ارزیابی کارکردهای شناختی کودکان مبتلا به مالاریای مغزی در استان سیستان و بلوچستان

نوع مقاله : مقاله های پژوهشی

نویسندگان

1 استادیار، گروه روان‌شناسی، دانشکده‌ی علوم تربیتی و روانشناسی، دانشگاه اصفهان، اصفهان، ایران

2 کارشناس ارشد، گروه روان‌شناسی بالینی، دانشگاه آزاد اسلامی، واحد خوراسگان، اصفهان، ایران

3 دانشیار، گروه روانپزشکی و روان‌شناسی بالینی، دانشکده‌ی پزشکی، دانشگاه علوم پزشکی زاهدان، زاهدان، ایران

چکیده

مقدمه: مالاریای مغزی یکی از شایع‌ترین عفونت‌های سیستم اعصاب مرکزی است. این بیماری که در کودکان فراوانی بیشتری دارد، اختلالات عصب‌شناختی متعددی را سبب می‌شود. اختلالات عصب‌شناختی ناشی از این بیماری، می‌تواند بر عملکرد شناختی کودکان مبتلا به آن اثر بگذارد. هدف پژوهش حاضر، ارزیابی عملکرد شناختی کودکان مبتلا به مالاریای مغزی و مقایسه‌ی آن با کودکان سالم بود.روش‌ها: جامعه‌ی آماری پژوهش علی- مقایسه‌ای حاضر، شامل کودکان 12-7 ساله‌ی مبتلا به مالاریای مغزی و سالم استان سیستان و بلوچستان بود. آزمودنی‌ها شامل 30 کودک مبتلا به مالاریای مغزی و 30 کودک سالم بودند که با روش نمونه‌گیری در دسترس از بین مراجعه کنندگان به بیمارستان رازی شهرستان سراوان، بیمارستان امام علی (ع) شهرستان چابهار و مراکز مربوط به کودکان این دو شهرستان انتخاب شدند. برای جمع‌آوری داده‌ها از آزمون توجه ردیابی رنگی (CTT یا Trails test color)، شاخص حافظه‌ی فعال ویرایش چهارم آزمون هوش Wechsler (WMS یا Wechsler memory scale)، آزمون‌های حافظه‌ی دیداری- شنیداری Rey و آزمون عملکردهای اجرایی برج لندن (Tower of London) و برای تحلیل داده‌ها از آزمون ANOVA (Analysis of variance) استفاده شد.یافته‌ها: تفاوت معنی‌دار بین عملکرد دو گروه در مقیاس‌های توجه (001/0 > P)، حافظه‌ی فعال (001/0 > P)، حافظه‌ی دیداری فوری (001/0 > P)، حافظه‌ی دیداری تأخیری (001/0 > P)، حافظه‌ی شنیداری فوری (001/0 > P)، حافظه‌ی شنیداری تأخیری (001/0 > P) و کارکردهای اجرایی (010/0 > P) مشاهده شد.نتیجه‌گیری: مالاریای مغزی نقص‌هایی را در عملکرد شناختی کودکان مبتلا به آن ایجاد می‌کند. 

کلیدواژه‌ها


عنوان مقاله [English]

Assessment of Cognitive Functions in Children with Cerebral Malaria in Sistan and Baluchestan Province, Iran

نویسندگان [English]

  • Mahgol Tavakoli 1
  • Esmat Karimzadeh 2
  • Noormohammad Bakhshani 3
1 Assistant Professor, Department of Psychology, School of Educational Sciences and Psychology, University of Isfahan, Isfahan, Iran
2 Department of Clinical Psychology, Islamic Azad University, Khorasgan Branch, Isfahan, Iran
3 Professor, Department of Psychiatry and clinical Psychology, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran
چکیده [English]

Background: Cerebral malaria is the most common parasitic infection of the central nervous system. This disease is more common in children than adults. Cerebral malaria could cause neurologic injuries and cognitive deficits. The aim of this study was to assess cognitive function in children with cerebral malaria and to compare them with healthy children in Sistan and Baluchestan Province, Iran.Methods: The population of this causal-comparative study was children aged 7 to 12 years in Sistan and Baluchestan province. 30 children with cerebral malaria and 30 healthy children were selected from Razi hospital in Saravan, Imam Ali hospital in Chabahar and centers for children in these two cities. They were assessed through the Color Training Test (CTT), Working memory subscale of Wechsler Intelligence test for Children (WISC-IV), Rey visual memory test, Rey Auditory Memory Test and The executive functions Tower of London Test. The data were analysed using multivariate analysis of variances (MANOVA).Findings: There were significant differences between the two groups in attention (P < 0.001), working memory (P < 0.001), immediate visual memory (P < 0.001), delay visual memory (P < 0.001), immediate auditory memory (P < 0.001), delay auditory memory (P < 0.001) and executive functions (P < 0.01).Conclusion: Findings indicated that cerebral malaria causes deficits in cognitive performance of children with this disease.

