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Cognitive Impairment and Behavioural Disturbances Following Malaria or HIV Infection in Childhood

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Neglected Tropical Diseases and Conditions of the Nervous System

Abstract

While both falciparum malaria and human immunodeficiency virus infections are not classified under the neglected disease criteria, both have been shown to affect the central nervous system (CNS), which is of importance but neglected area of neuroscience research. The brunt of these two diseases is borne by children in sub-Saharan Africa, and unfortunately, the study of long-term effect cognitive deficits and disorders due the CNS infections in these children has been neglected. We review the evidence of the effect of falciparum malaria and HIV on the brain, describe the patterns of involvement and propose mechanisms by which these infections can alter the brain function. The results reveal that falciparum malaria results in different patterns of impairment, which may in part be explained by methodological and definition differences, however the cognitive impairment appear to cover all categories of cognition suggesting diffuse damage. HIV has been shown to impact on multiple developmental domains starting early in life and persisting into adolescence. Various biomedical and psychosocial factors have been observed to either exacerbate or ameliorate the negative effects of HIV. Existing knowledge gap on impairment related to malaria and HIV shows significant gaps especially as it relates to elucidating pathways to poor outcome. Future research efforts need to focus on understanding these mechanisms so as to guide targeted intervention.

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References

  • Abubakar A, Holding P, Newton C, Van Baar A, Van de Vijver F (2009) The role of weight for age and disease stage in poor psychomotor outcome of HIV-infected children in Kilifi, Kenya. Dev Med Child Neurol 51:968–973

    Google Scholar 

  • Al Serouri AW, Grantham-McGregor SM, Greenwood B, Costello A (2000) Impact of asymptomatic malaria parasitaemia on cognitive function and school achievement of schoolchildren in the Yemen Republic. Parasitology 121:337–345

    Article  PubMed  Google Scholar 

  • Bagenda D, Nassali A, Kalyesubula I, Sherman B, Drotar D, Boivin MJ, Olness K (2006) Health, neurologic, and cognitive status of HIV-infected, long-surviving, and antiretroviral-naive Ugandan children. Pediatrics 117:729–740

    Article  PubMed  Google Scholar 

  • Bangirana P, Musisi S, Boivin MJ, Ehnvall A, John CC, Bergemann TL, Allebeck P (2011) Malaria with neurological involvement in Ugandan children: effect on cognitive ability, academic achievement and behaviour. Malar J 10:334

    Article  PubMed Central  PubMed  Google Scholar 

  • Bayley N (1993) The Bayley Scales of Infant Development, 2nd edn. Harcourt/Psychological Corporation, New York

    Google Scholar 

  • Berhane R, Bagenda D, Marum L, Aceng E, Ndugwa C, Bosch RJ, Olness K (1997) Growth failure as a prognostic indicator of mortality in pediatric HIV infection. Pediatrics 100:1–4

    Article  Google Scholar 

  • Bisiacchi PS, Suppiej A, Laverda A (2000) Neuropsychological evaluation of neurologically asymptomatic HIV-infected children. Brain Cogn 43:49–52

    CAS  PubMed  Google Scholar 

  • Blanchette N, Smith ML, Fernandes-Penney A, King S, Read S (2001) Cognitive and motor development in children with vertically transmitted HIV infection. Brain Cogn 46:50–53

    Article  CAS  PubMed  Google Scholar 

  • Blanchette N, Smith ML, King S, Fernandes-Penney A, Read S (2002) Cognitive development in school-age children with vertically transmitted HIV infection. Dev Neuropsychol 21:223–241

    Article  PubMed  Google Scholar 

  • BMJ-group (2011) Assessment of learning difficulty and cognitive delay. Retrieved from http://bestpractice.bmj.com/best-practice/monograph/884.html

  • Boivin MJ (2002) Effects of early cerebral malaria on cognitive ability in Senegalese children. J Dev Behav Pediatr 23:353–364

