How should the possibility of more chronic forms of autoimmune encephalitis influence our neuronal antibody testing thresholds for patients with slower progressive cognitive decline?

I will disclose that I am not a cognitive/behavioral neurology specialist nor a neuroimmunologist per se, but I would exercise caution in interpreting the conclusions of the paper that was cited.

I went over the paper briefly, and I realized that 28 patients were diagnosed with "autoimmune dementia"...

I am a behavioral neurologist, and when the clinical picture is typical for a neurodegenerative condition and confirmed by atrophy on MRI or vascular disease, then I wouldn't test.

However, for younger patients or those who don't fit the typical picture, I would order labs for autoimmune encephaliti...

I think the main message is to consider testing for slower (>3 months) progressive cognitive decline when the syndrome is atypical for neurodegeneration or has neuropsychiatric, sleep, seizure, relapsing/fluctuating, inflammatory, or imaging clues pointing to an autoimmune process. I would not send ...