Neuropsychological sequelae of bacterial and viral meningitis
Neuropsychological sequelae of bacterial and viral meningitis
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DOI：
10.1093/brain/awh711
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发表时间：
2006-02-01
期刊：
影响因子：
14.5
通讯作者：
Nau, R
中科院分区：
文献类型：
--
作者：
Schmidt, H;Heimann, B;Nau, R
脑膜炎的幸存者经常抱怨神经和神经心理学后果。在这项研究中，这些后遗症的程度进行了量化，并与MRI结果。对年龄小于70岁的成年患者进行神经学、神经心理学和神经放射学检查，这些患者从细菌性脑膜炎（BM; n = 59）或病毒性脑膜炎（VM; n = 59）恢复后1-12年。仔细排除有其他潜在神经心理缺陷原因（如酗酒）的患者。将患者与30名健康受试者进行比较，调整年龄，性别和学校教育时间。除注意力功能外，两个患者组在所有检查领域的病理结果比对照组更频繁。应用总体认知总分，BM后患者的表现与VM后患者无显著差异。然而，对不同认知领域的单独分析显示，BM后短期记忆和工作记忆的持续性干扰率高于VM后。此外，BM后的患者表现出更大的执行功能障碍。语言材料的联想学习也减少了。这些缺陷不能归因于BM患者的警觉功能受损或动机降低。应用逻辑回归模型，神经心理学结果与神经功能结局相关。格拉斯哥结局量表（GOS）< 5分的患者非语言学习和记忆的测试结果更频繁受损。GOS也与执行功能的表现相关。细菌组脑体积低于VM组，脑室体积高于VM组，BM后患者脑体积和白色病变量与短时记忆和工作记忆呈负相关。总之，BM和VM后的患者具有良好的结果，表现出受影响的学习和记忆功能。BM后比VM后更多的患者表现出病理性短时记忆和工作记忆。BM导致执行功能，语言，短期记忆和口头学习/记忆测试的表现较差。由于神经和神经心理后遗症，GOS >= 4的BM导致日常生活活动减少，但只有少数患者残疾，社会功能受到影响。早期的研究可能高估了BM的神经心理学后遗症的程度，这些研究通常没有控制合并症因素，如酗酒。
Survivors of meningitis often complain about neurological and neuropsychological consequences. In this study, the extent of these sequelae was quantified and correlated to MRI findings. Neurological, neuropsychological and neuroradiological examinations were performed with adult patients younger than 70 years, 1-12 years after recovery from bacterial meningitis (BM; n = 59), or from viral meningitis (VM; n = 59). Patients with other potential causes for neuropsychological deficits (e.g. alcoholism) were carefully excluded. Patients were compared to 30 healthy subjects adjusted for age, gender and length of school education. With the exception of attention functions, both patient groups showed more frequently pathological results than the control group for all domains examined. Applying an overall cognitive sum score, patients after BM did not differ significantly in their performance from patients after VM. Separate analyses of various cognitive domains, however, revealed a higher rate of persistent disturbances in short-term and working memory after BM than after VM. Moreover, patients after BM exhibited greater impairment of executive functions. Associative learning of verbal material was also reduced. These deficits could not be ascribed to impaired alertness functions or decreased motivation in BM patients. Applying a logistic regression model, the neuropsychological outcome was related to the neurological outcome. Patients with a Glasgow Outcome Scale (GOS) of < 5 had more frequently impaired test results for non-verbal learning and memory. GOS was also correlated with performance in executive functions. Brain volume was lower and ventricular volume was higher in the bacterial than in the VM group, and cerebral volume and the amount of white matter lesions of patients after BM were negatively correlated with short-term and working memory. In conclusion, patients after both BM and VM with favourable outcome showed affected learning and memory functions. More patients after BM than after VM displayed pathological short-term and working memory. BM resulted in poorer performance in executive functions, language, short-term memory and verbal learning/memory tests. As a result of neurological and neuropsychological sequelae, BM with a GOS >= 4 led to decreased activities of daily living but only a minority of patients were disabled in a way that social functions were affected. The extent of neuropsychological sequelae of BM might have been overestimated in earlier studies which often had not been controlled for comorbidity factors such as alcoholism.