    Article  PubMed  Google Scholar 

  • Boivin MJ, Giordani B, Ndanga K, Maky MM, Manzeki KM, Ngunu N, Muamba K (1993) Effects of treatment for intestinal parasites and malaria on the cognitive abilities of schoolchildren in Zaire, Africa. Health Psychol 12:220–226

    Article  CAS  PubMed  Google Scholar 

  • Boivin MJ, Bangirana P, Byarugaba J, Opoka RO, Idro R, Jurek AM, John CC (2007) Cognitive impairment after cerebral malaria in children: a prospective study. Pediatrics 119:e360–e366

    Article  PubMed Central  PubMed  Google Scholar 

  • Boivin MJ, Gladstone MJ, Vokhiwa M, Birbeck GL, Magen JG, Page C, Taylor TE (2011) Developmental outcomes in Malawian children with retinopathy-positive cerebral malaria. Trop Med Int Health 16:263–271

    Article  PubMed Central  PubMed  Google Scholar 

  • Brackis-Cott E, Kang E, Dolezal C, Abrams EJ, Mellins CA (2009) The impact of perinatal HIV infection on older school-aged children’s and adolescents’ receptive language and word recognition skills. AIDS Patient Care STDS 23:415–421

    Article  PubMed Central  PubMed  Google Scholar 

  • Brown LK, Lourie KJ, Pao M (2000) Children and adolescents living with HIV and AIDS: a review. J Child Psychol Psychiatry 41:81–96

    Article  CAS  PubMed  Google Scholar 

  • Carter JA, Murira GM, Ross AJ, Mung’ala-Odera V, Newton CR (2003) Speech and language sequelae of severe malaria in Kenyan children. Brain Inj 17:217–224

    Article  CAS  PubMed  Google Scholar 

  • Carter JA, Mung’ala-Odera V, Neville BG, Murira G, Mturi N, Musumba C, Newton CR (2005) Persistent neurocognitive impairments associated with severe falciparum malaria in Kenyan children. J Neurol Neurosurg Psychiatry 76:476–481

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  • Clarke SE, Jukes MC, Njagi JK, Khasakhala L, Cundill B, Otido J, Brooker S (2008) Effect of intermittent preventive treatment of malaria on health and education in schoolchildren: a cluster-randomised, double-blind, placebo-controlled trial. Lancet 372:127–138

    Article  PubMed Central  PubMed  Google Scholar 

  • Coscia JM, Christensten BK, Henry RR, Wallston K, Radcliffe J, Rustein R (2001) Effects of home environment, socioeconomic status, and health status on cognitive functioning in children with HIV-1 infection. J Pediatr Psychol 26:321–329

    Article  CAS  PubMed  Google Scholar 

  • Croisile B (2004) Our cognitive functions: how they are organized, how they evolve with age, and how they are trained. Brain Today (e-mag)

    Google Scholar 

  • Dabis F, Ekpini ER (2002) HIV-1/AIDS and maternal and child health in Africa. Lancet 359:2097–2104

    Article  PubMed  Google Scholar 

  • de Miranda AS, Brant F, Machado FS, Rachid MA, Teixeira AL (2011) Improving cognitive outcome in cerebral malaria: insights from clinical and experimental research. Cent Nerv Syst Agents Med Chem 11:285–295

    Article  PubMed  Google Scholar 

  • Drotar D, Olness K, Wiznitzer M, Guay L, Marum L, Svilar G, Kiziri-Mayengo R (1997) Neurodevelopmental outcomes of Ugandan infants with human immunodeficiency virus type 1 infection. Pediatrics 100(1):E5

    Article  CAS  PubMed  Google Scholar 

  • Dugbartey AT, Spellacy FJ, Dugbartey MT (1998) Somatosensory discrimination deficits following pediatric cerebral malaria. Am J Trop Med Hyg 59:393–396

    CAS  PubMed  Google Scholar 

  • Fernando SD (2001) The impact of malaria on the cognitive performance and physical development of school children in a malaria endemic area of Sri Lanka. Ph.D dissertation, University of Colombo, Sri Lanka

