Cognitive Impairment in Tuberculous Meningitis

Angharad G Davis; Anna J Dreyer; Christine Albertyn; Mpumi Maxebengula; Cari Stek; Sean Wasserman; Suzaan Marais; Kathleen Bateman; Mark Solms; John Joska; Robert J Wilkinson; Sam Nightingale

doi:10.1093/cid/ciac831

Cognitive Impairment in Tuberculous Meningitis

Clin Infect Dis. 2023 Mar 4;76(5):842-849. doi: 10.1093/cid/ciac831.

Authors

Angharad G Davis^{1

2

3}, Anna J Dreyer⁴, Christine Albertyn^{5

6}, Mpumi Maxebengula³, Cari Stek^{3

7}, Sean Wasserman^{3

8}, Suzaan Marais^{6

9}, Kathleen Bateman⁶, Mark Solms¹⁰, John Joska⁴, Robert J Wilkinson^{1

2

3

7}, Sam Nightingale⁴

Affiliations

¹ The Francis Crick Institute, London, United Kingdom.
² Faculty of Life Sciences, University College London, London, United Kingdom.
³ Wellcome Centre for Infectious Diseases Research in Africa and Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, Republic of South Africa.
⁴ Division of Neuropsychiatry, Department of Psychiatry and Mental Health, HIV Mental Health Research Unit, Neuroscience Institute, University of Cape Town, Cape Town, South Africa.
⁵ Division of Neurology, Department of Medicine, Stellenbosch University, Cape Town, South Africa.
⁶ Division of Neurology, Department of Medicine, University of Cape Town, Cape Town, South Africa.
⁷ Department of Infectious Diseases, Imperial College London, London, United Kingdom.
⁸ Division of Infectious Diseases and HIV Medicine, Department of Medicine, University of Cape Town, Cape Town, South Africa.
⁹ Neurology Research Group, Neuroscience Institute, University of Cape Town, Cape Town, South Africa.
¹⁰ Division of Psychology, University of Cape Town, Cape Town, South Africa.

Abstract

Background: Cognitive impairment is reported as a common complication in adult tuberculous meningitis (TBM), yet few studies have systematically assessed the frequency and nature of impairment. Moreover, the impact of impairment on functioning and medication adherence has not been described.

Methods: A cognitive test battery (10 measures assessing 7 cognitive domains) was administered to 34 participants with human immunodeficiency virus (HIV)-associated TBM 6 months after diagnosis. Cognitive performance was compared with that a comparator group of 66 people with HIV without a history of tuberculosis. A secondary comparison was made between participants with TBM and 26 participants with HIV 6 months after diagnosis of tuberculosis outside the central nervous system (CNS). Impact on functioning was evaluated, including through assessment of medication adherence.

Results: Of 34 participants with TBM, 16 (47%) had low performance on cognitive testing. Cognition was impaired across all domains. Global cognitive performance was significantly lower in participants with TBM than in people with HIV (mean T score, 41 vs 48, respectively; P < .001). These participants also had lower global cognition scores than those with non-CNS tuberculosis (mean global T score, 41 vs 46; P = .02). Functional outcomes were not significantly correlated with cognitive performance in the subgroup of participants in whom this was assessed (n = 19).

Conclusions: Low cognitive performance following HIV-associated TBM is common. This effect is independent of, and additional to, effects of HIV and non-CNS tuberculosis disease. Further studies are needed to understand longer-term outcomes, clarify the association with treatment adherence, a key predictor of outcome in TBM, and develop context-specific tools to identify individuals with cognitive difficulties in order to improve outcomes in TBM.

Keywords: HIV; cognitive impairment; functional impairment; treatment adherence; tuberculous meningitis.

Publication types

Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

MeSH terms

Adult
Cognitive Dysfunction* / complications
HIV Infections* / complications
Humans
Tuberculosis, Meningeal* / complications
Tuberculosis, Meningeal* / diagnosis
Tuberculosis, Meningeal* / drug therapy

Abstract

Publication types

MeSH terms

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