Spectrum of cognitive impairment in neurocysticercosis: Differences according to disease phase

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Abstract

Objectives:

Cognitive decline related to neurocysticercosis (NC) remains poorly characterized and underdiagnosed. In a cross-sectional study with a prospective phase, we evaluated cognitive decline in patients with strictly calcified form (C-NC), the epidemiologically largest subgroup of NC, and investigated whether there is a spectrum of cognitive abnormalities in the disease.

Methods:

Forty treatment-naive patients with C-NC aged 37.6 ± 11.3 years and fulfilling criteria for definitive C-NC were submitted to a comprehensive cognitive and functional evaluation and were compared with 40 patients with active NC (A-NC) and 40 healthy controls (HC) matched for age and education. Patients with dementia were reassessed after 24 months.

Results:

Patients with C-NC presented 9.4 ± 3.1 altered test scores out of the 30 from the cognitive battery when compared to HC. No patient with C-NC had dementia and 10 patients (25%) presented cognitive impairment–no dementia (CIND). The A-NC group had 5 patients (12.5%) with dementia and 11 patients (27.5%) with CIND. On follow-up, 3 out of 5 patients with A-NC with dementia previously still presented cystic lesions with scolex on MRI and still had dementia. One patient died and the remaining patient no longer fulfilled criteria for either dementia or CIND, presenting exclusively calcified lesions on neuroimaging.

Conclusions:

Independently of its phase, NC leads to a spectrum of cognitive abnormalities, ranging from impairment in a single domain, to CIND and, occasionally, to dementia. These findings are more conspicuous during active vesicular phase and less prominent in calcified stages.

GLOSSARY

A-NC: active neurocysticercosis

GLOSSARY

AED: antiepileptic drug

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BCSB: Brief Cognitive Screening Battery

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BNT: Boston Naming Test

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C-NC: calcified neurocysticercosis

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CDT: clock-drawing test

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CE: cryptogenic epilepsy

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CERAD: Consortium to Establish a Registry for Alzheimer's Disease

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CFT: Category Fluency Test

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CI: confidence interval

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CIND: cognitive impairment–no dementia

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CP: constructive praxis

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DSB: digit-span backward

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DSF: digit-span forward

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DSM-IV: Diagnostic and Statistical Manual of Mental Disorders, 4th edition

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HC: healthy controls

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NC: neurocysticercosis

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PFAQ: Pfeffer Functional Activities Questionnaire

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SCIT: Stroop Color-Interference Test

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TMT-A: Trail-Making Test A

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TMT-B: Trail-Making Test B

GLOSSARY

VMT: Verbal Memory Test

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