کلیدواژه‌ها [English]

  • Cerebral malaria
  • Cognitive function
  • Memory
  • Attention
  • Executive functions
  1. Longo DL, Fauci AS, Kasper DK, Hauser SL, Jameson JL, Loscalzo J. Harrison's principles of internal medicine: Infectious diseases. Trans. Bouzari B, Taleb Nesar Hoseinin M.Tehran, Iran: Arjmand Publications; 2012.
  2. Mohammadi S. Genotyping of KI and 3D7 alleles of N-terminals of merozoite surface protein-3? gene of plasmodium falciparum malaria (pfMSP-3) using Nested-PCR method, in South-East of Iran [MSc Thesis]. Zahedan, Iran: Zahedan University of Medical Sciences; 2011. [In Persian].
  3. Idro R, Ndiritu M, Ogutu B, Mithwani S, Maitland K, Berkley J, et al. Burden, features, and outcome of neurological involvement in acute falciparum malaria in Kenyan children. JAMA 2007; 297(20): 2232-40.
  4. Mturi N, Musumba CO, Wamola BM, Ogutu BR, Newton CR. Cerebral malaria: optimising management. CNS Drugs 2003; 17(3): 153-65.
  5. Lucas CS. Recent developments in infectious diseases and HIV/AIDS pathology. Histopathology 2002; 41(S2): 38-76.
  6. Solimani Gh, Keshavarz K. Cerebral malaria in children: a case report. Iran J Pediatr 2004; 14(2): 163-6.
  7. Idro R, Jenkins NE, Newton CR. Pathogenesis, clinical features, and neurological outcome of cerebral malaria. Lancet Neurol 2005; 4(12): 827-40.
  8. Bangirana P, Allebeck P, Boivin MJ, John CC, Page C, Ehnvall A, et al. Cognition, behaviour and academic skills after cognitive rehabilitation in Ugandan children surviving severe malaria: a randomised trial. BMC Neurol 2011; 11: 96.
  9. Newton CR, Crawley J, Sowumni A, Waruiru C, Mwangi I, English M, et al. Intracranial hypertension in Africans with cerebral malaria. Arch Dis Child 1997; 76(3): 219-26.
  10. Varney NR, Roberts RJ, Springer JA, Connell SK, Wood PS. Neuropsychiatric sequelae of cerebral malaria in Vietnam veterans. J Nerv Ment Dis 1997; 185(11): 695-703.
  11. Bernard C, Anderson A, Becker A, Poolos NP, Beck H, Johnston D. Acquired dendritic channelopathy in temporal lobe epilepsy. Science 2004; 305(5683): 532-5.
  12. John CC, Panoskaltsis-Mortari A, Opoka RO, Park GS, Orchard PJ, Jurek AM, et al. Cerebrospinal fluid cytokine levels and cognitive impairment in cerebral malaria. Am J Trop Med Hyg 2008; 78(2): 198-205.
  13. John CC, Bangirana P, Byarugaba J, Opoka RO, Idro R, Jurek AM, et al. Cerebral malaria in children is associated with long-term cognitive impairment. Pediatrics 2008; 122(1): e92-e99.
  14. Idro R, Otieno G, White S, Kahindi A, Fegan G, Ogutu B, et al. Decorticate, decerebrate and opisthotonic posturing and seizures in Kenyan children with cerebral malaria. Malar J 2005; 4: 57.
  15. Opoka RO, Bangirana P, Boivin MJ, John CC, Byarugaba J. Seizure activity and neurological sequelae in Ugandan children who have survived an episode of cerebral malaria. Afr Health Sci 2009; 9(2): 75-81.
  16. Boivin MJ, Bangirana P, Byarugaba J, Opoka RO, Idro R, Jurek AM, et al. Cognitive impairment after cerebral malaria in children: a prospective study. Pediatrics 2007; 119(2): e360-e366.
  17. Carter JA, Mung'ala-Odera V, Neville BG, Murira G, Mturi N, Musumba C, et al. Persistent neurocognitive impairments associated with severe falciparum malaria in Kenyan children. J Neurol Neurosurg Psychiatry 2005; 76(4): 476-81.
  18. Llorente AM, Williams J, Satz P, Delia LF. Children Color Trails Test (CCTT). Odessa FL: Psychological Assessment Resources; 2003.
  19. Sadeghi A, Rabiee M, Abedi MR. validation and reliability of the Wechsler intelligence scale of children IV. Developmental Psychology 2011; 7(28): 47-55. [In Persian].
  20. Panahi A. Normalization of Rey complex figure Test (figure A) on male students in Tehran [MSc Thesis]. Roudehen, Iran: Roudehen Branch, Islamic Azad University: 2003. [In Persian].
  21. Groth-Marna G. Handbook of psychological assessment. 5th ed. Hoboken, NJ: John Wiley and Sons; 2009.
