Cognitive deficits after recovery from thrombotic thrombocytopenic purpura
April S. Kennedy
From the Department of Medicine and Department of Psychiatry & Behavioral Sciences, College of Medicine, and the Department of Biostatistics and Epidemiology, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma; and the Department of Hematology and Central Hematology Laboratory, Inselspital, Berne University Hospital and University of Berne, Berne, Switzerland.
Search for more papers by this authorQurana F. Lewis
From the Department of Medicine and Department of Psychiatry & Behavioral Sciences, College of Medicine, and the Department of Biostatistics and Epidemiology, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma; and the Department of Hematology and Central Hematology Laboratory, Inselspital, Berne University Hospital and University of Berne, Berne, Switzerland.
Search for more papers by this authorJames G. Scott
From the Department of Medicine and Department of Psychiatry & Behavioral Sciences, College of Medicine, and the Department of Biostatistics and Epidemiology, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma; and the Department of Hematology and Central Hematology Laboratory, Inselspital, Berne University Hospital and University of Berne, Berne, Switzerland.
Search for more papers by this authorJohanna A. Kremer Hovinga
From the Department of Medicine and Department of Psychiatry & Behavioral Sciences, College of Medicine, and the Department of Biostatistics and Epidemiology, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma; and the Department of Hematology and Central Hematology Laboratory, Inselspital, Berne University Hospital and University of Berne, Berne, Switzerland.
Search for more papers by this authorBernhard Lämmle
From the Department of Medicine and Department of Psychiatry & Behavioral Sciences, College of Medicine, and the Department of Biostatistics and Epidemiology, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma; and the Department of Hematology and Central Hematology Laboratory, Inselspital, Berne University Hospital and University of Berne, Berne, Switzerland.
Search for more papers by this authorDeirdra R. Terrell
From the Department of Medicine and Department of Psychiatry & Behavioral Sciences, College of Medicine, and the Department of Biostatistics and Epidemiology, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma; and the Department of Hematology and Central Hematology Laboratory, Inselspital, Berne University Hospital and University of Berne, Berne, Switzerland.
Search for more papers by this authorSara K. Vesely
From the Department of Medicine and Department of Psychiatry & Behavioral Sciences, College of Medicine, and the Department of Biostatistics and Epidemiology, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma; and the Department of Hematology and Central Hematology Laboratory, Inselspital, Berne University Hospital and University of Berne, Berne, Switzerland.
Search for more papers by this authorJames N. George
From the Department of Medicine and Department of Psychiatry & Behavioral Sciences, College of Medicine, and the Department of Biostatistics and Epidemiology, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma; and the Department of Hematology and Central Hematology Laboratory, Inselspital, Berne University Hospital and University of Berne, Berne, Switzerland.
Search for more papers by this authorApril S. Kennedy
From the Department of Medicine and Department of Psychiatry & Behavioral Sciences, College of Medicine, and the Department of Biostatistics and Epidemiology, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma; and the Department of Hematology and Central Hematology Laboratory, Inselspital, Berne University Hospital and University of Berne, Berne, Switzerland.
Search for more papers by this authorQurana F. Lewis
From the Department of Medicine and Department of Psychiatry & Behavioral Sciences, College of Medicine, and the Department of Biostatistics and Epidemiology, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma; and the Department of Hematology and Central Hematology Laboratory, Inselspital, Berne University Hospital and University of Berne, Berne, Switzerland.
Search for more papers by this authorJames G. Scott
From the Department of Medicine and Department of Psychiatry & Behavioral Sciences, College of Medicine, and the Department of Biostatistics and Epidemiology, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma; and the Department of Hematology and Central Hematology Laboratory, Inselspital, Berne University Hospital and University of Berne, Berne, Switzerland.
Search for more papers by this authorJohanna A. Kremer Hovinga
From the Department of Medicine and Department of Psychiatry & Behavioral Sciences, College of Medicine, and the Department of Biostatistics and Epidemiology, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma; and the Department of Hematology and Central Hematology Laboratory, Inselspital, Berne University Hospital and University of Berne, Berne, Switzerland.
Search for more papers by this authorBernhard Lämmle
From the Department of Medicine and Department of Psychiatry & Behavioral Sciences, College of Medicine, and the Department of Biostatistics and Epidemiology, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma; and the Department of Hematology and Central Hematology Laboratory, Inselspital, Berne University Hospital and University of Berne, Berne, Switzerland.
Search for more papers by this authorDeirdra R. Terrell
From the Department of Medicine and Department of Psychiatry & Behavioral Sciences, College of Medicine, and the Department of Biostatistics and Epidemiology, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma; and the Department of Hematology and Central Hematology Laboratory, Inselspital, Berne University Hospital and University of Berne, Berne, Switzerland.
Search for more papers by this authorSara K. Vesely
From the Department of Medicine and Department of Psychiatry & Behavioral Sciences, College of Medicine, and the Department of Biostatistics and Epidemiology, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma; and the Department of Hematology and Central Hematology Laboratory, Inselspital, Berne University Hospital and University of Berne, Berne, Switzerland.
Search for more papers by this authorJames N. George
From the Department of Medicine and Department of Psychiatry & Behavioral Sciences, College of Medicine, and the Department of Biostatistics and Epidemiology, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma; and the Department of Hematology and Central Hematology Laboratory, Inselspital, Berne University Hospital and University of Berne, Berne, Switzerland.
Search for more papers by this authorThis project was supported by the Hematology Research Fund of the University of Oklahoma Health Sciences Center and the Swiss National Science Foundation (Grant 3200B0-108261).
Abstract
BACKGROUND: Patients with apparent complete recovery from thrombotic thrombocytopenic purpura (TTP) often complain of problems with memory, concentration, and fatigue.
STUDY DESIGN AND METHODS: Twenty-four patients who were enrolled in the Oklahoma TTP-HUS Registry for their initial episode of TTP, 1995-2006, and who had ADAMTS13 activity of less than 10 percent were evaluated for a broad range of cognitive functions 0.1 to 10.6 years (median, 4.0 years) after their most recent episode. At the time of their evaluation, they had normal physical and Mini-Mental State Examinations and no evidence of TTP.
RESULTS: The patients, as a group, performed significantly worse on 4 of the 11 cognitive domains tested than standardized US data from neurologically normal individuals adjusted for age, sex, and education (p < 0.05). These four domains measured complex attention and concentration skills, information processing speed, rapid language generation, and rote memorization. Twenty-one (88%) patients performed below expectations on at least 1 of the 11 domains. No clear patterns were observed between cognitive test results and patients' characteristics or features of the preceding TTP, including age, occurrence of severe neurologic abnormalities, multiple episodes, and interval from an acute episode.
CONCLUSION: Patients who have recovered from TTP may have persistent cognitive abnormalities. The abnormalities observed in these patients are characteristic of disorders associated with diffuse subcortical microvascular disease. Studies of larger patient groups will be required to confirm these preliminary observations and to determine patient characteristics that may contribute to persistent cognitive abnormalities.
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