Cognitive Outcomes and Psychiatric Symptoms of Retinopathy-Positive Cerebral Malaria: Cohort Description and Baseline Results

Rachel Brim Department of Osteopathic Medical Specialties, College of Osteopathic Medicine, Michigan State University, East Lansing, Michigan;

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Sebastian Mboma Blantyre Malaria Project, University of Malawi College of Medicine, Blantyre, Malawi;

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Margaret Semrud-Clikeman Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota;

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Sam Kampondeni Blantyre Malaria Project, University of Malawi College of Medicine, Blantyre, Malawi;

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Jed Magen Department of Psychiatry, College of Osteopathic Medicine, Michigan State University, East Lansing, Michigan;

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Terrie Taylor Department of Osteopathic Medical Specialties, College of Osteopathic Medicine, Michigan State University, East Lansing, Michigan;
Blantyre Malaria Project, University of Malawi College of Medicine, Blantyre, Malawi;

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John Langfitt Department of Neurology, University of Rochester, Rochester, New York

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Cerebral malaria (CM) is a common cause of death and disability among children in sub-Saharan Africa. Many prior studies of neuropsychiatric morbidity have been limited by a cross-sectional design or a short duration of follow-up. Most have included subjects who may have presented with coma due to a disease process other than CM. No studies have assessed the relationship between magnetic resonance imaging (MRI) findings and long-term outcomes. The Cognitive Outcomes and Psychiatric symptoms of retinopathy-positive CM (COPS) cohort is the first large (N = 221) prospectively recruited cohort of stringently defined cases of CM and hospital-based, age-matched, non-CM controls in whom cognitive and psychiatric outcomes are assessed with standardized measures semi-annually for up to 5 years. We report baseline characteristics of the cohort and outcomes at 1 month. At enrollment, CM cases were more likely to come from families with fewer socioeconomic resources and to have health characteristics that increase risk for malaria. In children younger than 5 years, cases were delayed in motor, language, and social development by approximately 6 months, compared with controls. More significant delays occurred in those with MRI abnormalities at the 1-month follow-up visit. There were no differences between cases and controls in inhibitory self-control, nor in cognitive function in children ≥ 5 years of age. The latter finding may be related to the smaller sample size, case-control imbalance in socioeconomic status, or the use of cognitive and behavioral assessments that are less culturally appropriate to this population. Continued follow-up will help determine predictors of long-term outcomes.

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Author Notes

Address correspondence to John Langfitt, Strong Memorial Hospital, Box 673, Rochester, NY 14642. E-mail: john_langfitt@urmc.rochester.edu

Financial support: This study received primary funding from the Department of Psychiatry, College of Osteopathic Medicine, Michigan State University, East Lansing, MI.

Authors’ addresses: Rachel Brim, Department of Osteopathic Medical Specialties, College of Osteopathic Medicine, Michigan State University, East Lansing, MI, and Department of Pediatrics, UCSF Benioff Children’s Hospital, San Francisco, CA, E-mail: rachel.brim@gmail.com. Sebastian Mboma and Sam Kampondeni, Blantyre Malaria Project, University of Malawi College of Medicine, Blantyre, Malawi, E-mails: sebastianmboma@gmail.com and s.kampo154@gmail.com. Margaret Semrud-Clikeman, Department of Pediatrics, University of Minnesota, Minneapolis, MN, E-mail: semrud@gmail.com. Jed Magen, Department of Psychiatry, College of Osteopathic Medicine, Michigan State University, East Lansing, MI, E-mail: jed.magen@hc.msu.edu. Terrie Taylor, Department of Osteopathic Medical Specialties, College of Osteopathic Medicine, Michigan State University, East Lansing, MI, E-mail: ttmalawi@gmail.com. John Langfitt, Departments of Neurology and University of Rochester, Rochester, NY, E-mail: john_langfitt@urmc.rochester.edu.

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