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Publications

Journal Article Ahead of print

PubMed: 41832838 DOI: 10.1016/j.msard.2026.107096

Characterising executive functioning in the chronic phase of autoimmune encephalitis: A study by the Australian autoimmune encephalitis consortium.

Mult Scler Relat Disord 109:107096

Authors: Katherine Y Ko, Nabil Seery, Sarah Griffith, Christina Kazzi, Robb Wesselingh, Tiffany Rushen, Tracie H Tan, Hannah Ford, Catherine Meade, Marie F O'Shea, Mirasol Forcadela, Andrew Duncan, Ernest G Butler, Anneke Van Der Walt, Wendyl D'Souza, Udaya Seneviratne, Katherine Buzzard, Richard Macdonell, Sudarshini Ramanathan, Stephen W Reddel, Todd A Hardy, Helmut Butzkueven, Terence J O'Brien, Rubina Alpitsis, Charles B Malpas, Mastura Monif

Affiliations

  • Department of Neurosciences, Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Level 6, Alfred Centre, 99 Commercial Road, Melbourne, VIC 3004, Australia; Department of Neurology, Alfred Health, Level 6, Alfred Centre, 99 Commercial Road, Melbourne, VIC, 3004, Australia.
  • Department of Neurosciences, Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Level 6, Alfred Centre, 99 Commercial Road, Melbourne, VIC 3004, Australia.
  • Department of Neurosciences, Monash Health, 246 Clayton Road, Clayton 3168, VIC Australia.
  • Department of Neurosciences, St Vincent's Hospital, 41 Victoria Parade, Fitzroy, VIC 3065, Australia.
  • Department of Neurology, Austin Health, 145 Studley Road, Heidelberg VIC 3084, Australia.
  • Department of Neurology, Peninsula Health, 49 Cranbourne Road, Frankston VIC 3199, Australia.
  • Department of Neurosciences, Eastern Health Clinical School, Monash University, 8 Arnold Street, Box Hill VIC 3128, Australia.
  • Department of Neurology and Concord Clinical School, Concord Repatriation General Hospital, Hospital Road, Concord NSW 2139, Australia; Translational Neuroimmunology Group, Kids Neuroscience Centre, Faculty of Medicine and Health, University of Sydney, Science Road, Camperdown NSW 2050, Australia; Brain and Mind Centre, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Science Road, Camperdown NSW 2050, Australia.
  • Department of Neurology and Concord Clinical School, Concord Repatriation General Hospital, Hospital Road, Concord NSW 2139, Australia; Brain and Mind Centre, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Science Road, Camperdown NSW 2050, Australia.
  • Department of Neurosciences, Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Level 6, Alfred Centre, 99 Commercial Road, Melbourne, VIC 3004, Australia; Department of Neurology, Royal Melbourne Hospital, 300 Grattan Street, Parkville, VIC 3050, Australia; Department of Medicine (Royal Melbourne Hospital), The University of Melbourne, VIC 3010, Australia; Melbourne School of Psychological Sciences, The University of Melbourne, VIC 3052, Australia.
  • Department of Neurosciences, Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Level 6, Alfred Centre, 99 Commercial Road, Melbourne, VIC 3004, Australia; Department of Neurology, Alfred Health, Level 6, Alfred Centre, 99 Commercial Road, Melbourne, VIC, 3004, Australia; Department of Neurology, Royal Melbourne Hospital, 300 Grattan Street, Parkville, VIC 3050, Australia.

Abstract

BACKGROUND AND OBJECTIVES

This study investigated executive functioning in patients with autoimmune encephalitis (AE) in the chronic phase of the illness. Relationships between Behavior Rating Inventory of Executive Function-Adult Version (BRIEF-A) scores and clinical outcomes-including AE subtype, time since disease onset, and scores on the modified Rankin Scale (mRS) and Clinical Assessment Scale in Autoimmune Encephalitis (CASE)-were also examined.

METHODS

Sixty-six AE patients (50% female, Mage=55.71, SDage=17.26) from the Australian Autoimmune Encephalitis Consortium Project completed BRIEF-A questionnaires, time-matched to their CASE and/or mRS scores within six months.

RESULTS

On average, assessments occurred 12 months post-onset. Median CASE and mRS scores were 2, with 66.67% of patients having mRS ≤2. Self- and informant-reported BRIEF-A scores were significantly elevated across domains, indicating substantial executive dysfunction, particularly in Emotional Control and Working Memory, where patients reported worse outcomes than informants. Patients with seronegative AE reported the most severe dysfunction, especially in emotional and behavioural regulation. Psychiatric comorbidities and seizures were associated with poorer executive functioning, while disease duration showed no significant impact. Dichotomising mRS at ≤1 vs. >1 better captured executive dysfunction, with patients in the >1 group showing significantly greater executive dysfunction than those classified as mRS >2. mRS scores significantly predicted executive dysfunction (28-43% variance); the inclusion of the CASE score did not improve these models.

DISCUSSION

AE patients in the chronic stage of the illness exhibit significant executive dysfunction. Combining self- and informant reports offers a comprehensive approach to assess executive dysfunction and guide personalised treatment strategies.

MeSH

Multiple Sclerosis, Executive Function, Encephalitis