Neurocognitive Outcomes and Their Correlation with Brain-Based Biomarkers in Tuberculous Meningitis: A Prospective...

Tuberculous meningitis (TBM) is a serious type of infection that impacts the central nervous system, and it is frequently associated with high mortality and long-term neurological sequelae. Although cerebrospinal fluid (CSF) biomarkers are involved in inflammatory processes in TBM, their relationship with cognitive outcomes has not been explored. We aimed to evaluate the cognitive profile of patients with grades 1 and 2 TBM and its correlation with the various immunological markers as well as brain-based biomarkers. Sixty patients (ages 16 years old and older) with definite and probable TBM (grades 1 and 2) underwent clinical, cognitive (the Indian Council of Medical Research Neurocognitive Toolbox Battery), neuroimaging, and CSF biomarkers (interferon-γ [IFN-γ], interleukin-6 [IL-6], tumor necrosis factor-α [TNF-α], S100 calcium-binding protein B [S100B], matrix metalloproteinase-9, and neuron-specific enolase [NSE]) evaluation on admission and at the 3-month follow-up. Nearly all patients demonstrated cognitive impairment at baseline, most prominently in attention, executive function, and memory. Partial recovery was noted at 3 months, particularly in grade 1 TBM. Inflammatory markers (IL-6, IFN-γ, and TNF-α) and brain-based biomarkers (S100B and NSE) were significantly elevated in TBM as compared with controls but showed weak, nonsignificant correlations with cognitive outcomes. Matrix metalloproteinase-9 showed a shifting trend, suggesting a possible delayed neuroprotective role. Neurocognitive impairment is common in TBM. Biomarker correlations suggest potential for monitoring severity and recovery. Larger long-term studies are needed to clarify their role in neurocognitive outcomes.