Neuro-cognitive impairment
Although developmental psychologists are in very limited supply in the
typical African setting, a multidisciplinary team for the management of
NF should include not just clinicians and surgeons, but also parents and
educationalists (including teachers, educational psychologists,
developmental psychologists) as well35. Poor school
performance was identified in 2 (5.8%) of our cases. In our analysis,
we used school performance as a surrogate for neuro-cognitive
impairment, since this was not specifically tested. However, this low
prevalence should not be misleading. When specifically screened,
neuro-cognitive impairment has been found in up to 40% of cases of NF153. In this study, we observed the failure to assess
or document relevant information about cognitive function in more than
90% of cases. Cognitive impairment, in majority of NF cases, is often
mild 54. We therefore suggest that school teachers or
administrators could be trained, as part of a multidisciplinary team for
management of NF, to identify and refer individuals with consistently
poor performance for their age, for medical and ophthalmic screening to
exclude NF and other neurological complications. Furthermore, school age
patients on follow up for NF could have annual assessment of their
cognitive function to facilitate early diagnosis of impairments54.