Hostname: page-component-78c5997874-ndw9j Total loading time: 0 Render date: 2024-11-04T19:41:00.912Z Has data issue: false hasContentIssue false
  • English
  • Français

The neuropsychological profile of symptomatic AIDS and ADC patients in the pre-HAART era: A meta-analysis

Published online by Cambridge University Press:  17 May 2006

LUCETTE A.J. CYSIQUE ,
PAUL MARUFF  and
BRUCE J. BREW
LUCETTE A.J. CYSIQUE
Affiliation:
Faculty of Medicine, St. Vincent's Clinical School, University of New South Wales, Sydney, Australia
PAUL MARUFF
Affiliation:
School of Psychology, LaTrobe University, Melbourne, Australia
BRUCE J. BREW
Affiliation:
Departments of Neurology and HIV Medicine, St. Vincent's Hospital, Sydney, Australia
Get access Rights & Permissions [Opens in a new window]

Abstract

It remains essential to document the neuropsychological profile of acquired immunodeficiency syndrome (AIDS) dementia complex (ADC) and minor forms human immunodeficiency virus (HIV)-associated neurocognitive impairment by quantifying the magnitude of impairment across eras of treatment. Indeed, with the introduction of the highly active antiretroviral therapy (HAART), there is evidence of changes in aspects of ADC. To allow quantitative and qualitative comparisons with the HAART era studies, we developed a summary of neuropsychological performance acquired in pre-HAART era studies in advanced HIV infection and ADC. Using a meta-analytical procedure and a test nomenclature that accounts for task complexity, we found that individuals with symptomatic infection (but no AIDS) demonstrated a global mild level of cognitive impairment, except for the domains complex attention/psychomotor speed, motor coordination, and learning, which showed moderate impairment. Individuals with AIDS demonstrated a global moderate level of cognitive impairment with a predominance of deficits in attention, complex attention/psychomotor speed, learning, motor coordination, with additional deficits in verbal memory and reasoning. Individuals with ADC demonstrated the most severe cognitive disturbances in domains of learning, motor coordination, with additional deficits in verbal fluency and verbal memory. Moderate impairment was evidenced in domains of complex attention/psychomotor speed, whereas naming and visuospatial functions were relatively preserved. The profile of deficits in ADC suggests that it may not be only interpreted as a worsening form of the impairment that is seen in the AIDS and symptomatic stages of HIV disease but that there are also additional deficits suggestive of an alternate pathogenetic process(es). (JINS, 2006, 12, 368–382.)

Keywords

AIDS dementia complexHIV/AIDSNeuropsychological functioningCognitionNeuropsychologyMeta-analysis
Type
Research Article
Information
Journal of the International Neuropsychological Society , Volume 12 , Issue 3 , May 2006 , pp. 368 - 382
Copyright
© 2006 The International Neuropsychological Society

