Department of Infectious Diseases, Lithuanian University of Health Sciences, Kaunas, Lithuania.
Department of Health Psychology, Lithuanian University of Health Sciences, Kaunas, Lithuania.
Infect Dis (Lond). 2024 Sep;56(9):732-742. doi: 10.1080/23744235.2024.2346793. Epub 2024 May 6.
The aim of this study was to characterise long-term neurological and neurocognitive sequelae after tick-borne encephalitis (TBE) in adults.
98 prospective consecutive TBE patients, classified by disease severity, were included. Immediate outcomes were evaluated with Glasgow Outcome Scale (GOS) and Rankin Scale (RS). After 6 and 18 months, long-term disability was evaluated using Modified Rankin Scale (MRS) and neurocognitive assessment was performed with Matrics Consensus Cognitive Battery (MCCB), measuring processing speed, attention/vigilance, working memory, verbal learning, visual learning, reasoning/problem solving and social cognition. The MCCB results were compared to healthy age, gender and education-matched controls.
Mild, moderate, and severe TBE was diagnosed in 53.1%, 38.8%, and 8.2% of cases, respectively. At discharge, 25.5% of the patients had major or moderate impairments (GOS) and various levels of disability in 34.7% (RS). Up to 18 months from the onset of TBE, over 20% remained with slight to moderate disability (MRS). GOS, RS and MRS scores correlated with disease severity. At 6 months after the onset, TBE patients scored significantly lower than controls in processing speed, verbal, and visual learning. Two latter domains were significantly more impaired in patients with mild TBE. Patients aged 18-39 performed significantly worse in attention/vigilance and working memory, whereas aged 60+ in verbal learning. A year later, significant improvement was observed in six of seven cognitive domains.
Long-term neurological sequelae persist in a substantial proportion of TBE patients with significant impairment in several cognitive domains, especially in younger patients and even after mild TBE.
本研究旨在描述成人蜱传脑炎（TBE）后的长期神经和神经认知后遗症。
纳入 98 例前瞻性连续 TBE 患者，按疾病严重程度分类。使用格拉斯哥结局量表（GOS）和 Rankin 量表（RS）评估即刻结局。6 个月和 18 个月后，使用改良 Rankin 量表（MRS）评估长期残疾，使用 Matrics 共识认知电池（MCCB）进行神经认知评估，测量处理速度、注意力/警觉性、工作记忆、言语学习、视觉学习、推理/解决问题和社会认知。将 MCCB 结果与健康年龄、性别和教育匹配的对照组进行比较。
轻度、中度和重度 TBE 分别诊断为 53.1%、38.8%和 8.2%。出院时，25.5%的患者存在严重或中度损伤（GOS），34.7%的患者存在不同程度的残疾（RS）。从 TBE 发病到 18 个月，超过 20%的患者仍有轻微至中度残疾（MRS）。GOS、RS 和 MRS 评分与疾病严重程度相关。发病后 6 个月，TBE 患者在处理速度、言语和视觉学习方面的得分明显低于对照组。后两个领域在轻度 TBE 患者中受损更为严重。18-39 岁的患者在注意力/警觉性和工作记忆方面表现明显较差，而 60 岁以上的患者在言语学习方面表现较差。一年后，七个认知领域中有六个有明显改善。
在相当一部分 TBE 患者中，存在长期神经后遗症，在多个认知领域存在显著损伤，尤其是在年轻患者中，甚至在轻度 TBE 后也是如此。
