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Cognitive Impairment in Tuberculous Meningitis
Angharad G Davis1,2,3, Anna J Dreyer4, Christine Albertyn5,6
1The Francis Crick Institute, London, United Kingdom.
Summary
Cognitive impairment is common after tuberculous meningitis (TBM) in adults with HIV, affecting all cognitive domains. This impairment is distinct from HIV or non-central nervous system tuberculosis effects.
Area of Science:
- Neuroscience
- Infectious Diseases
- Public Health
Background:
- Cognitive impairment is a frequent complication of adult tuberculous meningitis (TBM).
- Limited research systematically assesses the frequency and characteristics of TBM-related cognitive deficits.
- The impact of cognitive impairment on daily functioning and medication adherence in TBM patients remains under-described.
Purpose of the Study:
- To systematically assess the frequency and nature of cognitive impairment in adults with HIV-associated TBM.
- To compare cognitive performance in TBM patients with HIV-only and HIV with non-CNS tuberculosis controls.
- To evaluate the impact of cognitive impairment on functioning and medication adherence.
Main Methods:
- Administered a cognitive test battery (10 measures, 7 domains) to 34 participants with HIV-associated TBM 6 months post-diagnosis.
- Compared cognitive performance with 66 individuals with HIV without tuberculosis history and 26 with HIV and non-CNS tuberculosis.
- Assessed functional outcomes and medication adherence in a subgroup of participants.
Main Results:
- 47% of TBM participants (16 of 34) exhibited low cognitive performance across all assessed domains.
- TBM patients showed significantly lower global cognitive performance compared to HIV-only controls (mean T score 41 vs 48, P < .001).
- TBM patients also had lower global cognition than those with non-CNS tuberculosis (mean T score 41 vs 46, P = .02).
Conclusions:
- Low cognitive performance is a common sequela of HIV-associated TBM, independent of HIV or non-CNS tuberculosis.
- Further research is needed to understand long-term outcomes and the relationship between cognitive function and treatment adherence.
- Development of context-specific tools is crucial for identifying and managing cognitive difficulties in TBM patients to improve outcomes.
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