Alterations in white matter free water in anti-N-methyl-D-aspartate receptor encephalitis

Acta Universitatis Medicinalis Anhui 2025, 07, v.60 1225-1230     font:big middle small

Fund programs: National Natural Science Foundation of China (No. 32071054)

Authors:Hu Jie; Wang Xin; Guo Yuanyuan; Lv Xinyi; Fan Siyu; Tian Yanghua

Keywords:anti-N-methyl-D-aspartate receptor encephalitis; diffusion tensor imaging; free water; white matter; cognitive function; encephalitis;

DOI:10.19405/j.cnki.issn1000-1492.2025.07.009

〔Abstract〕 Objective To analyze the distribution characteristics of free water ( FW) and FW-corrected fractional anisotropy (FAt) in the white matter of the brain in patients with anti-N-methyl-D-aspartate receptor ( NMDAR) encephalitis and to explore their correlation with cognitive function.Methods A total of 38 patients with anti- NMDAR encephalitis and 30 controls were recruited from three hospitals in Hefei.Diffusion tensor imaging data and neuropsychological assessment results were collected.Tract-Based Spatial Statistics was applied to compare group differences in FW and FAt across the whole brain white matter.Correlation analyses were further performed to ex- amine the relationships between FW/ FAt metrics and cognitive function.Results Compared to the control group, patients with anti-NMDAR encephalitis showed significantly lower scores on the montreal cognitive assessment,im- mediate recall,delayed recall,and the verbal fluency test (all P<0. 05) ,as well as significantly longer comple- tion times for color naming and word reading tasks in the stroop color word test (all P<0. 05) .Diffusion tensor im- aging analysis revealed significantly elevated FW and reduced FAt in widespread white matter regions in the patient group (all P<0. 000 1) .Further correlation analysis showed that increased FW was positively associated with the completion time of the color-switching condition in the color digital trail making test (P = 0. 044 ) and with the difference between color-switching and number sequencing conditions ( P = 0. 016 ) ,while negatively correlated with semantic fluency scores (P = 0. 002) .Additionally,FAt was positively associated with delayed recall perform- ance (P = 0. 012) ,and negatively correlated with the completion times for color naming (P = 0. 018 ) and word reading (P = 0. 046) tasks in the SCWT.Conclusion Patients with anti-NMDAR encephalitis exhibit significantly elevated FW and significantly reduced FAt in white matter tracts,both of which are closely linked to cognitive im- pairment.