Cognitive function in idiopathic intracranial hypertension: a prospective case–control study

Abstract

ObjectiveTo explore the extent and nature of cognitive deficits in patients with idiopathic intracranial hypertension (IIH) at the time of diagnosis and after 3 months of treatment.DesignProspective case–control study.SettingNeurological department, ophthalmological department and a tertiary headache referral clinic at a Danish university hospital.Participants31 patients with definite IIH referred from June 2011 to February 2013 and included within 1 week of diagnostic intracranial pressure (ICP) measurement. 29 patients completed re-examination at the 3-month follow-up. At the time of testing, none of the patients took medication potentially affecting cognitive function. Controls were 31 healthy age-matched and sex-matched volunteers from the local community.Outcome measuresExecutive function, working memory, visuospatial memory, processing speed, attention and reaction time assessed by a comprehensive neuropsychological test battery consisting of validated computerised (Cambridge neuropsychological test automated battery) and paper-and-pencil tests.ResultsPatients with IIH performed significantly worse than controls in four of six cognitive domains (p≤0.02). Deficits were most pronounced in reaction time (1.45 SD below controls 95% CI 2.10 to 0.85) and processing speed (1.48 SD below controls 95% CI 2.08 to 0.81). Despite marked improvement in ICP and headache, re-examination showed persistent cognitive dysfunction 3 months after diagnosis and start of treatment.ConclusionsWe demonstrate for the first time in a well-defined cohort of patients that IIH may be associated with cognitive dysfunction. This could explain the functional disability of patients with IIH. A focused multidisciplinary approach including neuropsychological rehabilitation, therefore, might be relevant in the treatment of patients with IIH.

Evolving evidence in adult idiopathic intracranial hypertension: pathophysiology and management

“…In the IIHTT QOL scores were measured and found to be reduced at the time of the IIH diagnosis 75. PMD in the best eye, visual acuity in the worst eye, visual symptoms, and pain symptoms, but not obesity, were independently associated with reduced QOL.…”

The diagnosis and management of idiopathic intracranial hypertension and the associated headache

“…Other symptoms and clinical signs include dizziness, nausea, reduced memory and concentration and horizontal diplopia due to sixth nerve palsy [Carta et al 2004;Mollan et al 2014;Yri and Jensen, 2015;Yri et al 2012]. Recent studies demonstrated a marked cognitive dysfunction [Kharkar et al 2011;Yri et al 2014a;Zur et al 2015] and indicated that impaired executive function, working memory, processing speed and reaction time remained after normalization of ICP and alleviation of the headache and the visual symptoms [Yri et al 2014a]. It is likely that such cognitive dysfunction could contribute to the substantial loss of work capacity and life quality in patients with IIH and increased focus of the underlying pathophysiology and of their rehabilitation are highly relevant.…”

Quality of life in idiopathic intracranial hypertension at diagnosis

“…Several series regarding patients with IIH have reported cognitive dysfunction associated with a lower NEI-VFQ-25 composite score and NeuroOphthalmic Supplement score. 31 It may be that symptoms of cognitive dysfunction also contribute to a lower QOL.…”