Trajectories of Cognitive Decline in Patients with Calcified Neurocysticercosis: A Population-Based, Prospective, Longitudinal Study in a Highly Endemic Setting

The long-term cognitive consequences of calcified neurocysticercosis (NCC) remain poorly understood. This population-based study investigates cognitive trajectories in individuals with calcified NCC in coastal Ecuador. Utilizing repeated Montreal Cognitive Assessment (MoCA) screenings, the study evaluates whether calcified NCC independently contributes to cognitive decline and the role of hippocampal atrophy (HA) in this context. Among 720 community dwellers ages 40 years old and older, 85 (12%) had calcified NCC. The mean interval between baseline and first follow-up MoCA was 3.27 ± 1.07 years and between baseline and second follow-up MoCA was 10.87 ± 1.22 years. Of 720 participants, 617 (86%) completed the first follow-up MoCA, and 464 (75%) of them also had the subsequent follow-up MoCA. Proportions of NCC patients included in follow-ups were consistent with their representation at baseline. Baseline MoCA scores (β: 0.40; 95% CI: -0.48 to 1.29) or rates of MoCA decline at follow-up visits (β: 0.17; 95% CI: -0.67 to 1.0) did not differ significantly between NCC and non-NCC participants after adjusting for relevant covariates. The magnetic resonance imaging substudy showed that 31 of 83 NCC cases and 40 of 283 controls had HA (adjusted odds ratio: 2.63; 95% CI: 1.15 to 4.11). Additionally, HA was significantly associated with lower MoCA scores at baseline (β: -1.86; 95% CI: -2.98 to -0.74) and follow-up (β: -2.76; 95% CI: -3.83 to -1.69). These results suggest that calcified NCC alone was not associated with cognitive decline over time. However, NCC-associated HA emerged as a major determinant of poor cognitive performance.