Objective:

To investigate demographic, clinical, diagnostic, and prognostic factors associated with Neurocognitive Impairment (NCI) in patients with Neurosarcoidosis (NS).

Background:

Neurocognitive impairment (NCI) is a poorly understood yet disabling manifestation of NS, often under-recognized due to overlap with psychiatric comorbidities. Prior studies have not characterized the clinical and prognostic features associated with NCI in NS patients.

Design/Methods:

This retrospective chart review examined patients with probable or definite NS treated between 2010 and 2025. NCI was defined using MMSE and MOCA scores, developing after initial NS diagnosis. Analyses were done using IBM SPSS, with Pearson Chi-Square and ANOVA statistical tests. 

Results:

NCI was present in 32/83 patients (38.6%) with NS. Compared with NS patients without NCI, those with NCI were more likely to present with seizures (NCI = 34.4% vs non-NCI = 11.8%; n=11 vs n=6; p = .042), male sex (NCI = 59.4% vs non-NCI = 29.4%; n=19 vs n=15; p = .023), psychiatric symptoms (NCI = 56.3% vs non-NCI = 35.3%; n=18 vs n=18; p = .041), and headaches (NCI = 56.3% vs non-NCI = 31.4%; n=18 vs n=16; p = .039). NCI patients also had higher rates of elevated CSF protein >45 mg/dL (NCI = 51.5% vs non-NCI = 20%; n=17 vs n=9; p = .0069), and higher CSF RBC counts (median NCI = 11 vs non-NCI = 2; p = .009). Malignancies were significantly less common among NCI patients (NCI = 3.1% vs non-NCI = 21.6%; n=1 vs n=11; p = .020). Finally, outcomes analysis demonstrated increased hospitalizations among patients with NCI (NCI = 1.43 vs non-NCI = 0.68; p = .012).

Conclusions:

NS patients with NCI exhibit a distinct clinical phenotype marked by male predominance, higher seizure and psychiatric symptom burden, elevated CSF markers, and increased healthcare utilization, underscoring the need for early recognition. Further studies are necessary to confirm validity.