Improvements in Attention and Executive Functioning Following Short-Term Cognitive Remediation in a Young Woman Recovering from Anti-NMDA Receptor Encephalitis: A Case Study

Objective: This case study compares neuropsychological test performance in a 16-year-old woman following anti-N-methyl-D-aspartate (anti-NMDA) receptor encephalitis and subsequent cognitive remediation. Neurometrics were completed 6 months before illness (for academic accommodations), as well as immediately following discharge and after 1 month of cognitive remediation. Data were compared in order to: (a) characterize the neurocognitive changes pre-/post-anti-NMDA receptor encephalitis and (b) to evaluate neuropsychological changes following intensive remediation. Method: The patient initially presented with psychosis, agitation, and altered mental status and was found to have anti-NMDA receptor IgG antibodies in her CSF. She was discharged after responding well to a series of rituximab infusions. Alternate forms and different, yet comparable, neuropsychological test batteries were administered to minimize the role of practice effects. Results: Baseline data revealed relative weaknesses in attention, executive functioning (EF), and visuospatial abilities (Borderline Impaired-Low Average). The patient had an existing ADHD diagnosis and was treated with Strattera and Focalin. Testing immediately following discharge revealed additional impairments in attention, EF, and non-verbal memory (Severely Impaired-Low Average). Hourly remediation sessions were provided twice weekly for 5 weeks. Attention and working memory tasks were adapted from the Attention Process Training-II Program and EF exercises focused on inhibiting impulsive responding, and strategic problem-solving, planning, and organization. Marked improvements in attention, EF, and visual memory were seen after remediation (Average-Very Superior), when compared with testing immediately after hospitalization and baseline functioning. Conclusions: Short-term, targeted cognitive remediation immediately following anti-NMDA receptor encephalitis may hasten natural recovery by facilitating improvements in attention and EF.