    Google Scholar 

  • Fernando SD, Gunawardena DM, Bandara MR, De Silva D, Carter R, Mendis KN, Wickremasinghe AR (2003) The impact of repeated malaria attacks on the school performance of children. Am J Trop Med Hyg 69:582–588

    CAS  PubMed  Google Scholar 

  • Fernando SD, de Silva D, Carter R, Mendis KN, Wickremasinghe R (2006) A randomized, double-blind, placebo-controlled, clinical trial of the impact of malaria prevention on the educational attainment of school children. Am J Trop Med Hyg 74:386–393

    PubMed  Google Scholar 

  • Fernando SD, Rodrigo C, Rajapakse S (2010) The ‘hidden’ burden of malaria: cognitive impairment following infection. Malar J 9:366

    Article  PubMed Central  PubMed  Google Scholar 

  • Fishkin PE (2000) Brief report: relationship between HIV infection and WPPSI-R performance in preschool-age children. J Pediatr Psychol 25:347–351

    Article  CAS  PubMed  Google Scholar 

  • Gay CL, Armstrong FD, Cohen D, Lai S, Hardy MD, Swales TP, Scott GB (1995) The effects of HIV on cognitive and motor development in children born to HIV-seropositive women with no reported drug use: birth to 24 months. Pediatrics 96:1078–1082

    CAS  PubMed  Google Scholar 

  • Hardy DJ, Vance DE (2009) The neuropsychology of HIV/AIDS in older adults. Neuropsychol Rev 19:263–272

    Article  PubMed  Google Scholar 

  • Hay SI, Okiro EA, Gething PW, Patil AP, Tatem AJ, Guerra CA, Snow RW (2010) Estimating the global clinical burden of Plasmodium falciparum malaria in 2007. PLoS Med 7(6):e1000290

    Google Scholar 

  • Holding PA, Kitsao-Wekulo PK (2004) Describing the burden of malaria on child development: what should we be measuring and how should we be measuring it? Am J Trop Med Hyg 71(2 Suppl):71–79

    PubMed  Google Scholar 

  • Holding PA, Stevenson J, Peshu N, Marsh K (1999) Cognitive sequelae of severe malaria with impaired consciousness. Trans R Soc Trop Med Hyg 93:529–534

    Article  CAS  PubMed  Google Scholar 

  • Holding PA, Taylor HG, Kazungu SD, Mkala T, Gona J, Mwamuye B, Stevenson J (2004) Assessing cognitive outcomes in a rural African population: development of a neuropsychological battery in Kilifi District, Kenya. J Int Neuropsychol Soc 10:246–260

    Article  PubMed  Google Scholar 

  • Hult B, Chana G, Masliah E, Everall I (2008) Neurobiology of HIV. Int Rev Psychiatry 20:3–13

    Article  PubMed  Google Scholar 

  • John CC, Bangirana P, Byarugaba J, Opoka RO, Idro R, Jurek AM, Boivin MJ (2008) Cerebral malaria in children is associated with long-term cognitive impairment. Pediatrics 122:e92–e99

    Article  PubMed Central  PubMed  Google Scholar 

  • Jukes MCH, Pinder M, Grigorenko EL, Smith HB, Walraven G, Bariau EM, Bundy DAP (2006) Long-term impact of malaria chemoprophylaxis on cognitive abilities and educational attainment: follow-up of a controlled trial. PLoS Clin Trials 1(4):e19

    Article  PubMed Central  PubMed  Google Scholar 

  • Kaufman AS, Kaufman NL (1983) Kaufman Assessment Battery for Children. American Guidance Service, Circle Pines

    Google Scholar 

  • Kihara M, Carter JA, Newton CR (2006) The effect of Plasmodium falciparum on cognition: a systematic review. Trop Med Int Health 11:386–397

