Unmasking the cognitive burden of adult tuberculous meningitis: A systematic review and meta analysis.

INTRODUCTION: Tuberculous meningitis (TBM) is a devastating form of extrapulmonary tuberculosis with high mortality and substantial long-term neurological sequelae. Cognitive impairment is a particularly debilitating outcome yet remains under-recognised and understudied. However, heterogeneous methodologies and tools remain a major barrier to pooling data and forming clinical guidelines. AIMS AND OBJECTIVES: To evaluate the prevalence, patterns, and determinants of cognitive impairment among adult TBM patients. METHODOLOGY: A total of 761 records were identified, and six studies met the inclusion criteria and were included in the qualitative synthesis, of which four studies were included in the quantitative meta-analysis. RESULTS: Cognitive impairment ranging from 12% to over 90% was found across studies, with severity ranging from mild deficits to severe global dysfunction. The most consistently affected domains were memory, attention, and executive function, followed by language and visuospatial. CONCLUSION: Multidomain cognitive impairment is a common sequela of tuberculous meningitis, underscoring the need for routine screening and long-term rehabilitation.