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

Andersen, R. (1976). Verbal and visuo-spatial memory. Scandinavian Journal of Psychology, 17, 198–204.Google Scholar
Andrewes, D., Bullen, J.G., Tomlinson, L., Elwes, R.D.C., & Reynolds, E.H. (1986). A comparative study of the effects of phenytoin and carbamezapine in new referrals with epilepsy. Epilepsia, 27, 128–134.Google Scholar
Ayers, M., Abrams, D., Newell, T., & Frieddrich, F. (1987). Performance of individuals with AIDS on the Luria-Nebraska neuropsychological battery. The International Journal of Clinical Neuropsychology, 9, 101–104.Google Scholar
Baldeweg, T., Catalan, J., Lovett, E., Gruzelier, J., Riccio, M., & Hawkins, D. (1995). Long-term zidovudine reduces neurocognitive deficits in HIV-1 infection. AIDS, 9, 589–596.CrossRefGoogle Scholar
Basso, M.R. & Bornstein, R.A. (2000). Effects if immunosuppression and disease severity upon neuropsychological function in HIV infection. Journal of Clinical and Experimental Neuropsychology, 22, 104–114.Google Scholar
Becker, J.T. & Salthouse, T.A. (1999). Neuropsychological test performance in the Acquired Immunodeficiency Syndrome independent effects of diagnostic group on functioning. Journal of the International Neuropsychological Society, 5, 41–47.Google Scholar
Bornstein, R.A., Nasarallah, H.A., Para, M.F., Whitacre, C.C., Rosenberger, P., & Fass, R.J. (1993). Neuropsychological performance in symptomatic and asymptomatic HIV-infection. AIDS, 7, 519–524.Google Scholar
Brew, B.J. (2004). Evidence for a change in AIDS Dementia Complex in the era of Highly Active Antiretroviral Therapy and the possibility of new forms of AIDS Dementia Complex. AIDS, 18(Suppl. 1), S75–S78.Google Scholar
Brouwers, P., Hendricks, M., Lietzau, J.A., Pluda, J.M., Mitsuya, H., Broder, S., & Yarchoan, R. (1997). Effect of combination therapy with zidovudine and didanosine on neuropsychological functioning in patients with symptomatic HIV disease: A comparison of simultaneous and alternating regimens. AIDS, 11, 59–66.CrossRefGoogle Scholar
Brouwers, P., Mohr, E., Hildebrand, K., Hendricks, M., Claus, J.J., Baron, I.S., Young, M., & Pierce, P. (1996). A novel approach to the determination and characterization of HIV dementia. Canadian Journal of Neurological Sciences, 23, 104–109.Google Scholar
CDC. (1987). Revision of the CDC surveillance case definition for acquired immunodeficiency syndrome. MMWR, 36(Suppl. 1), 1–15.Google Scholar
CDC. (1993). Revised classification system for HIV infection and expanded surveillance case definition for AIDS among adolescents and adults. MMWR 1992, 41, No. RR-17.
Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2nd ed.). New York: Academic Press.
Collie, A. & Maruff, P. (2000). The neuropsychology of preclinical Alzheimer's disease and mild cognitive impairment. Neurosciences and Biobehavioral Review, 24, 365–374.Google Scholar
Cummings, J.L. (1993). Fronto-subcortical circuits and human behavior. Archives of Neurology, 50, 873–880.Google Scholar
Cysique, L., Maruff, P., & Brew, B. (2004a). Prevalence and pattern of neuropsychological impairment in HIV/AIDS-infection across pre and post-highly active antiretroviral therapy eras: A combined study of 2 cohorts. Journal of Neurovirology, 10, 350–357.Google Scholar
Cysique, L., Maruff, P., & Brew, B. (2004b). Antiretroviral therapy in HIV infection: Are neurologically active drugs important? Archives of Neurology, 61, 1699–1704.Google Scholar
Cysique, L.A., Maruff, P., Darby, D., & Brew, B.J. (2006). The assessment of cognitive function in advanced HIV-1 infection and Aids Dementia Complex using a new computerized cognitive test battery. Archives of Clinical Neuropsychology, 21, 185–194.CrossRefGoogle Scholar
Dubois, B. & Pillon, B. (1997). Cognitive deficits in Parkinson's disease. Journal of Neurology, 244, 2–8.Google Scholar
Dunbar, N.J. (1996). A model of neuropsychological impairment in AIDS dementia complex (Vol. 57 (1-B)): US: Univ Microfilms International.
