Characteristics and Changes of Cingulate Gyrus Function and Perfusion in Patients With Anti-N-Methyl-D-Aspartate Receptor Encephalitis

Abstract

Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is an autoimmune condition associated with neuropsychiatric and cognitive deficits. Changes in the cingulate cortex may be central to this disorder. This study investigates subregional alterations in the cingulate cortex of patients with anti-NMDAR encephalitis and their relationship to cognitive deficits using functional and perfusion imaging. Thirty-eight patients with anti-NMDAR encephalitis and 30 healthy controls (HC) underwent resting-state MRI and neuropsychological assessments. We measured low-frequency amplitude (fALFF), degree centrality (DC), and cerebral blood flow (CBF) in the cingulate cortex, and performed functional connectivity (FC) and CBF connectivity analyses. We also analyzed the relationship between subregional changes and cognitive impairment. Finally, we applied support vector machines (SVM) to classify patients and controls based on functional and perfusion features. Patients with anti-NMDAR encephalitis showed significant cognitive impairments in memory and executive function, along with anxiety symptoms. Neuroimaging revealed decreased fALFF, DC, and CBF in the left pregenual anterior cingulate cortex (pgACC.L). FC between pgACC.L and several brain regions, including the parahippocampal gyrus and precuneus, was reduced. Additionally, pgACC.L exhibited altered CBF connectivity patterns with other brain regions. Moreover, the changes of fALFF, DC, and FC are related to the impaired cognitive function of patients. SVM classification based on fALFF, DC, and CBF features successfully distinguished patients from controls. Our findings suggest that pgACC abnormalities play a key role in the pathomechanism of anti-NMDAR encephalitis and may serve as biomarkers for disease monitoring.