Abstract T P361: Reduced Brain and Cerebellar Volumes Correlate With Cognitive Deficits in Chagas Disease

Abstract

Background: Chagas disease (CD) is a major cause of stroke and cardiomyopathy in Latin America. Brain atrophy has been associated with CD independently of stroke or cardiac disease, but cognitive effects of this finding has not been explored. Our objective was to compare cognitive impairment in patients with CD and non-CD cardiomyopathy; and to correlate these findings with quantification of brain and cerebellar volumes. Methods: Consecutive patients from a cardiomyopathy clinic without a history of stroke were submitted to a structured interview including clinical information and cognitive tests (Mini Mental State Exam - MMSE, digit span, clock drawing test, delayed memory test). Brain MRI was performed and brain and cerebellar volumes quantified by ITK-SNAP software. MR spectroscopy quantified N-acetylaspartate (NAA)-, choline- and myoinositol-to-creatine ratios. Results: 118 patients were recruited; mean age 54 +/- 12 years, 53% female, 49% with CD. Despite a better systolic cardiac function by echocardiography (ejection fraction 45 vs 38%, P=0.006), patients with CD performed worse on various cognitive tests (MMSE, delayed memory test and clock drawing test, P<0.01). Cerebellar volumes, but not brain volumes, were significantly smaller in CD vs non-CD cardiomyopathy (125 vs 136ml, P=0.035) and correlated with clock drawing test results (rS=0.219, P=0.024). In a multivariable analysis, delayed memory impairment, NAA/creatine ratio and cerebellar volumes were independently associated with Chagas disease. Conclusions: Cognitive dysfunction in CD occurred independently of cardiac disease severity and was associated with cerebellar atrophy.