Neuropsychological sequelae of bacterial and viral meningitis

Abstract

Survivors of meningitis often complain about neurological and neuropsychological consequences. In this study, the extent of these sequelae was quantified and correlated to MRI findings. Neurological, neuropsychological and neuroradiological examinations were performed with adult patients younger than 70 years, 1-12 years after recovery from bacterial meningitis (BM; n = 59), or from viral meningitis (VM; n = 59). Patients with other potential causes for neuropsychological deficits (e.g. alcoholism) were carefully excluded. Patients were compared to 30 healthy subjects adjusted for age, gender and length of school education. With the exception of attention functions, both patient groups showed more frequently pathological results than the control group for all domains examined. Applying an overall cognitive sum score, patients after BM did not differ significantly in their performance from patients after VM. Separate analyses of various cognitive domains, however, revealed a higher rate of persistent disturbances in short-term and working memory after BM than after VM. Moreover, patients after BM exhibited greater impairment of executive functions. Associative learning of verbal material was also reduced. These deficits could not be ascribed to impaired alertness functions or decreased motivation in BM patients. Applying a logistic regression model, the neuropsychological outcome was related to the neurological outcome. Patients with a Glasgow Outcome Scale (GOS) of <5 had more frequently impaired test results for non-verbal learning and memory. GOS was also correlated with performance in executive functions. Brain volume was lower and ventricular volume was higher in the bacterial than in the VM group, and cerebral volume and the amount of white matter lesions of patients after BM were negatively correlated with short-term and working memory. In conclusion, patients after both BM and VM with favourable outcome showed affected learning and memory functions. More patients after BM than after VM displayed pathological short-term and working memory. BM resulted in poorer performance in executive functions, language, short-term memory and verbal learning/memory tests. As a result of neurological and neuropsychological sequelae, BM with a GOS > or = 4 led to decreased activities of daily living but only a minority of patients were disabled in a way that social functions were affected. The extent of neuropsychological sequelae of BM might have been overestimated in earlier studies which often had not been controlled for comorbidity factors such as alcoholism.

Assessing the Chronic Neuropsychologic Sequelae of Human Immunodeficiency Virus–Negative Cryptococcal Meningitis by Using Diffusion Tensor Imaging

“…27 Cognitive deficiencies after bacterial and viral meningitis (predominantly shortterm and working memory) also have been described. 28 Although impaired cognition related to CM infection, ranging from acute confusion, psychosis, and mania to encephalopathy, is well known, evidence is based on case reports [29][30][31][32] or comorbidity with HIV infection. 33 This is the first study to show correlations between neuropsychologic sequelae and changes in DTI parameters in patients with HIV-negative CM by measuring DTI parameters.…”

Dexamethasone and long‐term outcome in adults with bacterial meningitis

“…5 A recent German study evaluating cognitive outcome 1 to 12 years after bacterial meningitis found a much higher rate of cognitive impairment (37%). 33 These differences are explained by different criteria for cognitive dysfunction. The German study used less strict criteria, resulting in impaired cognitive functioning of the control subjects ranging from 7 to 27% per domain.…”

Distributed, Limbic Gray Matter Atrophy in Patients after Bacterial Meningitis

“…From a neuropsychological point of view, the hippocampal predominance of volume loss might explain a considerable part of the memory dysfunctions that survivors of BM often experience. 11,15,16 In our previous study in the same cohort, 11 we found significantly worse neuropsychological performance in BM for working memory, executive, and visoconstructive functions.…”

“…From the 58 patients of our previous, retrospective cohort study 11 who had undergone a volumetric MR imaging scan, we excluded those with visible morphologic alterations (12/58). In 5 patients the original DICOM datasets were not available or had quality problems (eg, movement artifacts).…”