WHO Neuropsychiatric AIDS study, cross-sectional phase II. Neuropsychological and neurological findings.

BACKGROUND The neuropsychological and neurological complications of HIV-1 infection and AIDS were explored within the cross-sectional phase of the WHO Neuropsychiatric AIDS Study. Special attention was devoted to the controversial issue of the prevalence and clinical significance of subtle cognitive deficits in asymptomatic seropositive subjects. METHODS A neuropsychological test battery validated for cross-cultural use, a structured interview for the diagnosis of dementia, a rating scale of functioning in daily living activities, and a neurological module were administered to representative samples of seropositive subjects and to matched seronegative controls living in the five geographic areas predominantly affected by the HIV-1 epidemic. Data are available for five centers. RESULTS The prevalence of global neuropsychological impairment was significantly increased in asymptomatic seropositive subjects compared with controls in only two centers. A significant effect of education on neuropsychological performance was observed among asymptomatic seropositive individuals. In the two African centers, low-education, but not high-education, asymptomatic seropositive persons had an impaired performance. The frequency of impaired functioning in daily living activities and of neurologic abnormalities was higher in symptomatic, but not in asymptomatic, seropositive subjects compared with controls in all centers. CONCLUSIONS These data suggest that the risk of subtle cognitive deficits may be increased in asymptomatic stages of HIV-1 infection. However, these deficits are not associated with neurologic changes and do not seem to affect subjects' social functioning.

[1]  B. Woolf.  ON ESTIMATING THE RELATION BETWEEN BLOOD GROUP AND DISEASE , 1955, Annals of human genetics.

[2]  O. Selnes,et al.  Metacognition in HIV-1 seropositive asymptomatic individuals: self-ratings versus objective neuropsychological performance. Multicenter AIDS Cohort Study (MACS). , 1991, Journal of clinical and experimental neuropsychology.

[3]  L. Bélec,et al.  Low prevalence of neuro-psychiatric clinical manifestations in central African patients with acquired immune deficiency syndrome. , 1989, Transactions of the Royal Society of Tropical Medicine and Hygiene.

[4]  W. Nkya,et al.  Neurological disorders in AIDS and HIV disease in the northern zone of Tanzania. , 1989, AIDS.

[5]  M. Maj.  Mental Disorders in HIV-1 Infection and AIDS , 1993 .

[6]  J. Parnas,et al.  A preliminary report on the neuropsychologic sequelae of human immunodeficiency virus. , 1991, Archives of general psychiatry.

[7]  S. Galderisi,et al.  Evaluation of two new neuropsychological tests designed to minimize cultural bias in the assessment of HIV-1 seropositive persons: a WHO study. , 1993, Archives of clinical neuropsychology : the official journal of the National Academy of Neuropsychologists.

[8]  J. Sidtis,et al.  Neuropsychological characterization of the AIDS dementia complex: a preliminary report. , 1988, AIDS.

[9]  R. Janssen,et al.  Neurological complications of HIV-1-seropositive internal medicine inpatients in Kinshasa, Zaire. , 1992, Journal of acquired immune deficiency syndromes.

[10]  J. Becker,et al.  Neuropsychological performance in HIV‐1‐infected homosexual men , 1990, Neurology.

[11]  A. Beaumanoir,et al.  A controlled study of early neurologic abnormalities in men with asymptomatic human immunodeficiency virus infection. , 1990, The New England journal of medicine.

[12]  M. Maj,et al.  The World Health Organization's Cross-cultural Study on Neuropsychiatric Aspects of Infection with the Human Immunodeficiency Virus 1 (HIV-1) Preparation and Pilot Phase , 1991, British Journal of Psychiatry.

[13]  I. Elovaara,et al.  Cognitive changes as early signs of HIV infection , 1988, Acta neurologica Scandinavica.

[14]  H. Morgenstern,et al.  Low education as a possible risk factor for cognitive abnormalities in HIV-1: findings from the multicenter AIDS Cohort Study (MACS). , 1993, Journal of acquired immune deficiency syndromes.

[15]  M. Åsberg,et al.  A New Depression Scale Designed to be Sensitive to Change , 1979, British Journal of Psychiatry.

[16]  R. Boswell,et al.  Neuropsychological and neurological function of human immunodeficiency virus seropositive asymptomatic individuals. , 1989, Archives of neurology.

[17]  R. Reitan,et al.  The Halstead-Reitan neuropsychological test battery: Theory and clinical interpretation , 1993 .

[18]  W. Barr,et al.  Neuropsychological function in physically asymptomatic, HIV-seropositive men. , 1989, The Journal of neuropsychiatry and clinical neurosciences.

[19]  B Horwitz,et al.  Longitudinal study of the early neuropsychological and cerebral metabolic changes in dementia of the Alzheimer type. , 1988, Journal of clinical and experimental neuropsychology.

[20]  A. Saykin,et al.  Neurological and neuropshychological manifestations of HIV‐1 infection: Association with AIDS‐related complex but not asymptomatic HIV‐1 infection , 1989, Annals of neurology.

[21]  K. Marder,et al.  Multidisciplinary baseline assessment of homosexual men with and without human immunodeficiency virus infection. III. Neurologic and neuropsychological findings. , 1991, Archives of general psychiatry.

[22]  Andrew J. Saykin,et al.  Nomenclature and research case definitions for neurologic manifestations of human immunodeficiency virus‐type 1 (HIV‐1) infection , 1991, Neurology.

[23]  C Eisdorfer,et al.  Cognition in early human immunodeficiency virus infection. , 1990, Archives of neurology.

[24]  M. Maj,et al.  WHO Neuropsychiatric AIDS study, cross-sectional phase I. Study design and psychiatric findings. , 1994, Archives of general psychiatry.

[25]  M. Fischl,et al.  Neurologic Disease as the Presenting Manifestation of Acquired Immunodeficiency Syndrome , 1987, Southern medical journal.

[26]  P. Rubé,et al.  L’examen Clinique en Psychologie , 1959 .

[27]  Eric N. Miller,et al.  HIV‐1 infection , 1990, Neurology.

[28]  D. Richman,et al.  Evidence for early central nervous system involvement in the acquired immunodeficiency syndrome (AIDS) and other human immunodeficiency virus (HIV) infections. Studies with neuropsychologic testing and magnetic resonance imaging. , 1987, Annals of internal medicine.

[29]  J. Sidtis,et al.  The brain in AIDS: central nervous system HIV-1 infection and AIDS dementia complex. , 1988, Science.

[30]  P. Selwyn,et al.  A prospective comparison of neuropsychologic function in HIV-seropositive and seronegative methadone-maintained patients. , 1990, AIDS.

[31]  M. Zaudig,et al.  SIDAM – A Structured Interview for the diagnosis of Dementia of the Alzheimer type, Multi-infarct dementia and dementias of other aetiology according to ICD-10 and DSM-III-R , 1991, Psychological Medicine.