ArticleFrontiers in immunology2026
Microstructural white matter alterations and cognitive impairment in anti-NMDAR encephalitis: evidence from T1w/T2w ratio analysis.
Article in Frontiers in immunology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Objective: Anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis often causes cognitive impairment, yet conventional MRI lacks sensitivity to detect related microstructural changes. This study aimed to investigate T1-weighted/T2-weighted (T1w/T2w) ratios alterations in normal-appearing white matter (NAWM) and their relationship with cognitive function in patients with anti-NMDAR encephalitis, including a 12-month longitudinal follow-up. Methods: Fifty-nine patients with anti-NMDAR encephalitis (31 with mild cognitive impairment (MCI), 28 with no cognitive impairment (NCI)) and 34 healthy controls (HCs) underwent 3.0T whole-brain MRI and comprehensive neuropsychological assessments, including the Montreal Cognitive Assessment (MoCA), Mini-Mental State Examination (MMSE), and domain-specific tests for attention-executive function, memory, and visuospatial reasoning. T1w/T2w ratios were calculated for globel NAWM and multiple major white matter (WM) tracts. Eighteen MCI patients were followed longitudinally for 12 months to evaluate changes in T1w/T2w ratios and cognitive performance over time. Results: Compared with NCI patients and HCs, MCI patients exhibited significantly reduced T1w/T2w ratios in global NAWM ( Conclusion: T1w/T2w ratios derived from routine MRI provide a sensitive, clinically feasible biomarker for detecting NAWM microstructural damage in anti-NMDAR encephalitis. Longitudinal changes in these ratios may parallel cognitive improvement, and these preliminary findings support further investigation of this metric as an imaging biomarker, independent cohorts.
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