Cognitive Function, Mental Health, and Quality of Life in Leprosy: A Narrative Review

Background

Leprosy is a chronic infectious disease caused by Mycobacterium Leprae and remains endemic in resource-limited communities. In addition to skin and peripheral nerve involvement, it has significant psychological, emotional and social repercussions due to stigma. Although multidrug therapy (MDT) is effective, the number of new cases remains over 200,000 per year worldwide. Damage to the peripheral nerves can result in sensory symptoms and muscle weakness, and autonomic impairment. The central nervous system (CNS) is rarely directly affected, but cognitive problems can be related to chronic inflammation, psychological stress, autonomic imbalance and social isolation.

Methods

This narrative review examines published evidence on cognitive impairment, neurological complications, psychological burden, stigma, and social factors associated with leprosy.

Results

Depression and anxiety are common in leprosy patients and are linked with disability, deformity, long treatment duration and social discrimination. Both external and self-stigma can have negative outcomes on emotional health, social functioning and can delay diagnosis and treatment. There may be increased psychosocial burden for economically disadvantaged, women, and older persons. Early detection of cognitive impairment could be achieved with MRI, PET, EEG, salivary biomarkers and machine-learning screening, but these tools are not well studied in low-resource, endemic settings.

Conclusions

Leprosy can have an impact on cognitive and psychological function via interacting pathways that are neurological, inflammatory, autonomic and psychosocial. However, there are only indirect indications. Validation of approaches to cognitive assessment and emerging biomarkers in endemic areas is required.