other diseases&#46;<a class="elsevierStyleCrossRef" href="#bb0160"><span class="elsevierStyleSup">32</span></a> We found no significant correlations with the remaining factors analysed&#59; future prospective studies with larger samples may provide valuable information on this topic&#46;</p><p id="p0110" class="elsevierStylePara elsevierViewall">Our study has several limitations&#44; including the small sample size and the fact that patients were selected by convenience sampling&#44; which prevents us from extrapolating our results or identifying associated factors&#46; The design of our study prevents us from providing a detailed description of the progression of cognitive impairment&#46; Furthermore&#44; antibody studies were not performed for all patients&#59; therefore&#44; the percentage of patients with definite AE may be underestimated&#46; Neuropsychological test performance may be influenced by treatment with methylprednisolone&#46; In any case&#44; this is the first study of cognitive impairment in a representative sample of patients with AE from a national-level reference centre in Peru&#46; Few studies have provided detailed descriptions of the neuropsychological tools used to evaluate cognitive performance in the acute phase of AE&#46;<a class="elsevierStyleCrossRef" href="#bb0005"><span class="elsevierStyleSup">1</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bb0025"><span class="elsevierStyleSup">5</span></a> Neuropsychological assessment during the acute phase represents a major challenge due to the severity of the associated symptoms&#59; a qualitative description of cognitive function is frequently performed in this stage&#44; with standardised tests being more feasible in the subacute and chronic phases of AE&#46;<a class="elsevierStyleCrossRef" href="#bb0090"><span class="elsevierStyleSup">18</span></a></p><p id="p0115" class="elsevierStylePara elsevierViewall">In conclusion&#44; our study shows that AE affects not only memory but also executive function&#44; language&#44; attention&#44; and praxis&#46; Therefore&#44; a comprehensive neuropsychological assessment of these patients&#44; including tests for all cognitive domains&#44; should be performed starting in the acute phase&#44; and repeated periodically&#46; Future studies should aim to describe the peculiarities of cognitive impairment in each type of AE&#44; explore associated factors&#44; and measure treatment response&#46;</p></span><span id="s0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0085">Conflicts of interest</span><p id="p0120" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span><span id="s0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0090">Funding</span><p id="p0125" class="elsevierStylePara elsevierViewall">This study has received no specific funding from any public&#44; commercial&#44; or non-profit organisation&#46;</p></span></span>"
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    "fechaRecibido" => "2021-08-11"
    "fechaAceptado" => "2022-01-04"
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            0 => "Cognitive impairment"
            1 => "Autoimmune encephalitis"
            2 => "Anti-NMDAR encephalitis"
            3 => "Peru"
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          "palabras" => array:4 [
            0 => "Deterioro cognitivo"
            1 => "Encefalitis autoinmune"
            2 => "Encefalitis R-NMDA"
            3 => "Per&#250;"
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        "titulo" => "Abstract"
        "resumen" => "<span id="as0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0035">Introduction</span><p id="sp0045" class="elsevierStyleSimplePara elsevierViewall">Cognitive impairment&#44; usually associated with seizures and psychosis&#44; is one of the main symptoms of autoimmune encephalitis&#46; The objective of our study is to analyse cognitive impairment in patients with autoimmune encephalitis&#46;</p></span> <span id="as0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0040">Methods</span><p id="sp0050" class="elsevierStyleSimplePara elsevierViewall">We conducted a descriptive cross-sectional study of clinical data from 39 patients older than 18 years diagnosed with autoimmune encephalitis&#46; Twenty-two patients underwent neuropsychological assessment&#46;</p></span> <span id="as0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0045">Results</span><p id="sp0055" class="elsevierStyleSimplePara elsevierViewall">All but one of the patients presented cognitive impairment&#46; Memory was the most frequently affected domain &#40;90&#46;91&#37;&#41;&#44; followed by language &#40;50&#37;&#41;&#44; attention &#40;45&#46;45&#37;&#41;&#44; executive function &#40;40&#46;91&#37;&#41;&#44; praxis &#40;40&#46;91&#37;&#41;&#44; and visuospatial skills &#40;9&#46;09&#37;&#41;&#46; No association was found with disease progression time&#44; age&#44; sex&#44; or education level&#46; Results from cerebrospinal fluid analysis&#44; electroencephalography&#44; and brain magnetic resonance imaging studies revealed alterations in 77&#46;27&#37;&#44; 57&#46;89&#37;&#44; and 55&#37; of cases&#44; respectively&#46;</p></span> <span id="as0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0050">Conclusions</span><p id="sp0060" class="elsevierStyleSimplePara elsevierViewall">Memory is the most frequently affected cognitive domain&#59; however&#44; other cognitive domains were also altered in our patients&#46; Neuropsychological assessment is crucial to determine which cognitive domains are impaired in patients with autoimmune encephalitis&#46;</p></span>"
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            "titulo" => "Introduction"
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        "resumen" => "<span id="as0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0010">Introducci&#243;n</span><p id="sp0025" class="elsevierStyleSimplePara elsevierViewall">El deterioro cognitivo&#44; usualmente asociado a crisis epil&#233;pticas y psicosis&#44; es uno de los principales s&#237;ntomas de la encefalitis autoinmune&#46; El objetivo de nuestro estudio fue describir las alteraciones cognitivas en pacientes con encefalitis autoinmune&#46;</p></span> <span id="as0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0015">M&#233;todos</span><p id="sp0030" class="elsevierStyleSimplePara elsevierViewall">Trabajo descriptivo transversal&#46; Se revisaron 39 registros de pacientes mayores de 18 a&#241;os con diagn&#243;stico de encefalitis autoinmune&#44; 22 de los cuales tuvieron evaluaci&#243;n neuropsicol&#243;gica&#46;</p></span> <span id="as0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0020">Resultados</span><p id="sp0035" class="elsevierStyleSimplePara elsevierViewall">de los 22 pacientes s&#243;lo uno no present&#243; deterioro cognitivo&#46; El dominio m&#225;s comprometido fue la memoria &#40;90&#44;91&#37;&#41;&#44; seguido del lenguaje &#40;50&#37;&#41;&#44; atenci&#243;n &#40;45&#44;45&#37;&#41;&#44; funciones ejecutivas &#40;40&#44;91&#37;&#41;&#44; apraxia &#40;40&#44;91&#37;&#41; y habilidades visuoespaciales &#40;9&#44;09&#37;&#41;&#46; No se encontr&#243; asociaci&#243;n con el tiempo de enfermedad&#44; grado de instrucci&#243;n&#44; sexo o edad&#46; Los an&#225;lisis de l&#237;quido cefalorraqu&#237;deo&#44; encefalograma y resonancia magn&#233;tica estuvieron alterados en 77&#44;27&#37;&#44; 57&#44;89&#37; y 55&#37; de los casos respectivamente&#46;</p></span> <span id="as0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0025">Conclusiones</span><p id="sp0040" class="elsevierStyleSimplePara elsevierViewall">El trastorno de memoria es el compromiso m&#225;s frecuente&#59; sin embargo&#44; nosotros encontramos que nuestros pacientes presentaban alteraciones de otras &#225;reas cognitivas&#46; La evaluaci&#243;n neuropsicol&#243;gica es fundamental para determinar qu&#233; dominios est&#225;n comprometidos en los pacientes con encefalitis autoinmune&#46;</p></span>"
