The HNRC 500-Neuropsychology of Hiv infection at different disease stages

Abstract The present study examined neuropsychological (NP) functioning and associated medical, neurological, brain magnetic resonance imaging (MRI), and psychiatric findings in 389 nondemented males infected with Human Immunodeficiency Virus-Type 1 (HIV-1), and in 111 uninfected controls. Using a comprehensive NP test battery, we found increased rates of impairment at each successive stage of HIV infection. HIV-related NP impairment was generally mild, especially in the medically asymptomatic stage of infection, and most often affected attention, speed of information processing, and learning efficiency; this pattern is consistent with earliest involvement of subcortical or frontostriatal brain systems. NP impairment could not be explained on the bases of mood disturbance, recreational drug or alcohol use, or constitutional symptoms; by contrast, impairment in HIV-infected subjects was related to central brain atrophy on MRI, as well as to evidence of cellular immune activation and neurological abnormalities linked to the central nervous system. (JINS, 1995, 1, 231–251.)

[1]  S Spudich.  Neuropsychiatric aspects of HIV-1 infection. , 1990, Bulletin of the World Health Organization.

[2]  J. D. Weisman,et al.  Depressed mood and its relationship to neuropsychological test performance in HIV-1 seropositive individuals. , 1992, Journal of clinical and experimental neuropsychology.

[3]  R. Heaton,et al.  Neuropsychological findings in relapsing-remitting and chronic-progressive multiple sclerosis. , 1985, Journal of consulting and clinical psychology.

[4]  C. Cordon-Cardo,et al.  HIV antigen in the brains of patients with the AIDS dementia complex , 1987, Annals of neurology.

[5]  A. Monsch,et al.  Neuropsychological studies of asymptomatic Human Immunodeficiency Virus-Type-1 infected individuals , 1995, Journal of the International Neuropsychological Society.

[6]  R. Bornstein,et al.  Drug and alcohol use and neuropsychological performance in asymptomatic HIV infection. , 1993, The Journal of neuropsychiatry and clinical neurosciences.

[7]  M. Hamilton.  The assessment of anxiety states by rating. , 1959, The British journal of medical psychology.

[8]  B. Kendall,et al.  Neurological and neuropsychological performance in HIV seropositive men without symptoms. , 1992, Journal of neurology, neurosurgery, and psychiatry.

[9]  A. Kaszniak,et al.  Neuropsychological aspects of human immunodeficiency virus infection , 1989 .

[10]  Donna J. Sorenson,et al.  Visual attention in HIV-1 infection. , 1994 .

[11]  L. Robertson,et al.  Performance of patients with early HIV-1 infection on the Stroop Task. , 1992, Journal of clinical and experimental neuropsychology.

[12]  I. Grant,et al.  Neuropsychology of HIV infection , 1994 .

[13]  S. Tross,et al.  Psychological distress and neuropsychological complications of HIV infection and AIDS. , 1988, The American psychologist.

[14]  R. Letz,et al.  Quantitative neurologic and neurobehavioral testing of persons infected with human immunodeficiency virus type 1. , 1991, Archives of neurology.

[15]  D. Vlahov,et al.  HIV‐1 infection and nervous system abnormalities among a cohort of intravenous drug users , 1991, Neurology.

[16]  M. Trimble,et al.  Neuropsychological and NMR abnormalities in HIV infection , 1992 .

[17]  John W. Ward,et al.  1993 revised classification system for HIV infection and expanded surveillance case definition for AIDS among adolescents and adults. , 1993, MMWR. Recommendations and reports : Morbidity and mortality weekly report. Recommendations and reports.

[18]  W. Snider,et al.  Neurological complications of acquired immune deficiency syndrome: Analysis of 50 patients , 1983, Annals of neurology.

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

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

[21]  J. D. Ball,et al.  Neuropsychological functioning of HIV-infected males. , 1991, Journal of clinical and experimental neuropsychology.

[22]  M. Maj,et al.  WHO Neuropsychiatric AIDS study, cross-sectional phase II. Neuropsychological and neurological findings. , 1994, Archives of general psychiatry.

[23]  J. Haxby,et al.  Assessment of AIDS-related cognitive changes: recommendations of the NIMH Workshop on Neuropsychological Assessment Approaches. , 1990, Journal of clinical and experimental neuropsychology.

[24]  L. Thal,et al.  Neurological Symptoms, Not Signs,Are Common in Early HIV Infection. , 1996, Journal of neuro-AIDS.

[25]  D. Bredesen,et al.  Neurological manifestations of the acquired immunodeficiency syndrome (AIDS): experience at UCSF and review of the literature. , 1985, Journal of neurosurgery.