    Article  PubMed  Google Scholar 

  • Kihara M, Carter JA, Holding PA, Vargha-Khadem F, Scott RC, Idro R, Newton CR (2009) Impaired everyday memory associated with encephalopathy of severe malaria: the role of seizures and hippocampal damage. Malar J 8:273

    Article  PubMed Central  PubMed  Google Scholar 

  • Koekkeok S, Eggermont L, De Sonneville L, Jupimal T, Wicharuk S, Apateerapong W, Ananworanich J (2006) Effects of highly active antiretroviral therapy (HAART) on psychomotor performance in children with HIV disease. J Neurol 253:1615–1624

    Article  Google Scholar 

  • Koekkoek S, de Sonneville LM, Wolfs TF, Licht R, Geelen SP (2008) Neurocognitive function profile in HIV-infected school-age children. Eur J Paediatr Neurol 12:290–297

    Article  PubMed  Google Scholar 

  • Le Doare K, Bland R, Newell ML (2012) Neurodevelopment in children born to HIV-infected mothers by infection and treatment status. Pediatrics 130(5):e1326–e1344

    Article  PubMed  Google Scholar 

  • Lepage P, Msellati P, Hitimana DG, Bazubagira A, Van Goethem C, Simonon A, Dabis F (1996) Growth of human immunodeficiency type 1-infected and uninfected children: a prospective cohort study in Kigali, Rwanda, 1988 to 1993. Pediatr Infect Dis J 15:479–485

    Article  CAS  PubMed  Google Scholar 

  • Martin SC, Wolters PL, Toledo-Tamula MA, Zeichner SL, Hazra R, Civitello L (2006) Cognitive functioning in school-aged children with vertically acquired HIV infection being treated with highly active antiretroviral therapy (HAART). Dev Neuropsychol 30:633–657

    Article  PubMed  Google Scholar 

  • McGrath N, Fawzi WW, Bellinger D, Robins J, Msamanga GI, Manji K, Tronick E (2006) The timing of mother-to-child transmission of human immunodeficiency virus infection and the neurodevelopment of children in Tanzania. Pediatr Infect Dis J 25:47–52

    Article  PubMed  Google Scholar 

  • Mellins C, Smith R, O’Driscoll P, Madger L, Brouwers P, Chase C, Matzen E (2003) High rates of behavioral problems in perinatally HIV-infected children are not linked to HIV disease. Pediatrics 111:384–393

    Article  PubMed  Google Scholar 

  • Melrose RJ, Tinaz S, Castello JMB, Courtney MG, Stern CG (2008) Compromise to fronto-stratial functioning in HIV: an FMRI investigation of the semantic event sequencing. Behav Brain Res 188:33–347

    Article  Google Scholar 

  • Menon A, Glazebrook C, Ngoma MS (2009) Mental health of HIV positive adolescents in Zambia. Med J Zambia 36:151–156

    Google Scholar 

  • Molyneux ME, Taylor TE, Wirima JJ, Borgstein A (1989) Clinical features and prognostic indicators in paediatric cerebral malaria: a Study of 131 comatose Malawian children. Q J Med 71:441–459

    CAS  PubMed  Google Scholar 

  • Muntendam AH, Jaffar S, Bleichrodt N, Hensbroek MB (1996) Absence of neuropsychological sequelae following cerebral malaria in Gambian children. Trans R Soc Trop Med Hyg 90:391–394

    Article  CAS  PubMed  Google Scholar 

  • Musisi S, Kinyanda E (2009) Emotional and behavioral disorders in HIV seropositive adolescents in urban Uganda. East Afr Med J 86:16–24

    Article  CAS  PubMed  Google Scholar 

  • Newell M, Coovadia H, Cortina-Borja M, Rollins N, Gaillard P, Dabis F (2004) Mortality of infected and uninfected infants born to HIV-infected mothers in Africa: a pooled analysis. Lancet 364:1236–1243

