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To: Journal of PRACTICAL NEUROLOGY Letters

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Short reports: J Ramirez-Bermudez, J Higuera, A L Sosa, E Lopez-Meza, M Lopez-Gomez, and T Corona Is dementia reversible in patients with neurocysticercosis? J Neurol Neurosurg Psychiatry 2005; 76: 1164-1166 [Abstract] [Full text] [PDF]

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Dementia in Neurocysticercosis

Daniel Ciampi de Andrade, Luís Dos Ramos Machado, José A. Livramento, and Paulo Caramelli   (10 November 2005)

Dementia in Neurocysticercosis 10 November 2005
Daniel Ciampi de Andrade, neurologist Behavioral and Cognitive Neurology Unit Dept of Neurology University of São Paulo School of Medicine, Luís Dos Ramos Machado, José A. Livramento, and Paulo Caramelli Send letter to journal: Re: Dementia in Neurocysticercosis ciampi{at}terra.com.br Daniel Ciampi de Andrade, et al.	Dear Editor The research from Dr Ramirez-Bermudez is outstanding. It contributes to a subject with such scarce publications in the literature. The high number of patients evaluated and the care in performing correlations between cognitive alterations due to neurocysticercosis (NCC), cerebral spinal fluid and neuroimaging studies are remarkable. However, some topics should be pointed out: First, there was a great difference between the groups with and without dementia concerning some basic epidemiological characteristics: the dementia group showed a median of 63 years of age, 2 years of education and a prevalence of epilepsy of 85%, while the non-dementia group had a median of 33 years of age, 2 years of education, and a much lower prevalence of epilepsy (58%). Age and years of education are well- known variables interfering with cognitive testing(1) and could be responsible for part of the results found in the study. Epilepsy is also related to cognitive changes and the difference in its prevalence might have some effect on the results of this study. Second, there was an absence of information on the anti-epileptic drugs taken by the patients. This is an important issue, since 85% of the dementia group patients were found to have this disorder. Neither the number of patients actually taking anti-epileptic drugs, nor its type or dosing were provided. Also, seizure control was not assessed, which could have greatly contributed to the discussion on whether or not interictal seizure activity plays a role on the cognitive deficits of these patients(2). Another point missing is the presence of alcohol abuse, which is known to be strongly associated to lower socio-economic and educational status (commonly found in patients with NCC) and which plays a crucial whole on cognitive performance. Lastly, the authors did not provide information on the prevalence of active NCC disease in the group that had dementia and showed cognitive improvement on the second evaluation. This could also enrich the discussion on the role of active disease being the sole agent causing cognitive deficit(3). For instance, if there were some patients with inactive disease who were classified as having dementia on the first evaluation and improved on the second assessment, it could suggest that active disease is not the only agent causing cognitive decline in this population, as it is probably true. References 1. Forlenza OV, Filho AHGV, Nobrega JPS, et al. Psychiatric manifestations of neurocysticercosis: a study of 38 patients from a neurology clinic in Brazil. J Neurol Neurosurg Psychiatry 1997;62:612–16. 2. Caramelli P, Castro LHM. Dementia associated with epilepsy. Intenational Psychogeriatrics 2005;17: 195-206. 3. VC Terra-Bustamarte, et al. Cognitive performance of patients with mesial temporal lobe epilepsy and incidental calcified neurocysticercosis. J Neurol Neurosurg Psychiatry 2005;76: 1080-83.