Chagas disease is independently associated with brain atrophy

Abstract

Chagas disease (CD) remains a major cause of cardiomyopathy and stroke in developing countries. Brain involvement in CD has been attributed to left ventricular dysfunction, resulting in chronic brain ischemia due to hypoperfusion and/or embolic infarcts. However, cognitive impairment in CD may occur independently of cardiac disease. Therefore, we aimed to investigate head computed tomography (CT) findings in patients with Chagas disease cardiomyopathy (CDC) in comparison with other cardiomyopathies (OC). We studied 73 patients with CDC (n = 41) or OC (n = 32) matched for age and gender. These patients underwent head CT, rated by an investigator blinded to all clinical information. Head CT was rated for the presence of lacunar or territorial infarcts, as well as for measuring the total volumes of the brain, cerebellum and ventricles. Total brain volume was smaller in CDC as compared to OC patients (1,135 +/- 150 vs. 1,332 +/- 198 cm(3), P < 0.001). Cerebellar and ventricular volumes did not differ between the groups. The prevalence of brain infarcts did not differ significantly between the groups. Chagas disease was the only independent predictor of brain atrophy in the multivariable analysis (OR = 1.38; 95% CI = 1.06-1.79, P = 0.017). Chagas disease is associated with brain atrophy independent of structural cardiac disease related to cardiomyopathy. Brain atrophy, rather than multiple infarcts, may represent the main anatomical substrate of cognitive impairment in Chagas disease.

Neurologic Manifestations of Chagas Disease

“…More recently, a CT study showed cerebral atrophy independently associated with chagasic cardiomyopathy (41 patients), when compared with other cardiomyopathy etiologies (32 patients). No cerebellum atrophy or ventricular volume alteration was found [27].…”

The VMC Survey. XXIX. Turbulence-controlled Hierarchical Star Formation in the Small Magellanic Cloud

“…It is undergoing dynamical interactions with the Large Magellanic Cloud (LMC; Irwin et al 1990;Bekki & Chiba 2007;Belokurov et al 2017;Ripepi et al 2017;Subramanian et al 2017) as well as with the more distant Milky Way (Besla et al 2007;Diaz & Bekki 2011;D'Onghia & Fox 2016). It is abundant in both current and past star-forming activity (Oliveira 2009;Rubele et al 2015), and its stellar populations can be spatially resolved even with ground-based telescopes.…”

Neurologic manifestations of the neglected tropical diseases

“…Intravenous tissue plasminogen activator (IV-tPA) appears to be safe for treatment of acute stroke in Chagas disease [17]. The development of cognitive impairment following Chagas disease has been described in case-control and large, population-based cohort studies [18], but a causal relationship has not been confirmed [8,19].…”