    Article  PubMed  Google Scholar 

  • Newton CR, Hien TT, White N (2000) Cerebral malaria. J Neurol Neurosurg Psychiatry 69:433–441

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  • Nozyce M, Hittelman J, Muenz L, Durako SJ, Fischer ML, Willoughby A (1994) Effect of perinatally acquired human immunodeficiency virus infection on neurodevelopment in children during the first two years of life. Pediatrics 94:883–891

    CAS  PubMed  Google Scholar 

  • Puthanakit T, Aurpibul L, Louthrenoo O, Tapanya P, Nadsasarn R, Insee-ard S, Sirisanthana V (2010) Poor cognitive functioning of school-aged children in Thailand with perinatally acquired HIV infection taking antiretroviral therapy. AIDS Patient Care STDS 24(3):141–146

    Article  PubMed Central  PubMed  Google Scholar 

  • Raskino C, Pearson DA, Baker CJ, Lifschitz MH, O’Donnell K, Mintz M, Englund JA (1999) Neurologic, neurocognitive, and brain growth outcomes in human immunodeficiency virus-infected children receiving different nucleoside antiretroviral regimens. Pediatric AIDS Clinical Trials Group 152 Study Team. Pediatrics 104(3):e32

    Article  CAS  PubMed  Google Scholar 

  • Ruel TD, Boivin MJ, Boal HE, Bangirana P, Charlebois E, Havlir DV, Wong JK (2012) Neurocognitive and motor deficits in HIV-infected Ugandan children with high CD4 cell counts. Clin Infect Dis 54(7):1001–1009

    Article  PubMed Central  PubMed  Google Scholar 

  • Sanmaneechai O, Puthanakit T, Louthrenoo O, Sirisanthana V (2005) Growth, developmental, and behavioral outcomes of HIV-affected preschool children in Thailand. J Med Assoc Thai 88(12):1873–1879

    PubMed Central  PubMed  Google Scholar 

  • Shanbhag MC, Rutstein RM, Zaoutis T, Zhao H, Chao D, Radcliffe J (2005) Neurocognitive functioning in pediatric human immunodeficiency virus infection: effects of combined therapy. Arch Pediatr Adolesc Med 159(7):651–656

    Article  PubMed  Google Scholar 

  • Sherr L, Mueller J, Varrall R (2009) A systematic review of cognitive development and child human immunodeficiency virus infection. Psychol Health Med 14:387–404

    Article  PubMed  Google Scholar 

  • Sherwood B, Maria H, Peggy J (2008) A review of pediatric HIV effects on neurocognitive development. Issues Compr Pediatr Nurs 31:107–121

    Article  Google Scholar 

  • Smith R, Malee K, Charurat M, Magder L, Mellins C, Macmillan C, Moye J (2000) Timing of perinatal human immunodeficiency virus type 1 infection and rate of neurodevelopment. The Women and Infant Transmission Study Group. Pediatr Infect Dis J 19:862–871

    Article  CAS  PubMed  Google Scholar 

  • Smith R, Chernoff M, Williams PL, Malee KM, Sirois PA, Kammerer B, Rutstein R (2012) Impact of HIV severity on cognitive and adaptive functioning during childhood and adolescence. Pediatr Infect Dis J 31:592–598

    Article  PubMed  Google Scholar 

  • Stanley FJ, Blair E, Alberman E (2000) Cerebral palsies: epidemiology and causal pathways. Mac Keith, London

    Google Scholar 

  • Sullivan EV (2009) Special section of neuropsychology review on HIV/neuroAIDS. Neuropsychol Rev 19(2):143

    Article  PubMed  Google Scholar 

  • Sutcliffe CG, van Dijk JH, Bolton C, Persaud D, Moss WJ (2008) Effectiveness of antiretroviral therapy among HIV-infected children in sub-Saharan Africa. Lancet Infect Dis 8:477–489

