Cognitive impairment after cerebral malaria in children: a prospective study.
OBJECTIVE
This study was conducted to assess prospectively the frequency of cognitive deficits in children with cerebral malaria.


METHODS
Cognitive testing in the areas of working memory, attention, and learning was performed for Ugandan children 5 to 12 years of age with cerebral malaria (n = 44), children with uncomplicated malaria (n = 54), and healthy community children (n = 89) at admission and 3 and 6 months later.


RESULTS
Six months after discharge, 21.4% of children with cerebral malaria had cognitive deficits, compared with 5.8% of community children. Deficits were seen in the areas of working memory (11.9% vs 2.3%) and attention (16.7% vs 2.3%). Children with cerebral malaria had a 3.7-fold increased risk of a cognitive deficit, compared with community children, after adjustment for age, gender, nutritional status, school level, and home environment. Among children with cerebral malaria, those with a cognitive deficit had more seizures before admission (mean: 4.1 vs 2.2) and a longer duration of coma (43.6 vs 30.5 hours), compared with those without a deficit. Children with uncomplicated malaria did not have an increased frequency of cognitive deficits.


CONCLUSIONS
Cerebral malaria may be a major cause of cognitive impairment in children in sub-Saharan Africa. Cognitive deficits in children with cerebral malaria are more likely for those who have multiple seizures before effective treatment for cerebral malaria.
Boivin
Michael J
MJ
International Neurologic and Psychiatric Epidemiology Program, College of Osteopathic Medicine, Michigan State University, East Lansing, Michigan, USA.
Bangirana
Paul
P
Byarugaba
Justus
J
Opoka
Robert O
RO
Idro
Richard
R
Jurek
Anne M
AM
John
Chandy C
CC
D002648:Child; D002675:Child, Preschool; D003072:Cognition Disorders / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D006801:Humans; D016779:Malaria, Cerebral / Q000150:complications*; D008297:Male; D011446:Prospective Studies