Neurocognitive outcomes of tuberculous meningitis in a primarily HIV-positive Ugandan cohort.
Neurocognitive outcomes of tuberculous meningitis in a primarily HIV-positive Ugandan cohort.
复制标题
主要是HIV阳性乌干达队列中结核性脑膜炎的神经认知结果。
DOI：
10.12688/wellcomeopenres.16967.2
复制
发表时间：
2021
影响因子：
--
通讯作者：
Cresswell FV
中科院分区：
文献类型：
--
作者：
Quinn CM;Kasibante J;Namudde A;Bangdiwala AS;Kabahubya M;Nakasujja N;Lofgren S;Elliott A;Boulware DR;Meya DB;Cresswell FV
背景资料：结核性脑膜炎（TBM）的死亡率和残疾率都相当高，但康复方面的进步有可能改善幸存者的功能和生活质量。然而，在撒哈拉以南非洲艾滋病毒为主的人群中，TBM幸存者神经认知障碍的典型表型仍未得到研究。 研究方法：我们在诊断后8周和24周对乌干达36名TBM幸存者进行了一系列全面的神经认知评估，并将结果与一组代表性的未感染HIV的乌干达人进行了比较。 结果如下：虽然参与者在8周时有广泛的损伤，但到24周时有明显的改善，当时出现了包括运动功能，语言学习和记忆，处理速度和执行功能缺陷在内的损伤表型。尽管临床医生评定功能状态良好，但仍存在这些缺陷。大多数（23/27，85%）在第8周和第24周（18/24，75%）时有中度至重度抑郁的证据。 结论：这些发现强调了需要对TBM幸存者进行更全面的神经认知评估，并进一步投资和研究康复，包括抑郁症的管理，以改善这一人群的长期结局。
Background: The toll of tuberculous meningitis (TBM) in both mortality and disability is considerable, but advancements in rehabilitation have the potential to improve the functional abilities and the quality of survivors’ lives. However, the typical phenotype of neurocognitive impairment in TBM survivors remains unstudied in HIV-predominant populations in sub-Saharan Africa. Methods: We tested 36 survivors of TBM in Uganda with a comprehensive battery of neurocognitive assessments at 8 and 24 weeks after diagnosis, and compared results to a representative cohort of HIV-uninfected Ugandans. Results: While participants had a broad range of impairments at eight weeks, there was marked improvement by 24 weeks, when a phenotype of impairment including deficits in motor functioning, verbal learning and memory, processing speed, and executive function emerged. These deficits were present despite good clinician-rated functional status. The majority (23/27, 85%) had evidence of moderate to severe depression at week 8, and at week 24 (18/24, 75%). Conclusion: These findings highlight the need for more comprehensive neurocognitive assessment in the survivors of TBM, and further investment in and study of rehabilitation, including management of depression, to improve long-term outcomes in this population.