Determinants of cognitive performance in children relying on cyanogenic cassava as staple food

While risk factors for konzo are known, determinants of cognitive impairment in konzo-affected children remain unknown. We anchored cognitive performance (KABC-II scores) to serum levels of free-thyroxine (free-T4), thyroid-stimulating hormone (TSH), albumin, and motor proficiency (BOT-2 scores) in 40 children including 21 with konzo (median age: 9 years) and 19 without konzo (median age: 8 years). A multiple regression model was used to determine variables associated with changes in KABC-II scores. Age (β: -0.818, 95%CI: -1.48, -0.152) (p=0.018), gender (β: -5.72; 95 % CI: -9.87, -1.57 for females) (p=0.009), BOT-2 score (β: 0.390; 95 % CI: 0.113, 0.667) (p=0.008), and free-T4 (β: 1.88; 95 % CI: 0.009, 3.74) (p=0.049) explained 61.1 % of variation in KABC-II scores. Subclinical hypothyroidism was not associated with poor cognition. A crude association was found between serum albumin and KABC-II scores (β: 1.26; 95 % CI: 0.136, 2.39) (p=0.029). On spot urinary thiocyanate reached 688 μmol/l in children without konzo and 1,032 μmol/L in those with konzo. Female gender and low serum albumin are risk factors common to cognitive and proportionally associated motor deficits in children exposed to cassava cyanogens. The two types of deficits may share common mechanisms.