Long-term Cognitive Outcomes in Tuberculous Meningitis

Abstract

ObjectiveData on cognitive changes in patients of tuberculous meningitis (TBM) are sparse. We aimed to study the cognitive profile of grade I TBM patients and correlate with the cytokine values.MethodsProspectively 60 (M:F-31:29) patients of grade I TBM were recruited. Clinical details, CSF estimation of cytokines, neuropsychological assessment was done and correlation were done.ResultsMean age of presentation and duration of symptoms were 32.2 (32.2 ± 10.1) years and 29.9 (29.9 ± 25.9) days respectively. Definitive evidence of mycobacterial infection was observed in 28.3%. Mean levels of tumor necrosis factor-α (TNF-α), interferon (IFN-γ) and interleukin-6 (IL-6) were 11.57 ± 30.35, 197.02 ± 186.64, and 127.03 ± 88.71 pg/mL respectively. TNF-α levels were significantly elevated in definitive TBM (p = 0.044). Neuropsychological tests revealed impaired Auditory verbal learning test (88.3%) followed by complex figure test (50%), spatial span test (50%), clock drawing test (48.3%), Digit span test (35%), Color trail test 1 and 2 (30% and 33.3% respectively) and animal naming test (28.3%). Elevated levels of IFN-γ and IL-6 in TBM were directly correlated with the number of impaired neuropsychological tests. During follow up, significant improvement was noticed in Animal naming test (p = 0.005), Clock drawing test (p = 0.003), color trail test 2 (0.02), spatial span test (p = 0.012) and digit span test (0.035). Verbal learning did not show any significant change. Overall Neuropsychological tests showed better recovery of attention, working memory, category fluency and minimal recovery of verbal learning.ConclusionsThere is subclinical evidence of cognitive impairment in patients of TBM and this correlated with elevated cytokines. Both the frontal and temporal lobes show varying degree of cognitive impairment.

Neurocognitive Outcome Following Tuberculous Meningitis Treatment in Adults: A Systematic Review

“…12 HIV-P patients who have cognitive changes need to be suspected of having TBM. 14 With low CD4 and immune response, tuberculomas do not form, this causes the clinical presentation to be subtle in the form of neurocognitive changes. 10,13,18 Cognitive functions that are disturbed are attention, executive function, memory short-term, and learning memory.…”

“…Other compromised tests included the spatial span test (50%), clock drawing test (48.3%), digit span test (35%) and the colour trail test 1 and 2 (30% and 33.3%, respectively). 14 After a 1-year follow-up, a neuropsychological evaluation of 43 patients (71.6%) revealed that 58.1% of the patients had impairment on one or two tests, and 32.5% had impairment on three or more tests. In all the assessed domains, four patients (9.3%) received normal neuropsychological evaluations.…”

“…Compared to healthy subject, patient of TBM with HIV negative had worse outcome in aspect of verbal comprehension, perceptual organization, and working memory. 14 Study by Ganaraja et al, showed that in terms of cognitive impairment, 31.7% of the patients had "mild" impairment, 28.3% had "mild-tomoderate" impairment, 28.3% had "moderate-to-severe" impairment, and 5% of the patients had "severe" impairment. The study participants signi cantly struggled on the auditory verbal learning test (90%), which was followed by visual learning and memory on the complicated gure test (50%).…”

“…Verbal learning did not alter signi cantly throughout the followup period, but visual learning and memory did (p = 0.008). 14 Meanwhile, study Popoca-Rodriguez et al, discovered signi cant short-, mid-, and long-term memory loss, as well as loss of thinking ability, judgement, and executive skills and verbal uency alteration, and even mood alterations, with mild depression predominating according to evaluation with the MoCA and NEUROPSI tests. MoCA testing was performed during hospital admission as well as during outpatient follow-up before and after 12 months after discharge.…”

Post-TB health and wellbeing

“… 199 , 200 Another recent prospective study of 60 adults with TBM reported varying degrees of cognitive impairment in more than 90% of 43 patients tested at 1 year follow-up. 201 …”