Cognitive outcome in adults with moderate disability after pneumococcal meningitis

Abstract

Summary Objectives: To assess cognitive outcome and quality of life in patients with moderate disability after bacterial meningitis as compared to patients with good recovery. Methods: Neuropsychological evaluation was performed in 40 adults after pneumococcal meningitis; 20 patients with moderate disability at discharge on the glasgow outcome scale (GOS score 4) and 20 with good recovery (GOS score 5). Results: Patients with GOS score 4 had similar test results as compared to patients with GOS score 5 for the neuropsychological domains 'intelligence', 'memory' and 'attention and executive functioning'. Patients with GOS score 4 showed less cognitive slowness than patients with GOS score 5. In a linear regression analysis cognitive speed was related to current intelligence, years of education and time since meningitis. Overall performance on the speed composite score correlated significantly with time since meningitis (K0.62; P!0.001). Therefore, difference between both groups may have been related to a longer time between meningitis and testing for GOS four patients (29 vs. 12 months; P!0.001). Conclusions: Patients with moderate disability after bacterial meningitis are not at higher risk for neuropsychological abnormalities than patients with good recovery. In addition, cognitive slowness after bacterial meningitis may be reversible in time.

Dexamethasone and long‐term outcome in adults with bacterial meningitis

“…Previous studies on cognitive outcome in adults who survived bacterial meningitis described cognitive slowness, impairment of psychomotor and visuoconstructive performance, and higher scores on depression scales. 5,27,[33][34][35] Our findings agree with previous observations. 5,27,33 Hippocampal damage has been related to learning and memory deficits in humans and in animal models.…”

“…5,27,[33][34][35] Our findings agree with previous observations. 5,27,33 Hippocampal damage has been related to learning and memory deficits in humans and in animal models. 10 This suggests that neuronal apoptosis in the hippocampal dentate gyrus represents the major neuropathological process responsible for cognitive impairment in survivors of bacterial meningitis.…”

“…This is in contrast with our previous study, which suggested that loss of cognitive speed might be partially reversible in time. 27 This might well be explained by the longer time interval between meningitis and neuropsychological evaluation in this study compared with those previous studies (median , 8 27 respectively). Our findings imply that neuropsychological impairment improves in the first years after bacterial meningitis and becomes relatively stable with time.…”

“…To compare cognitive speed between groups, we formed a speed composite score for each participant by calculation of a mean T-score of tests in which cognitive speed is important, as described previously. 5,27 Cognitive slowness was defined as a speed composite score worse than the fifth centile of the control group, after correction for age and education.…”

Distributed, Limbic Gray Matter Atrophy in Patients after Bacterial Meningitis

“…From a neuropsychological point of view, the hippocampal predominance of volume loss might explain a considerable part of the memory dysfunctions that survivors of BM often experience. 11,15,16 In our previous study in the same cohort, 11 we found significantly worse neuropsychological performance in BM for working memory, executive, and visoconstructive functions.…”