Swetlik, Carol

ABSTRACTObjectiveClinical outcome measures for autoimmune encephalitis (AE) are not yet well defined. Cognitive outcome measures (CogOs) and patient‐reported outcomes (PROs) may capture the symptoms of AE, beyond clinician‐reported outcomes (ClinROs) (the Modified Rankin Scale [mRS] and Clinical Assessment Scale in Autoimmune Encephalitis [CASE]).MethodsThis retrospective cohort study examined LGI‐1‐IgG AE patients at Cleveland Clinic. CogOs included the Rey Auditory Verbal Learning Test (RAVLT) and Brief Visuospatial Memory Test (BVMT). PROs included Neuro‐QoL, PROMIS Global Physical (GPH) and Mental Health (GMH). Abnormal RAVLT, BVMT (≤ −1.5 SD), Neuro‐QoL, and PROMIS (≥ 10 T‐scores) proportions were analyzed. CogOs and PROs were correlated with ClinROs using Spearman's rank correlation.ResultsForty‐four patients (64% male, mean age 68 [SD = 11], median follow‐up 19 months) were included. ClinROs improved, with median mRS decreasing from 2.5 (IQR = 2–3) to 2 (IQR = 1–2), and CASE from 5 (IQR = 3–6) to 3 (IQR = 2–3) (all p < 0.05). RAVLT (n = 15), BVMT (n = 16), Neuro‐QoL (n = 21), and PROMIS (n = 34) were available. At > 12 months from diagnosis, cognition was impaired on BVMT (56%) and RAVLT (20%). PROs showed impairments in Neuro‐QoL lower (38%) and upper (27%) extremity function, cognition (31%), and PROMIS‐GPH (25%). RAVLT correlated with Neuro‐QoL cognition, depression, and stigma, while BVMT correlated with PROMIS‐GMH (all unadjusted p < 0.05). Neither RAVLT nor BVMT correlated with ClinROs. ClinROs correlated with Neuro‐QoL lower extremity function, cognition, and social roles (all p < 0.05).InterpretationLGI‐1‐IgG AE patients have long‐term impairments in cognition, physical health, and social roles, which can be objectively measured using CogOs and PROs and are not captured by ClinROs.

Background: Little is known about the relationship between neighborhood disadvantage and neuromyelitis optica spectrum disorder (NMOSD) outcomes. Objective: The objective is to determine the impact of neighborhood disadvantage on time from symptom onset to diagnosis and annualized relapse rate (ARR). Methods: Neighborhood disadvantage were captured with the Area Deprivation Index (ADI), a validated measure of neighborhood-level disadvantage. Negative binomial regression models assessed the impact of ADI on diagnostic delay (⩾3 months between symptom onset and diagnosis) and ARR. Results: A total of 158 NMOSD patients were identified, a majority of whom were White (56.3%) and female (89.9%) with a mean age of 46 years at diagnosis. The ADI did not significantly affect odds of diagnostic delay (odds ratio (OR) = 0.99, p = 0.26). In univariable models, the ADI was not significantly associated with ARR (OR = 1.004, p = 0.29), but non-White race (OR = 1.541, p = 0.02) and time on immunosuppressive therapies (ISTs; OR = 0.994, p = 0.03) were. White patients used IST for an average of 81% of the follow-up period, compared to an average of 65% for non-White patients ( p < 0.01). Conclusion: No significant relationship between neighborhood-level disadvantage and diagnostic delay or ARR in NMOSD patients was observed. Non-White patients had a higher ARR, which may be related to less IST use.