  22. Jafari Z, Moritz S, Zandi T, Akbari Kamrani AA, Malayeri S. Iranian version of the Rey Auditory Verbal Learning Test: a validation study. Payesh Health Monit 2010; 9(3): 271-8. [In Persian].
  23. Kazemi M. Developmental analysis of private speech in children and the effect of private speech on executive and cognitive function.[PhD Thesis]. Isfahan, Iran: University of Isfahan; 2010. [In Persian].
  24. Dugbartey AT, Spellacy FJ, Dugbartey MT. Somatosensory discrimination deficits following pediatric cerebral malaria. Am J Trop Med Hyg 1998; 59(3): 393-6.
  25. Holding PA, Stevenson J, Peshu N, Marsh K. Cognitive sequelae of severe malaria with impaired consciousness. Trans R Soc Trop Med Hyg 1999; 93(5): 529-34.
  26. Al Serouri AW, Grantham-McGregor SM, Greenwood B, Costello A. Impact of asymptomatic malaria parasitaemia on cognitive function and school achievement of schoolchildren in the Yemen Republic. Parasitology 2000; 121 (Pt 4): 337-45.
  27. Boivin MJ. Effects of early cerebral malaria on cognitive ability in Senegalese children. J Dev Behav Pediatr 2002; 23(5): 353-64.
  28. Boivin MJ, Busman RA, Parikh SM, Bangirana P, Page CF, Opoka RO, et al. A pilot study of the neuropsychological benefits of computerized cognitive rehabilitation in Ugandan children with HIV. Neuropsychology 2010; 24(5): 667-73.
  29. Fernando D, Wickremasinghe R, Mendis KN, Wickremasinghe AR. Cognitive performance at school entry of children living in malaria-endemic areas of Sri Lanka. Trans R Soc Trop Med Hyg 2003; 97(2): 161-5.
  30. Idro R, Carter JA, Fegan G, Neville BG, Newton CR. Risk factors for persisting neurological and cognitive impairments following cerebral malaria. Arch Dis Child 2006; 91(2): 142-8.
  31. Kihara M, de HM, Garrashi HH, Neville BG, Newton CR. Atypical brain response to novelty in rural African children with a history of severe falciparum malaria. J Neurol Sci 2010; 296(1-2): 88-95.
  32. Kihara M, Carter JA, Newton CR. The effect of Plasmodium falciparum on cognition: a systematic review. Trop Med Int Health 2006; 11(4): 386-97.
  33. Birbeck GL, Molyneux ME, Kaplan PW, Seydel KB, Chimalizeni YF, Kawaza K, et al. Blantyre Malaria Project Epilepsy Study (BMPES) of neurological outcomes in retinopathy-positive paediatric cerebral malaria survivors: a prospective cohort study. Lancet Neurol 2010; 9(12): 1173-81.
  34. Idro R, Marsh K, John CC, Newton CR. Cerebral malaria: mechanisms of brain injury and strategies for improved neurocognitive outcome. Pediatr Res 2010; 68(4): 267-74.
  35. Potchen MJ, Birbeck GL, Demarco JK, Kampondeni SD, Beare N, Molyneux ME, et al. Neuroimaging findings in children with retinopathy-confirmed cerebral malaria. Eur J Radiol 2010; 74(1): 262-8.
  36. Gamanagatti S, Kandpal H. MR imaging of cerebral malaria in a child. Eur J Radiol 2006; 60(1): 46-7.
  37. Miyake A, Friedman NP, Emerson MJ, Witzki AH, Howerter A, Wager TD. The unity and diversity of executive functions and their contributions to complex "Frontal Lobe" tasks: a latent variable analysis. Cogn Psychol 2000; 41(1): 49-100.
  38. Locascio G, Mahone EM, Eason SH, Cutting LE. Executive dysfunction among children with reading comprehension deficits. J Learn Disabil 2010; 43(5): 441-54.
  39. Kihara M, Carter JA, Holding PA, Vargha-Khadem F, Scott RC, Idro R, et al. Impaired everyday memory associated with encephalopathy of severe malaria: the role of seizures and hippocampal damage. Malar J 2009; 8: 273.
  40. Teruya LC, Ortiz KZ, Minett TS. Performance of normal adults on Rey Auditory Learning Test: a pilot study. Arq Neuropsiquiatr 2009; 67(2A): 224-8.
  41. Austin JK, Dunn DW. Progressive behavioral changes in children with epilepsy. Prog Brain Res 2002; 135: 419-27.
  42. Holding PA, Taylor HG, Kazungu SD, Mkala T, Gona J, Mwamuye B, et al. Assessing cognitive outcomes in a rural African population: development of a neuropsychological battery in Kilifi District, Kenya. J Int Neuropsychol Soc 2004; 10(2): 246-60.