Ellis, R.J., Hsia, K., Spector, S.A., Nelson, J.A., Heaton, R.K., Wallace, M.R., Abramson, I., Atkinson, J.H., Grant, I., & McCutchan, J.A. (1997). Cerebrospinal fluid Human immunodeficiency Virus type-1 RNA levels are elevated in neurocognitively impaired individuals with Acquired Immunodeficiency Syndrome. Annals of Neurology, 42, 679–688.Google Scholar
Gibbs, A., Andrewes, D., Szmukler, G., Mulhall, B., & Bowden, S. (1990). Early HIV-related neuropsychological impairment: Relationship to stage of viral infection. Journal of Clinical and Experimental Neuropsychology, 12, 766–780.CrossRefGoogle Scholar
Grant, I., Atkinson, H.J., Hesselink, J.R., Kennedy, C.J., Richman, D.D., Spector, S.A., & McCutchan, J.A. (1987). Evidence for early central nervous system involvement in the Acquired Immunodeficiency Syndrome (AIDS) and other human immunodeficiency virus (HIV) infections. Studies with neuropsychological testing and magnetic resonance imaging. Annals of Internal Medicine, 107, 828–836.Google Scholar
Grassi, M.P., Perin, C., Clerici, F., Zocchetti, C., Cargnel, A., & Mangoni, A. (1993). Neuropsychological performances in HIV-1 infected drug abusers. Acta Neurologica Scandinavica, 88, 119–122.Google Scholar
Harrison, M.J., Newman, S.P., Hall-Craggs, M.A., Fowler, C.J., Miller, R., Kendall, B.E., Paley, M., Wilkinson, I., Sweeney, B., Lunn, S., Carter, S., & Williams, I. (1998). Evidence of CNS impairment in HIV infection: Clinical, neuropsychological, EEG, and MRI/MRS study. Journal of Neurology Neurosurgery and Psychiatry, 65, 301–307.CrossRefGoogle Scholar
Heaton, R., Grant, I., Butters, N., White, D.A., Kirson, D., Atkinson, H.J., McCutchan, J.A., Taylor, M., Kelly, M.D., Ellis, R.J., Wolfson, T., Velin, R.A., Marcotte, T.D., Hesselink, J.R., Jernigan, T.L., Chandler, J., Wallace, M., Abramason, I., & the HNRC Group (1995). The HNRC 500-neuropsychology of HIV infection at different disease stages. Journal of the International Neuropsychological Society, 1, 231–251.CrossRefGoogle Scholar
Hedges, L. (1994). Statistical considerations. In H. Cooper & L. Hedges (Eds.), The handbook of research synthesis, (pp. 29–38). New York: Russell Sage Foundation.
Hedges, L. & Olkin, I. (1985). Statistical methods for meta-analysis. Orlando, FL: Academic Press.
Hinkin, C., Cummings, J., Van Gorp, W., Satz, P., Mitrushina, M., & Freeman, D. (1990). Frontal/subcortical features of normal aging: An empirical analysis. Canadian Journal on Aging, 9, 104–119.CrossRefGoogle Scholar
Howell, D. (2002). Statistical Methods for Psychology (5th ed.). Pacific Grove, CA: Thomson Learning.
Janssen, R., Comblath, D., Hopkins, J., Epstein, L.G., Foa, R.P., McArthur, J.C., & Price, W. (1991). Nomenclature and research case definitions for neurologic manifestations immunodeficiency virus type-1 (HIV-1): Reports of a working group of the American Academy of Neurology AIDS task force. Neurology, 41, 778–785.Google Scholar
Jansen, R., Saykin, A., Canon, L., Campbell, J., Pinsky, P., Hessol, N., O'Malley, P., Lifson, A., Doll, L., Rutherford, G., & Kaplan, J. (1989). Neurological and neuropsychological manifestations of HIV-1 infection: Association with AIDS-Related Complex but not asymptomatic HIV-1 infection. Annals of Neurology, 26, 592–600.CrossRefGoogle Scholar
Joffe, R., Rubinow, D., Squillace, K., Lane, C., Duncan, C., & Fauci, A. (1986). Neuropsychiatric aspects of AIDS. Psychopharmacology Bulletin, 22, 684–688.Google Scholar
Josiassen, R., Curry, L., & Mancall, E. (1983). Development of neuropsychological deficits in Huntington's disease. Archives of Neurology, 40, 791–796.CrossRefGoogle Scholar
Krikorian, R. & Wrobel, A.J. (1991). Cognitive impairment in HIV-infection. AIDS, 5, 1501–1507.CrossRefGoogle Scholar
Lezak, M., Howieson, D., Loring, D., Hannay, J., & Fischer, J. (2004). Neuropsychological assessment (4th ed.). Oxford: Oxford University Press.
Lipsey, M. & Wilson, D. (2001). Practical Meta-analysis. London: Sage Publications.
Lunn, S., Skydsbjerg, M., Schulsinger, H., Parnas, J., Pedersen, J., & Mathiesen, L. (1991). A preliminary report on the neuropsychological sequelae of human immunodeficiency virus. Archives of General Psychiatry, 48, 139–142.Google Scholar
Mack, J. (1982). Short and long-term memory function in patients with unilateral hemispheric lesions. Paper presented at the International Neuropsychological Society North American Conference, Pittsburgh.