    Article  PubMed  Google Scholar 

  • Thompson PM, Dutton RA, Hayashi KM, Toga AW, Lopez OL, Aizenstein HT, Becker JT (2005) Thinning of the cerebral cortex visualized in HIV/AIDS reflects CD4 and T lymphocyte decline. Proc Natl Acad Sci U S A 102:15647–15652

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  • Thuilliez J, Sissoko MS, Toure OB, Kamate P, Berthelemy JC, Doumbo OK (2010) Malaria and primary education in Mali: a longitudinal study in the village of Doneguebougou. Soc Sci Med 71(2):324–334

    Article  PubMed Central  PubMed  Google Scholar 

  • UNAIDS (2012a) Report on the global AIDS epidemic. Retrieved from http://www.unaids.org/en/media/unaids/contentassets/documents/epidemiology/2012/gr2012/20121120_UNAIDS_Global_Report_2012_en.pdf

  • UNAIDS (2012b) Core slides: global summary of the AIDS epidemic. Retrieved from http://www.unaids.org/en/media/unaids/contentassets/documents/epidemiology/2012/201207_epi_core_en.pdf

  • Van Rie A, Mupuala A, Dow A (2008) Impact of the HIV/AIDS epidemic on the neurodevelopment of preschool-aged children in Kinshasa, Democratic Republic of the Congo. Pediatrics 122(1):e123–e128

    Article  PubMed Central  PubMed  Google Scholar 

  • Vitor-Silva S, Reyes-Lecca RC, Pinheiro TR, Lacerda MV (2009) Malaria is associated with poor school performance in an endemic area of the Brazilian Amazon. Malar J 8:230

    Article  PubMed Central  PubMed  Google Scholar 

  • White VA, Lewallen S, Beare NAV, Molyneux ME, Taylor TE (2009) Retinal pathology of pediatric cerebral malaria in Malawi. PLoS One 4(1):e4317

    Article  PubMed Central  PubMed  Google Scholar 

  • Wiktor SZ, Ekpini E, Nduati R (1997) Prevention of mother-to-child transmission of HIV1 in Africa. AIDS 11(Suppl B):S7987

    Google Scholar 

  • Wolters PL, Brouwers P, Moss HA, Pizzo PA (1994) Adaptive behavior of children with symptomatic HIV infection before and after zidovudine therapy. Pediatr Psychol 19:47–61

    Article  CAS  Google Scholar 

  • Wolters PL, Brouwers P, Moss HA, Pizzo PA (1995) Differential receptive and expressive language functioning of children with symptomatic HIV disease and relation to CT scan brain abnormalities. Pediatrics 95:112–119

    CAS  PubMed  Google Scholar 

  • Wolters PL, Brouwers P, Civitello L, Moss HA (1997) Receptive and expressive language function of children with symptomatic HIV infection and relationship with disease parameters: a longitudinal 24-month follow-up study. AIDS 11:1135–1144

    Article  CAS  PubMed  Google Scholar 

  • Woods SP, Moore DJ, Weber E, Grant I (2009) Cognitive neuropsychology of HIV-associated neurocognitive disorders. Neuropsychol Rev 19:152–168

    Article  PubMed Central  PubMed  Google Scholar 

  • World Health Organization (2000) Severe falciparum malaria. World Health Organization, Communicable Diseases Cluster. Trans R Soc Trop Med Hyg 94(Suppl 1):S1–S90

    Article  Google Scholar 

  • World Health Organization (2010) International classification of diseases, 10th revision. Retrieved from http://apps.who.int/classifications/icd10/browse/2010/en

  • World Malaria Report (2011) World Health Organization. Retrieved from http://www.who.int/entity/malaria/world_malaria_report_2011/9789241564403_eng.pdf

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Kihara, M., Abubakar, A., Newton, C.R.J.C. (2014). Cognitive Impairment and Behavioural Disturbances Following Malaria or HIV Infection in Childhood. In: Bentivoglio, M., Cavalheiro, E., Kristensson, K., Patel, N. (eds) Neglected Tropical Diseases and Conditions of the Nervous System. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-8100-3_21

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