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          "leyenda" => "<p id="sp0010" class="elsevierStyleSimplePara elsevierViewall">CT&#58; computed tomography&#59; EEG&#58; electroencephalography&#59; F&#58; female&#59; IQR&#58; interquartile range&#59; M&#58; male&#59; MRI&#58; magnetic resonance imaging&#46;</p>"
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Neuropsychological assessment</th><th class="td" title="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Yes &#40;n &#61; 22&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">36&#46;5 &#40;35&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&#46;701<a class="elsevierStyleCrossRef" href="#tf0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="\n
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                  \t\t\t\t">Sex &#40;M&#47;F&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">13&#47;9&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">10&#47;7&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&#46;987<a class="elsevierStyleCrossRef" href="#tf0010"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="\n
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                  \t\t\t\t">Disease progression time &#40;days&#41;&#44; median &#40;IQR&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">20&#46;5 &#40;52&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">15 &#40;34&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&#46;532<a class="elsevierStyleCrossRef" href="#tf0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Abnormal chest-abdomen-pelvis CT&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">2 &#40;9&#46;09&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1 &#40;5&#46;88&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#46;00<a class="elsevierStyleCrossRef" href="#tf0015"><span class="elsevierStyleSup">c</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="\n
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                  \t\t\t\t">Abnormal MRI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">11 &#40;50&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">6 &#40;35&#46;29&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&#46;380<a class="elsevierStyleCrossRef" href="#tf0010"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="\n
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                  \t\t\t\t">Abnormal EEG&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">15 &#40;68&#46;18&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">9 &#40;52&#46;94&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">&#46;229<a class="elsevierStyleCrossRef" href="#tf0010"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Total &#40;n &#61; 22&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">51&#46;11 &#40;15&#46;30&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&#46;172<a class="elsevierStyleCrossRef" href="#tf0020"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="\n
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                  \t\t\t\t">Memory&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">20 &#40;90&#46;91&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">12 &#40;60&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">8 &#40;40&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">1&#46;00<a class="elsevierStyleCrossRef" href="#tf0025"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="\n
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                  \t\t\t\t">Language&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">11 &#40;50&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">7 &#40;63&#46;64&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">4 &#40;36&#46;36&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;00<a class="elsevierStyleCrossRef" href="#tf0025"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="\n
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                  \t\t\t\t">Attention&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">10 &#40;45&#46;45&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">7 &#40;70&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">3 &#40;30&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;415<a class="elsevierStyleCrossRef" href="#tf0025"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="\n
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                  \t\t\t\t">Executive function&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">9 &#40;40&#46;91&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">5 &#40;55&#46;56&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">4 &#40;44&#46;44&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;00<a class="elsevierStyleCrossRef" href="#tf0025"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="\n
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                  \t\t\t\t">Constructional praxis&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">9 &#40;40&#46;91&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">5 &#40;55&#46;56&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">4 &#40;44&#46;44&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">2 &#40;9&#46;09&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">1 &#40;50&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#46;00<a class="elsevierStyleCrossRef" href="#tf0025"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
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Article information

ISSN: 26670496
Original language: English

DOI:10.1016/j.neurop.2022.01.004

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Year/Month	Html	Pdf	Total

2024 November	3	2	5
2024 October	37	8	45
2024 September	26	21	47
2024 August	38	17	55
2024 July	40	11	51
2024 June	41	11	52
2024 May	61	10	71
2024 April	49	8	57
2024 March	61	13	74
2024 February	66	18	84
2024 January	61	10	71
2023 December	66	8	74
2023 November	76	11	87
2023 October	91	18	109
2023 September	53	6	59
2023 August	62	6	68
2023 July	51	15	66
2023 June	42	9	51
2023 May	55	9	64
2023 April	52	6	58
2023 March	17	5	22
2023 February	22	1	23
2023 January	16	14	30
2022 December	12	6	18
2022 November	13	11	24
2022 October	12	15	27
2022 September	15	10	25
2022 August	10	6	16
2022 July	24	13	37
2022 June	32	20	52
2022 May	22	22	44
2022 April	29	32	61
2022 March	0	7	7
2022 February	0	5	5

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