Ganaraja Valakunja Harikrishna, Jamuna Rajeshwaran, Nagarathna Chandrashekhar, Saini Jitender, Netravathi Manjunath
Department of Neurology (VHG, MN), Department of Clinical Psychology (RJ), Department of Neuromicrobiology (CN), and Department of Neuroimaging and Interventional Neuroradiology (JS), National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India.
Neurol Clin Pract. 2021 Jun;11(3):e222-e231. doi: 10.1212/CPJ.0000000000000950.
Data on cognitive changes in patients with tuberculous meningitis (TBM) are sparse. We aimed to study the cognitive profiles of patients with grade I TBM and correlate them with the cytokine values.
Prospectively, 60 patients (M:F-31:29) with grade I TBM were recruited. Clinical details were collected; CSF estimation of cytokines, neuropsychological assessment, and correlation were performed.
Mean age at presentation was 32.2 years (32.2 ± 10.1), and the duration of symptoms was 29.9 days (29.9 ± 25.9), respectively. Definitive evidence of mycobacterial infection was observed in 28.3% of the patients. Mean levels of tumor necrosis factor-α (TNF-α), interferon (IFN-γ), and interleukin-6 (IL-6) were 11.57 ± 30.35, 197.02 ± 186.64, and 127.03 ± 88.71 pg/mL, respectively. TNF-α levels were significantly elevated in definitive TBM ( = 0.044). Neuropsychological tests revealed an impaired auditory verbal learning test (88.3%), followed by complex figure test (50%), spatial span test (50%), clock drawing test (48.3%), digit span test (35%), color trail tests 1 and 2 (30% and 33.3%, respectively), and animal naming test (28.3%). Elevated levels of IFN-γ and IL-6 in TBM directly correlated with the number of impaired neuropsychological tests. During follow-up, significant improvement was noticed in animal naming test ( = 0.005), clock drawing test ( = 0.003), color trail test 2 (0.02), spatial span test ( = 0.012), and digit span test (0.035). Verbal learning did not show any significant change. Overall, the neuropsychological tests showed better recovery of attention, working memory, and category fluency and showed minimal recovery of verbal learning.
There is subclinical evidence of cognitive impairment in patients with TBM, and this correlated with elevated cytokines. Both the frontal and temporal lobes showed varying degrees of cognitive impairment.
关于结核性脑膜炎（TBM）患者认知变化的数据稀少。我们旨在研究I级TBM患者的认知特征，并将其与细胞因子值相关联。
前瞻性地招募了60例I级TBM患者（男:女 = 31:29）。收集临床详细信息；进行脑脊液细胞因子评估、神经心理学评估及相关性分析。
就诊时的平均年龄为32.2岁（32.2±10.1），症状持续时间为29.9天（29.9±25.9）。28.3%的患者有结核分枝杆菌感染的确切证据。肿瘤坏死因子-α（TNF-α）、干扰素（IFN-γ）和白细胞介素-6（IL-6）的平均水平分别为11.57±30.35、197.02±186.64和127.03±88.71 pg/mL。确诊的TBM患者中TNF-α水平显著升高（P = 0.044）。神经心理学测试显示听觉言语学习测试受损（88.3%），其次是复杂图形测试（50%）、空间跨度测试（50%）、画钟试验（48.3%）、数字广度测试（35%）、色词试验1和2（分别为30%和33.3%）以及动物命名测试（28.3%）。TBM患者中IFN-γ和IL-6水平升高与神经心理学测试受损的数量直接相关。在随访期间，动物命名测试（P = 0.005）、画钟试验（P = 0.003）、色词试验2（P = 0.02）、空间跨度测试（P = 0.012）和数字广度测试（P = 0.035）有显著改善。言语学习没有显示出任何显著变化。总体而言，神经心理学测试显示注意力、工作记忆和类别流畅性恢复较好，而言语学习恢复最小。
TBM患者存在认知障碍的亚临床证据，且这与细胞因子升高相关。额叶和颞叶均显示出不同程度的认知障碍。
