부산대학교 도서관

To ascertain the clinical characteristics of anti-NMDA receptor encephalitis (NMDARE) in older patients. A systematic literature review using PubMed and Scopus of all published case reports of NMDARE was undertaken, from database inception to June 2020. From this, cases reporting on patients older than 65 years of age and whose diagnosis was confirmed by the presence of anti-NMDAR antibodies in CSF were selected. 23 case reports fulfilling the study's criteria were found. Median age was 70.1 years (range 65–84), fourteen were female (60.9%), and mostly presented with acute behavioral and cognitive changes (95.7%). Atypical psychosis occurred in eleven patients (47.8%) with a sudden onset and fluctuating clinical pattern of delusions (39.1%), hallucinations (30.4%), and motility disturbances (34.8%) including catatonia (17.4%). Nine patients presented with seizures (39.1%). Pleocytosis in CSF (>5 WBC) was described in twelve cases (52.2%). Eleven cases (47.8%) had abnormal brain magnetic resonance imaging (MRI) scans with limbic inflammatory lesions. Thirteen patients had an abnormal EEG (56.5%). NMDARE should be included in the differential diagnosis of older patients who present with new psychiatric episodes, especially when characterized by sudden onset psychotic polymorphic symptomatology, fluctuating course with marked cognitive decline, and with catatonic features. • Out of the 715 cases of NMDARE identified in the literature, only 23 (3.2%) were in patients 65 or older. • The most frequent clinical presentation observed in this review in older adults was in the form of acute behavioral and cognitive changes (95.7%). • Over half of case reports of NMDARE in older adults (56.5%) had a psychiatric onset mainly with a phenotype consisting of an atypical psychosis of acute onset with fluctuating delusions, hallucinations and motility disturbances, including catatonia. • Case reports indicate that NMDARE in older adults can present with mild or even absent inflammatory signs on brain MRI or CSF analysis, thus making the diagnosis more challenging. [ABSTRACT FROM AUTHOR]