Long-term linguistic outcome in adults with congenital cytomegalovirus infection

Abstract

Background

Congenital cytomegalovirus (cCMV) is the most common prenatal infection and the main infectious cause of neurodevelopmental abnormalities in developed countries. Long-term neuropsychological outcome of cCMV infection is still not well understood. This is the first study that presents linguistic follow-up data performed on adults who were infected in utero.

Method

All individuals from a universal newborn CMV screening study in Sweden sampled from 1977 to 1985 were invited to participate in a follow-up study. 34/71 persons (48%) with cCMV and 22/46 controls (48%) were enrolled. Participants were between 34 and 43 years. Linguistic ability was evaluated with two-word fluency tasks (FAS letter fluency and verb fluency), and a qualitative analysis of the participants’ word retrieval strategies was conducted.

Results

No statistically significant group differences were found in the total number of retrieved words. When related to Swedish norm data, 43% of participants with cCMV infection, all asymptomatic at birth, had adequate results on both FAS and verb fluency tasks, compared to 86% of the controls. Education level was the most important factor for word fluency ability in both groups. Adults with cCMV infection and higher education levels used less effective retrieval strategies on FAS letter fluency than controls.

Conclusion

This study suggests that adults with cCMV infection may have deficits in the word retrieval process, even in the absence of known neurodevelopmental disorders. Long-term effects of cCMV infection may exist even in those with asymptomatic infection at birth.

Keywords:

• congenital cytomegalovirus infection
• adults
• linguistic outcome
• word fluency
• long-term follow-up
• newborn screening

Acknowledgements

This study is dedicated to the late Karin Ahlfors (PhD, MD), the main author of the original study. The authors would like to thank Marcus Nyström for statistical assistance with Python programming.

Author contributions

KFS reviewed patient journals and performed data collection together with AN. UL and KFS performed statistical analysis, and KFS, MM, EK and UL performed data interpretation. All authors discussed the results, implications and commented on the manuscript at all stages. KFS and UL have planned the study and done most of the writing.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This study was supported by grants from Södra Sjukvårdsregionen Regionmedel, Acta Oto-Laryngologica Foundation and Agnes Ljunggren Foundation (KFS).