[26]  I Grant,et al.  Neuropsychological impairment in human immunodeficiency virus‐infection: implications for employment. HNRC Group. HIV Neurobehavioral Research Center. , 1994, Psychosomatic medicine.

[27]  A. Saykin,et al.  Neurological complications of human immunodeficiency virus infection in patients with lymphadenopathy syndrome , 1988, Annals of neurology.

[28]  M. Lorr,et al.  Manual for the Profile of Mood States , 1971 .

[29]  D. Richman,et al.  Incidence of AIDS dementia in a two-year follow-up of AIDS and ARC patients on an initial phase II AZT placebo-controlled study: San Diego cohort. , 1992, The Journal of neuropsychiatry and clinical neurosciences.

[30]  B. Perry.  Receptors and Ligands in Psychiatry , 1989 .

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

[32]  L. Prockop.  AIDS dementia complex. , 1988, The Journal of legal medicine.

[33]  D. Cooper,et al.  Simple and choice reaction time in patients with human immunodeficiency virus infection , 1989, Annals of neurology.

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

[35]  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.

[36]  R. Bornstein,et al.  Neuropsychological performance in asymptomatic HIV infection. , 1992, The Journal of neuropsychiatry and clinical neurosciences.

[37]  R. Price,et al.  Cerebrospinal fluid beta 2 microglobulin in patients infected with human immunodeficiency virus. , 1989, Neurology.

[38]  B. Jaffe.  Cognitive Therapy and the Emotional Disorders , 1977 .

[39]  Thomas P. Kobylski,et al.  Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised , 1988 .

[40]  F. Goebel,et al.  Psychiatric Symptoms and Neuropsychological Deficits in HIV Infection , 1990 .

[41]  L. Judd,et al.  The Collaborative Neuropsychological Study of Polydrug Users , 1978 .

[42]  A. Saykin,et al.  Longitudinal evaluation of neuropsychological function in homosexual men with HIV infection: 18-month follow-up. , 1991, The Journal of neuropsychiatry and clinical neurosciences.

[43]  B. Navia,et al.  The AIDS dementia complex: II. Neuropathology , 1986, Annals of neurology.

[44]  J. Phair,et al.  Low prevalence of neurological and neuropsychological abnormalities in otherwise healthy HIV‐1–infected individuals: Results from the multicenter AIDS cohort study , 1989, Annals of neurology.

[45]  I. Grant,et al.  Neuropsychologic findings in hypoxemic chronic obstructive pulmonary disease. , 1982, Archives of internal medicine.

[46]  I. Grant,et al.  A comparison of clinical and automated interpretation of the Halstead-Reitan Battery. , 1981, Journal of clinical neuropsychology.

[47]  M. Grassi,et al.  Neuropsychological performance in HIV‐1‐infected drug abusers , 1993, Acta neurologica Scandinavica.

[48]  F. Schmitt,et al.  Neuropsychological outcome of zidovudine (AZT) treatment of patients with AIDS and AIDS-related complex. , 1988, The New England journal of medicine.

[49]  R. Krikorian,et al.  Cognitive deficits associated with human immunodeficiency virus encephalopathy. , 1990, The Journal of neuropsychiatry and clinical neurosciences.

[50]  O. Strannegard,et al.  Elevated neopterin and beta 2-microglobulin levels in blood and cerebrospinal fluid occur early in HIV-1 infection. , 1989, AIDS.

[51]  J. Dilley,et al.  Immune function and neuropsychological performance in HIV-1-infected homosexual men. , 1993, Journal of acquired immune deficiency syndromes.

[52]  D. Delis,et al.  Verbal memory performance of patients with human immunodeficiency virus infection: evidence of subcortical dysfunction. The HNRC Group. , 1994, Journal of clinical and experimental neuropsychology.

[53]  A. Salazar,et al.  Working memory in individuals with HIV infection. , 1994, Journal of clinical and experimental neuropsychology.

[54]  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.

[55]  B. Navia,et al.  The acquired immunodeficiency syndrome dementia complex as the presenting or sole manifestation of human immunodeficiency virus infection. , 1987, Archives of neurology.

[56]  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.

[57]  L. Heston.  Neurobehavioral Aspects of Multiple Sclerosis , 1991 .

[58]  J. Catalan,et al.  Neuropsychiatric aspects of HIV-1 infection in gay men: controlled investigation of psychiatric, neuropsychological and neurological status. , 1993, Journal of psychosomatic research.

[59]  D. Rubinow,et al.  Neuropsychiatric consequences of AIDS , 1988, Annals of neurology.

[60]  H. Levin,et al.  Magnetic resonance imaging and neuropsychological findings in human immunodeficiency virus infection. , 1990, Journal of acquired immune deficiency syndromes.

