Rayamajhi Parash, Nepal Gaurav, Ojha Rajeev, Rajbhandari Reema, Gajurel Bikram Prasad, Karn Ragesh
Department of Neurology, Tribhuvan University Teaching Hospital, Kathmandu, Nepal.
Department of Internal Medicine, Tribhuvan University Teaching Hospital, Kathmandu, Nepal.
Encephalitis. 2022 Apr;2(2):36-44. doi: 10.47936/encephalitis.2021.00157. Epub 2021 Dec 30.
Although cognitive impairment is a known complication of acute encephalitis syndrome (AES), few studies have evaluated cognitive outcomes in patients with encephalitis. The primary objective of this study was to assess the cognitive profiles of patients diagnosed with AES, which is pivotal for improving rehabilitation strategies and prognostic measures.
This study was conducted at the Tribhuvan University Teaching Hospital. Adult patients with AES who met inclusion criteria were enrolled. The Montreal Cognitive Assessment (MoCA) tool was used to assess cognitive function at admission, discharge, and 3-month follow-up.
Thirty-six patients were enrolled in our study. The mean age of the participants was 43 ± 18 years. Fourteen patients (38.9%) were female, and 22 (61.1%) were male. Tuberculous (TB) meningoencephalitis was present in 14 cases (38.9%), with herpes simplex virus (HSV) encephalitis in 14 (38.9%), bacterial meningoencephalitis in 4 (11.1%), autoimmune encephalitis in 2 (5.6%), and Japanese encephalitis in 2 (5.6%). Patients with bacterial meningoencephalitis had the highest MoCA scores at admission, whereas those with HSV encephalitis had the highest scores at discharge and follow-up. Compared with the scores at admission, the scores at discharge and follow-up increased significantly in patients with TB meningoencephalitis and HSV encephalitis. The MoCA score at discharge was established as a significant predictor of cognitive function at follow-up.
We found that active treatment can improve the outcomes of AES patients with cognitive impairment. Although infectious etiologies are most common in low-income countries such as Nepal, autoimmune etiologies should not be overlooked.
尽管认知障碍是急性脑炎综合征（AES）的一种已知并发症，但很少有研究评估脑炎患者的认知结局。本研究的主要目的是评估被诊断为AES患者的认知概况，这对于改善康复策略和预后措施至关重要。
本研究在特里布万大学教学医院进行。纳入符合纳入标准的成年AES患者。使用蒙特利尔认知评估（MoCA）工具在入院时、出院时和3个月随访时评估认知功能。
36名患者纳入我们的研究。参与者的平均年龄为43±18岁。14名患者（38.9%）为女性，22名（61.1%）为男性。14例（38.9%）为结核性脑膜脑炎，14例（38.9%）为单纯疱疹病毒（HSV）脑炎，4例（11.1%）为细菌性脑膜脑炎，2例（5.6%）为自身免疫性脑炎，2例（5.6%）为日本脑炎。细菌性脑膜脑炎患者入院时MoCA评分最高，而HSV脑炎患者出院时和随访时评分最高。与入院时的评分相比，结核性脑膜脑炎和HSV脑炎患者出院时和随访时的评分显著增加。出院时的MoCA评分被确定为随访时认知功能的显著预测指标。
我们发现积极治疗可改善有认知障碍的AES患者的结局。尽管在尼泊尔等低收入国家感染性病因最为常见，但自身免疫性病因也不应被忽视。
