Correlation Analysis Between Regional Homogeneity And Executive Dysfunction In Patients With Anti-NMDA Receptor Encephalitis

Objective: Anti-N-methyl-D-aspartate receptor(NMDAR)encephalitis is characterized by a range of cognitive impairments,especially in executive function.However,the neurological mechanisms of impaired executive function in anti-NMDAR encephalitis patients currently remain unclear.Our study aims to identify the abnormal regional homogeneity(Re Ho)in anti-NMDAR encephalitis patients and its relationship with the executive function.Finally,multivariate pattern analysis(MVPA)was used to explored spatially distributed discriminative features derived from whole-brain Re Ho patterns.Methods: Forty patients and forty-two healthy volunteers undertook attention network test(ANT)and MRI scan.After functional MRI image preprocessing,Re Ho analysis was firstly performed to investigate the neuronal activity synchronization in all subjects.Subsequently,correlation analysis was conducted to assess the relationship between abnormal Re Ho values in anti-NMDAR encephalitis patients and the executive control network efficiency.Finally,based on Re Ho analysis,MVPA was carried out to classify patients and healthy controls(HCs).A receiver operating curve(ROC)was plotted to evaluate the performance of the classifier.Results: Compared to HCs,anti-NMDAR encephalitis patients had a lower executive control network efficiency(P <0.05).The patients presented reduced Re Ho values in the bilateral posterior cerebellar lobe,anterior cerebellar lobe,midbrain,bilateral caudate nucleus,right superior frontal gyrus,right middle temporal gyrus,bilateral inferior parietal lobule(IPL),and the left middle frontal gyrus.However,no increase in the Re Ho value was observed in the patient group compared with HCs.In addition,the Re Ho values of right and left IPL were found to be negatively associated with executive control network efficiency(r =-0.535,P <0.001;r =-0.538,P <0.001,respectively).The classification of patients and controls using MVPA had an accuracy of 76.83%,a sensitivity of 82.50%,a specificity of 71.43%,and the area under the curve(AUC)was 0.83.Conclusions: Our study provides evidence of abnormal cerebral function in anti-NMDAR encephalitis patients,which may contribute to unveil the neuropathological mechanisms of anti-NMDAR encephalitis and their influences on executive dysfunction.The MVPA classifier,based on Re Ho,is helpful in identifying anti-NMDAR encephalitis patients from healthy controls.