Martin, A., Heyes, M.P., Salazar, A.M., Kampen, D.L., Williams, J., Law, W.A., Coats, M.E., & Markey, S.P. (1992). Progressive slowing of reaction time and increasing cerebrospinal fluid concentration of quinolinic acid in HIV-1 affected individuals. Journal of Neuropsychiatry and Clinical Neurosciences, 4, 270–279.Google Scholar
Maruff, P., Currie, J., Malone, V., McArthur-Jackson, C., Mulhall, B., & Benson, E. (1994). Neuropsychological characterization of the AIDS Dementia Complex and rationalization of a test battery. Archives of Neurology, 51, 689–695.Google Scholar
Maruff, P., Malone, V., McAthur-Jackson, C., Mulhall, B., Benson, E., & Currie, J. (1995). Abnormalities of visual spatial attention in HIV infection and the HIV-associated dementia complex. The Journal of Neuropsychiatry and Clinical Neurosciences, 7, 325–333.Google Scholar
McArthur, J.C., Haughey, N., Gartner, S., Conant, K., Pardo, C.A., Nath, A., & Sacktor, N. (2003). Human Immunodeficiency Virus-associated dementia: An evolving disease. Journal of Neurovirology, 9, 205–221.CrossRefGoogle Scholar
McCaffrey, R., Cousins, J., Westervelt, H., Martynowicz, M., Remick, S., Szebenyi, S., Wagle, W.A., Bottomley, P.A., Hardy, C.J., & Haase, R.F. (1995). Practice effects with the NIMH-AIDS abbreviated neuropsychological battery. Archives of Clinical Neuropsychology, 10, 241–250.CrossRefGoogle Scholar
Navia, B.A., Cho, E.S., Petito, C.K., & Price, R.W. (1986). The aids dementia complex: II neuropathology. Annals of Neurology, 19, 525–535.CrossRefGoogle Scholar
Newman, S.P., Lunn, S., & Harrison, M.J. (1995). Do asymptomatic HIV-seropositive individuals show cognitive deficit? AIDS, 9, 1211–1220.Google Scholar
Oldfield, R.C. & Wingfield, A. (1965). Response latencies in naming objects. Quarterly Journal of Experimental Psychology, 17, 273–281.CrossRefGoogle Scholar
Peavy, G., Jacobs, D., Salmon, D., Butters, N., Delis, D., Taylor, M., Massman, P., Stout, J., Heindel, W., Kirson, D., Atkinson, J., Chandler, J., & Grant, I. (1994). Verbal memory performance of patients with Human Immunodeficiency Virus infection: Evidence of subcortical dysfunction. Journal of Clinical and Experimental Neuropsychology, 16, 508–523.CrossRefGoogle Scholar
Perdices, M. & Cooper, D.A. (1989). Simple and choice reaction time in patients with Human Immunodeficiency Virus infection. Annals of Neurology, 25, 460–467.CrossRefGoogle Scholar
Perdices, M. & Cooper, D.A. (1990). Neuropsychological investigation of patients with AIDS and ARC. Journal of Acquired Immune Deficiency Syndrome, 3, 555–564.Google Scholar
Petito, C., Roberts, B., Cantando, J., Rabinstein, A., & Duncan, R. (2001). Hippocampal injury and alterations in neuronal chemokine co-receptor expression in patients with AIDS. Journal of Neuropathology and Experimental Neurology, 60, 377–385.CrossRefGoogle Scholar
Power, C., Selnes, O., Grim, J., & McArthur, J. (1995). HIV dementia scale: A rapid screening test. Journal of Acquired Immune Deficiency Syndrome and Human Retrovirology, 8, 273–278.CrossRefGoogle Scholar
Price, R.W. & Brew, B.J. (1988). The Aids Dementia Complex. Journal of Infectious Disease, 158, 1079–1083.Google Scholar
Reger, M., Wesh, R., Razani, J., Martin, D.J., & Boone, K.B. (2002). A meta-analysis of the neuropsychological sequelae of HIV-infection. Journal of the International Neuropsychological Society, 8, 410–424.Google Scholar
Rennick, P.M. (1979). Color-naming and visual search tests for repeatable cognitive-perceptual motor battery. Grosse Point Park, MI: Axon Publishing Company.
Rubinow, D., Berrettini, C., Brouwers, P., & Lane, H. (1988). Neuropsychiatric consequences of AIDS. Annals of Neurology, 23(suppl.), S24–S26.Google Scholar
Sacktor, N.C., Bacellar, H., Hoover, D.R., Nance-Sproson, T.E., Selnes, O.A., Miller, E.N., Dal Pan, G.J., Kleeberger, C., Brown, A., Saah, A., & McArthur, J.C. (1996). Psychomotor slowing in HIV infection: A predictor of dementia, AIDS and death. Journal of Neurovirology, 2, 404–410.Google Scholar
