Cognitive impairment after cerebral malaria in children: A prospective study
Cognitive impairment after cerebral malaria in children: A prospective study
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DOI：
10.1542/peds.2006-2027
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发表时间：
2007-02-01
期刊：
影响因子：
8
通讯作者：
John, Chandy C.
中科院分区：
文献类型：
--
作者：
Boivin, Michael J.;Bangirana, Paul;John, Chandy C.
OBJECTIVE.本研究旨在前瞻性评估脑型疟疾儿童认知功能障碍的发生率。在工作记忆，注意力和学习领域的认知测试进行了乌干达5至12岁的脑型疟疾儿童（n = 44），无并发症的疟疾儿童（n = 54），健康的社区儿童（n = 89）在入院时和3个月和6个月后。出院后6个月，21.4%的脑型疟疾患儿有认知缺陷，而社区儿童为5.8%。工作记忆（11.9%对2.3%）和注意力（16.7%对2.3%）方面存在缺陷。在调整了年龄、性别、营养状况、学校水平和家庭环境后，与社区儿童相比，脑型疟疾儿童的认知缺陷风险增加了3.7倍。在患有脑型疟疾的儿童中，与没有认知缺陷的儿童相比，那些有认知缺陷的儿童在入院前有更多的癫痫发作（平均：4.1 vs 2.2）和更长的昏迷时间（43.6 vs 30.5小时）。患有单纯性疟疾的儿童并没有增加认知缺陷的频率。脑型疟疾可能是撒哈拉以南非洲儿童认知障碍的主要原因。脑型疟疾儿童的认知缺陷更可能是那些在有效治疗脑型疟疾之前多次癫痫发作的人。
OBJECTIVE. This study was conducted to assess prospectively the frequency of cognitive deficits in children with cerebral malaria.METHODS. Cognitive testing in the areas of working memory, attention, and learning was performed for Ugandan children 5 to 12 years of age with cerebral malaria (n = 44), children with uncomplicated malaria (n = 54), and healthy community children (n = 89) at admission and 3 and 6 months later.RESULTS. Six months after discharge, 21.4% of children with cerebral malaria had cognitive deficits, compared with 5.8% of community children. Deficits were seen in the areas of working memory (11.9% vs 2.3%) and attention (16.7% vs 2.3%). Children with cerebral malaria had a 3.7-fold increased risk of a cognitive deficit, compared with community children, after adjustment for age, gender, nutritional status, school level, and home environment. Among children with cerebral malaria, those with a cognitive deficit had more seizures before admission (mean: 4.1 vs 2.2) and a longer duration of coma (43.6 vs 30.5 hours), compared with those without a deficit. Children with uncomplicated malaria did not have an increased frequency of cognitive deficits.CONCLUSIONS. Cerebral malaria may be a major cause of cognitive impairment in children in sub-Saharan Africa. Cognitive deficits in children with cerebral malaria are more likely for those who have multiple seizures before effective treatment for cerebral malaria.