[61]  D. Vlahov,et al.  HIV‐1 infection and intravenous drug use , 1992, Neurology.

[62]  I. Grant,et al.  A screening algorithm to identify clinically significant changes in neuropsychological functions in the Diabetes Control and Complications Trial. DCCT Research Group. , 1994, Journal of clinical and experimental neuropsychology.

[63]  M. Hamilton.  A RATING SCALE FOR DEPRESSION , 1960, Journal of neurology, neurosurgery, and psychiatry.

[64]  J. Jakobsen,et al.  Progressive neurological dysfunction during latent HIV infection. , 1989, BMJ.

[65]  R. Price,et al.  Cerebrospinal fluid ß2 microglobulin in patients infected with human immunodeficiency virus , 1989, Neurology.

[66]  I. Grant,et al.  Normal neuropsychological abilities of alcoholic men in their late thirties. , 1979, The American journal of psychiatry.

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

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

[69]  I. Reinvang,et al.  Prevalence of neuropsychological deficit in HIV infection. Incipient signs of AIDS dementia complex in patients with AIDS , 1991, Acta neurologica Scandinavica.

[70]  A. Saykin,et al.  Neuropsychological dysfunction in HIV-infection: Characterization in a lymphadenopathy cohort , 1988 .

[71]  A. Salazar,et al.  Neuropsychological performance, mood, and complaints of cognitive and motor difficulties in individuals infected with the human immunodeficiency virus. , 1993, The Journal of neuropsychiatry and clinical neurosciences.

[72]  B. Navia,et al.  The AIDS dementia complex: I. Clinical features , 1986, Annals of neurology.

[73]  C. R. Snyder,et al.  Implications of self-reported cognitive and motor dysfunction in HIV-positive patients. , 1991, The American journal of psychiatry.

[74]  R. Janssen,et al.  Epidemiology of human immunodeficiency virus encephalopathy in the United States , 1992, Neurology.

[75]  E. Aylward,et al.  Regional brain atrophy in HIV‐1 infection: association with specific neuropsychological test performance , 1993, Acta neurologica Scandinavica.

[76]  R. Fimmers,et al.  Early signs of cognitive deficits among human immunodeficiency virus‐positive hemophiliacs , 1992, Acta psychiatrica Scandinavica.

[77]  E. Miller,et al.  Neuropsychological performance in HIV-1 immunocompromised patients: a preliminary report. , 1989, Journal of clinical and experimental neuropsychology.

[78]  S. Folstein,et al.  "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. , 1975, Journal of psychiatric research.

[79]  K. Marder,et al.  Mortality risks in gay men with human immunodeficiency virus infection and cognitive impairment , 1993, Neurology.

[80]  R. Bornstein,et al.  Depression and neuropsychological performance in asymptomatic HIV infection. , 1993, The American journal of psychiatry.

[81]  Association between intrathecal anti-HIV-1 immunoglobulin G synthesis and occurrence of HIV-1 in cerebrospinal fluid. , 1989, AIDS.

[82]  R. Olshen,et al.  Depressed mood does not explain neuropsychological deficits in HIV-infected persons. , 1993 .

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

[84]  R. Bornstein,et al.  Neuropsychological performance in symptomatic and asymptomatic HIV infection. , 1993, AIDS.

[85]  D. Andrewes,et al.  Early HIV-related neuropsychological impairment: relationship to stage of viral infection. , 1990, Journal of clinical and experimental neuropsychology.

[86]  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.

[87]  I. Grant,et al.  Neuropsychological and NMR abnormalities in HIV infection: The St. Mary's-Queen Square Study. , 1992 .

[88]  H. Handsfield,et al.  Central Nervous System Manifestations in Human Immunodeficiency Virus Infection Without AIDS , 1992, Journal of acquired immune deficiency syndromes.

[89]  I. Elovaara,et al.  Cognitive performance in HIV‐1 infection: relationship to severity of disease and brain atrophy , 1993, Acta neurologica Scandinavica.

[90]  J. Margolick,et al.  The diagnostic utility of elevation in cerebrospinal fluid β2‐microglobulin in HIV‐1 dementia , 1992, Neurology.

[91]  Terry L. Jernigan,et al.  Magnetic Resonance Imaging Morphometric Analysis of Cerebral Volume Loss in Human Immunodeficiency Virus Infection , 1993 .

[92]  C. Stefanis,et al.  Neuropsychological assessment of HIV-seropositive haemophiliacs. , 1991, AIDS.

[93]  R. Bornstein,et al.  Rate of CD4 decline and neuropsychological performance in HIV infection. , 1991, Archives of neurology.