Abstract
The HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP) is the most common neurological manifestation associated with human T-cell lymphotropic virus type-1 (HTLV-1) infection. Although cognitive impairment has been highlighted in the spectrum of HTLV-1 neurological manifestations, it may go unnoticed in those who do not spontaneously report it. We aimed at evaluating the applicability of a self-perceived memory score (SMS) and the cognitive event-related potential (P300) for early detection of cognitive impairment in HTLV-1-infected people. The SMS was measured by a 0-10 point numeric scale combined with a sad-happy face rating scale. The higher the number, the better was the SMS. The P300 was obtained through an oddball paradigm with a mental counting task. The participants were 15 (21.4%) individuals with HAM/TSP, 20 (28.6%) HTLV-1 asymptomatic carriers, and 35 (50%) seronegative controls. We found that SMS (p < 0.001) and P300 latency (p < 0.001) got progressively worse from the seronegative controls to the asymptomatic carriers and then to the HAM/TSP. The results that indicated cognitive impairment were SMS < 7.2 points and P300 latency > 369.0ms. The HAM/TSP group showed the highest prevalence of altered P300 (80%) and SMS (87%). Interestingly, the asymptomatic group also presented significantly higher prevalence of altered SMS (60%) and P300 (35%) when compared to controls (< 10%). The frequency of cognitive impairment was 16 times higher in the HTLV-1 asymptomatic group and 69 times higher in the HAM/TSP group when compared to controls. The use of SMS in the medical consultation was a useful and easy-to-apply method to screen HTLV-1-infected subjects for everyday memory complaints.
Highlights
The HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP) is the most common neurological manifestation associated with Human T-cell Lymphotropic Virus type-1 (HTLV-1) infection
The prevalence of neurological disorders that do not meet the criteria for definite HAM/TSP, such as urinary disorders, sexual dysfunction and skin lesions, can occur in around 30% of those individuals classified as HTLV-1-asymptomatic carriers [4,5,6]
Recent evidences have showed that HTLV-1 is related to a complex of neurological manifestations that are not limited to the clinical spectrum of HAM/TSP, affecting all the segments of the central nervous system to a greater or lesser extent [3, 8,9,10,11,12,13,14,15,16,17,18]
Summary
The HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP) is the most common neurological manifestation associated with Human T-cell Lymphotropic Virus type-1 (HTLV-1) infection. Recent evidences have showed that HTLV-1 is related to a complex of neurological manifestations that are not limited to the clinical spectrum of HAM/TSP, affecting all the segments of the central nervous system to a greater or lesser extent [3, 8,9,10,11,12,13,14,15,16,17,18] In this context, cognitive impairment has been reported as one of the manifestations of the HTLV-1 infection [11, 13, 19,20,21,22,23,24]. Cognitive impairment can be underdiagnosed and may go unnoticed in those individuals who do not spontaneously report the decline in cognitive functions [27]
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