[8315.4] Long-Term Cognitive Impairment in Children with Cerebral Malaria
Chandy C. John, Paul Bangirana, Robert O. Opoka, Justus Byarugaba, Richard Idro, Baolin Wu, Anne M. Jurek, Michael J. Boivin. Pediatrics, University of Minnesota Medical School, Minneapolis, MN; Pediatrics, Makere University and Mulago Hospital, Kampala, Uganda; Neurology, Michigan State University, East Lansing, MI.
BACKGROUND: Cerebral malaria (CM) is a major cause of mortality in sub-Saharan Africa, but to date no prospective studies have assessed long-term cognitive impairment following CM. It is also unclear whether uncomplicated malaria (UM) is associated with long-term cognitive deficits.
OBJECTIVE: To determine whether cognitive impairment is more frequent in children with CM or UM than healthy community children (CC) 2 years after the initial malaria episode.
DESIGN/METHODS: Two-hundred and fifty-six children from Kampala, Uganda, were enrolled in a prospective cohort study. Children 4-12 years of age presenting to Mulago Hospital with CM (n=82) or UM (n=76) were enrolled, along with healthy, asymptomatic community children (n=99). Detailed clinical information was obtained at enrollment, and cognitive testing was performed 2 years later on 233 of these children (CM, n=68, UM, n=62, CC, n=92). Primary outcome was presence of a deficit in one or more of three cognitive areas tested. A deficit was defined as a z-score of <-2 for the areas of working memory and attention and a z-score of >2 for the area of learning.
RESULTS: At 2 year follow-up testing, 27.9% of children with CM and 15.2% with UM had cognitive deficits in one or more areas, as compared to 5.4% of community children (P=0.0001 and 0.04 for children with CM and UM, respectively). After adjustment for age, gender, nutrition, home environment and school level, children with CM had a 5.78-fold increased risk of a cognitive deficit as compared to CC (95% CI, 2.5, 16.28, P=0.0009), and children with UM had a 2.6-fold increased risk as compared to CC (95% CI, 1.02, 10.40, P=0.045). No clinical feature was significantly associated with cognitive impairment.
CONCLUSIONS: Cerebral malaria is associated with a high frequency of cognitive impairment 2 years after the initial episode.