Neurocognitive and functional impairment in adult and paediatric tuberculous meningitis

Angharad G Davis; Sam Nightingale; Priscilla E Springer; Regan Solomons; Ana Arenivas; Robert J Wilkinson; Suzanne T Anderson; Felicia C Chow; Tuberculous Meningitis International Research Consortium

doi:10.12688/wellcomeopenres.15516.1

Neurocognitive and functional impairment in adult and paediatric tuberculous meningitis

Wellcome Open Res. 2019 Nov 13:4:178. doi: 10.12688/wellcomeopenres.15516.1. eCollection 2019.

Authors

Affiliations

¹ University College London, Gower Street, London, WC1E 6BT, UK.
² Francis Crick Institute, Midland Road, London, NW1 1AT, UK.
³ Institute of Infectious Diseases and Molecular Medicine. Department of Medicine, University of Cape Town, Observatory, 7925, South Africa.
⁴ HIV Mental Health Research Unit, University of Cape Town,, Observatory, 7925, South Africa.
⁵ Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
⁶ The Institute for Rehabilitation and Research Memorial Hermann, Department of Rehabilitation Psychology and Neuropsychology,, Houston, Texas, USA.
⁷ Baylor College of Medicine, Department of Physical Medicine and Rehabilitation, Houston, Texas, USA.
⁸ Department of Infectious Diseases, Imperial College London, London, W2 1PG, UK.
⁹ Wellcome Centre for Infectious Disease Research in Africa, Institute of Infectious Diseases and Molecular Medicine at Department of Medicine, University of Cape Town, Observatory, 7925, South Africa.
¹⁰ MRC Clinical Trials Unit at UCL, University College London, London, WC1E 6BT, UK.
¹¹ Evelina Community, Guys and St Thomas' NHS Trust, 5 Dugard Way, London, SE11 4TH, UK.
¹² Weill Institute of Neurosciences, Department of Neurology and Division of Infectious Diseases, University of California, San Francisco, California, USA.

^# Contributed equally.

Abstract

In those who survive tuberculous meningitis (TBM), the long-term outcome is uncertain; individuals may suffer neurocognitive, functional and psychiatric impairment, which may significantly affect their ability to lead their lives as they did prior to their diagnosis of TBM. In children who survive, severe illness has occurred at a crucial timepoint in their development, which can lead to behavioural and cognitive delay. The extent and nature of this impairment is poorly understood, particularly in adults. This is in part due to a lack of observational studies in this area but also inconsistent inclusion of outcome measures which can quantify these deficits in clinical studies. This leads to a paucity of appropriate rehabilitative therapies available for these individuals and their caregivers, as well as burden at a socioeconomic level. In this review, we discuss what is known about neurocognitive impairment in TBM, draw on lessons learnt from other neurological infections and discuss currently available and emerging tools to evaluate function and cognition and their value in TBM. We make recommendations on which measures should be used at what timepoints to assess for impairment, with a view to optimising and standardising assessment of neurocognitive and functional impairment in TBM research.

Keywords: Functional; Neurobehavioural; Neurocognitive; Neurodevelopmental; Psychiatric; Tuberculous Meningitis.

Publication types

Review

Abstract

Publication types

Grants and funding