Impaired everyday memory associated with encephalopathy of severe malaria: the role of seizures and hippocampal damage

A journal article by Dr. Michael Kihara, an Associate Professor of Psychology, at United States International University -AfricaBackground: Seizures are common in children admitted with severe falciparum malaria and are associated with neuro-cognitive impairments. Prolonged febrile seizures are associated with hippocampal damage and impaired memory. It was hypothesized that severe malaria causes impaired everyday memory which may be associated with hippocampal damage. Methods: An everyday memory battery was administered on 152 children with cerebral malaria (CM) (mean age, 7 y 4 months [SD 13 months]; 77 males) 156 children (mean age, 7 y 4 months [SD, 14 months]; 72 males) with malaria plus complex seizures (MS) and 179 children (mean age, 7 y 6 months [SD, 13 months]; 93 males) unexposed to either condition. Results: CM was associated with poorer everyday memory [95% CI, -2.46 to -0.36, p = 0.004] but not MS [95% CI, -0.91 to 1.16, p = 1.00] compared to unexposed children. Children with exposure to CM performed more poorly in recall [95% CI, -0.79 to -0.04, p = 0.024] and recognition subtests [95% CI, - 0.90 to -0.17, p = 0.001] but not in prospective memory tests compared to controls. The health factors that predicted impaired everyday memory outcome in children with exposure to CM was profound coma [95% CI, 0.02 to 0.88, p = 0.037] and multiple episodes of hypoglycaemia [95% CI, 0.05 to 0.78, p = 0.020],but not seizures. Discussion: The findings show that exposure to CM was associated with a specific impairment of everyday memory. Seizures commonly observed in severe malaria may not have a causal relationship with poor outcome, but rather be associated with profound coma and repeated metabolic insults (multihypoglycaemia) that are strongly associated with impaired everyday memory

Neuropsychological testing in a rural African school-age population:evaluating contributions to variability in test performance

This study investigated the psychometric properties of a number of neuropsychological tests adapted for use in sub-Saharan Africa. A total of 308 school-age children in a predominantly rural community completed the tests. These tests were developed to assess skills similar to those measured by assessments of cognitive development published for use in Western contexts. Culturally appropriate adaptations were made to enhance within-population variability. Internal consistency ranged from .70 to .84. Scores on individual tests were related to various background factors at the level of the child, household, and neighborhood. School experience was the most consistent predictor of outcome, accounting for up to 22.9% of the variance observed. Significant associations were identified to determine salient background characteristics that should be taken into account when measuring the discrete effects of disease exposure in similar sociocultural and economic settings

Impaired everyday memory associated with encephalopathy of severe malaria: the role of seizures and hippocampal damage.

BACKGROUND: Seizures are common in children admitted with severe falciparum malaria and are associated with neuro-cognitive impairments. Prolonged febrile seizures are associated with hippocampal damage and impaired memory. It was hypothesized that severe malaria causes impaired everyday memory which may be associated with hippocampal damage. METHODS: An everyday memory battery was administered on 152 children with cerebral malaria (CM) (mean age, 7 y 4 months [SD 13 months]; 77 males) 156 children (mean age, 7 y 4 months [SD, 14 months]; 72 males) with malaria plus complex seizures (MS) and 179 children (mean age, 7 y 6 months [SD, 13 months]; 93 males) unexposed to either condition. RESULTS: CM was associated with poorer everyday memory [95% CI, -2.46 to -0.36, p = 0.004] but not MS [95% CI, -0.91 to 1.16, p = 1.00] compared to unexposed children. Children with exposure to CM performed more poorly in recall [95% CI, -0.79 to -0.04, p = 0.024] and recognition subtests [95% CI, -0.90 to -0.17, p = 0.001] but not in prospective memory tests compared to controls. The health factors that predicted impaired everyday memory outcome in children with exposure to CM was profound coma [95% CI, 0.02 to 0.88, p = 0.037] and multiple episodes of hypoglycaemia [95% CI, 0.05 to 0.78, p = 0.020], but not seizures. DISCUSSION: The findings show that exposure to CM was associated with a specific impairment of everyday memory. Seizures commonly observed in severe malaria may not have a causal relationship with poor outcome, but rather be associated with profound coma and repeated metabolic insults (multi-hypoglycaemia) that are strongly associated with impaired everyday memory

Assessing cognitive outcomes in a rural African population: development of a neuropsychological battery in Kilifi district, Kenya

The ability to measure neuropsychological outcomes in a comparable manner in different cultural groups is important if studies conducted in geographically diverse regions are to advance knowledge of disease effects and moderating influences. The purpose of this study was to evaluate the application of neuropsychological test procedures developed for use in North America and Europe to children in a rural region of Kenya. Our specific aim was to determine if these methods could be adapted to a non-Western culture in a manner that would preserve test reliability and validity. Procedural modifications yielded reliable tests that were sensitive to both the sequelae of cerebral malaria and to children's social and school backgrounds. Results suggest that adaptations of existing tests can be made in such a way as to preserve their utility in measuring the cross-cultural sequelae of childhood neurological diseases

Behavioral problems in children with epilepsy in rural Kenya

Abstract: The aims of this study were to record behavioral problems in children with epilepsy (CWE), compare the prevalence with that reported among healthy children without epilepsy, and investigate the risk factors. A child behavioral questionnaire for parents comprising 15 items was administered to the main caregiver of 108 CWE and 108 controls matched for age in Kilifi, Kenya. CWE had a higher mean score for reported behavioral problems than controls (6.9 vs 4.9, t=4.7,

Scatter plots and regression equations derived from the correlation of inflammation markers (A: CRP and B: IL-6) and iron markers (C: SF, D: sTfR, and E: ZPP) with serum hepcidin.

<p>Scatter plots and regression equations derived from the correlation of inflammation markers (A: CRP and B: IL-6) and iron markers (C: SF, D: sTfR, and E: ZPP) with serum hepcidin.</p

Median levels, lower and upper quartile plus standard error, of serum hepcidin (ng/mL) by sex, measured in different subgroups.

<p>Criteria for subgroups were as follows: (<b>1</b>) total population; (<b>2</b>) no iron deficiency (ID), no anemia, and no elevated CRP concentration; (<b>3</b>) ID and anemia (IDA), but no elevated CRP concentration; (<b>4</b>) no ID and anemia, but elevated CRP concentration; (<b>5</b>) IDA and elevated CRP concentration. Cut-offs were as follows: anemia: Hb <110 g/L; ID: SF <12 ng/mL or sTfR ≥7.4 mg/L; IDA: concurrent anemia and ID; no ID: SF ≥12 ng/mL and sTfR <7.4 mg/L; elevated CRP: CRP≥4.1 mg/L. Note: all individuals with ID and no elevated CRP were anemic. Letters (a, b, c, d, e, and f) indicate significant differences at P<0.05.</p