Saykin, A., Jansen, R., Sprehn, G., Kaplan, J., Spira, T., & O'Connor, B. (1991). Longitudinal evaluation of neuropsychological function in homosexual men with HIV-infection: 18-month follow-up. The Journal of Neuropsychiatry and Clinical Neurosciences, 3, 286–298.Google Scholar
Selnes, O.A., Galai, N., Bacellar, M.A., Miller, E.N., Becker, J.T., Wesch, J., Van Gorp, W., & McArthur, J.C. (1995). Cognitive performance after progression to AIDS: A longitudinal study from the Multicenter AIDS cohort study. Neurology, 45, 267–275.CrossRefGoogle Scholar
Seltzer, R. & Mack, J. (1981). Visual design copying in patients with unilateral cerebral lesions. Paper presented at the International Neuropsychological Society European Conference, Bergen.
Sevigny, J.J., Albert, S.M., McDermott, M.P., McArthur, J.C., Sacktor, N., Conant, K., Schifitto, G., Selnes, O.A., Stern, Y., McClernon, D.R., Palumbo, D., Kieburtz, K., Riggs, G., Cohen, B., Epstein, L.G., & Marder, K. (2004). Evaluation of HIV RNA and markers of immune activation as predictors of HIV-Associated Dementia. Neurology, 63, 2084–2090.CrossRefGoogle Scholar
Sidtis, J.J., Gatsonis, C., Price, R.W., Singer, E.J., Collier, A.C., Richman, D.D., Hirsch, M.S., Schaerf, F.W., Fischl, M.A., Kieburtz, K., Simpson, D., Koch, M.A., Feinberg, J., Dafni, U., & the AIDS Trials Group. (1993). Zidovudine treatment of the aids dementia complex: Results of a placebo-controlled trial. Annals of Neurology, 33, 343–349.CrossRefGoogle Scholar
Skoraszewski, M., Ball, J., & Mikulka, P. (1991). Neuropsychological functioning of HIV-infected males. Journal of Clinical and Experimental Neuropsychology, 13, 278–290.Google Scholar
Spreen, O. & Strauss, E. (1998). A compendium of neuropsychological tests (2nd ed.). New York: Oxford University Press.
Stelmach, G., Phillips, J., & Chau, A. (1989). Visuo-spatial processing in parkinsonians. Neuropsychologia, 27, 485–493.CrossRefGoogle Scholar
Tozzi, V., Balestra, P., Galgani, S., Narciso, P., Ferri, F., Sebastiani, G., D'Amato, C., Affricano, C., Pigorini, F., Pau, M.F., De Felici, A., & Benedetto, A. (1999). Positive and sustained effects of Highly Active Antiretroviral Therapy on HIV-1 associated neurocognitive impairment. AIDS, 13, 1889–1897.Google Scholar
Tross, S., Price, R.W., Navia, B., Thaler, H.T., Gold, J., Hirsch, D.A., & Sidtis, J.J. (1988). Neuropsychological characterization of the AIDS Dementia Complex: A preliminary report. AIDS, 2, 81–88.CrossRefGoogle Scholar
Van Gorp, W., Mandelkern, M., Gee, M., Hinkin, C., Stern, C., Paz, D., Dixon, W., Evans, G., Flynn, F., & Frederick, C.J. (1992). Cerebral metabolic dysfunction in AIDS: Findings in a sample with and without dementia. Journal of Neuropsychiatry and Clinical Neurosciences, 4, 280–287.Google Scholar
Van Gorp, W.G., Miller, E.N., Satz, P., & Visscher, B. (1989). Neuropsychological performance in HIV-1-immunocompromised patients: A preliminary report. Journal of Clinical and Experimental Neuropsychology, 11, 763–773.CrossRefGoogle Scholar
White, D.A., Heaton, R., & Monsch, A.U. (1995). Neuropsychological studies of asymptomatic Human Immunodeficiency Virus-type 1 infected individuals. Journal of the International Neuropsychological Society, 1, 304–315.CrossRefGoogle Scholar
White, D.A., Taylor, M.J., Butters, N., Mack, C., Salmon, D.P., Peavy, G., Ryan, L., Heaton, R.K., Atkinson, H.J., Chandler, J., Grant, I., & the HNRC Group. (1997). Memory for verbal information in individuals with HIV-Associated Dementia Complex. Journal of Clinical and Experimental Neuropsychology, 19, 357–366.CrossRefGoogle Scholar
Wilson, D. (2001). Effect size determination program. Retrieved December 2004, from http://mason.Gmu.Edu/∼dwilsonb/ma.Html.
Worth, J., Savage, C.R., Baer, L., Esty, E.K., & Navia, B.A. (1993). Computer-based neuropsychological screening for AIDS Dementia Complex. AIDS, 7, 677–681.CrossRefGoogle Scholar
Zakzanis, K.K. (2001). Statistics to tell the truth, the whole truth, and nothing but the truth: Formulae, illustrative numerical examples, and heuristic interpretation of effect sizes analyses for neuropsychological researchers. Archives of Clinical Neuropsychology, 16, 653–667.CrossRefGoogle Scholar