This study examined whether individuals with substance dependence (ISDs) show impairments in working memory and whether there is a relationship between their impairments in decision making as measured by the gambling task (GT) paradigm and working memory as measured by a delayed nonmatching to sample (DNMS) task. Using the GT, 11% of healthy control participants and 61% of ISDs opted for choices with high immediate gains in spite of higher future losses. For the ISDs and controls with equal GT impairments, the ISDs performed significantly lower than controls on the DNMS task. The nonimpaired ISDs on the GT also performed significantly worse than matched controls on the DNMS task. The DNMS task deficit in ISDs was across all delay times, suggesting the deficit may lie in the "executive" process of working memory, which supports earlier findings (E. M. Martin et al., 2003). The authors suggest that the prefrontal cortex hosts multiple distinct mechanisms of decision making and inhibitory control and that ISDs may be affected in any one or combination of them.

Objective: To evaluate the frequency of HIV-associated neurocognitive disorder (HAND) in HIV1 individuals and determine whether the frequency of HAND changed over 4 years of follow-up. Methods:The Multicenter AIDS Cohort Study (MACS) is a prospective study of gay/bisexual men.Beginning in 2007, all MACS participants received a full neuropsychological test battery and functional assessments every 2 years to allow for HAND classification.

The purpose of this study was to determine the pattern and extent of caudate nucleus and putamen atrophy in HIV-infected men with well-controlled immune status and viral replication. 155 men underwent structural brain magnetic resonance imaging; 84 were HIV-infected and 71 were uninfected controls. MRI data were processed using the Fully Deformable Segmentation routine, producing volumes for the right and left caudate nucleus and putamen, and 3-D maps of spatial patterns of thickness. There was significant atrophy in the HIV-infected men in both the caudate and putamen, principally in the anterior regions. The volume of the basal ganglia was inversely associated with the time since first seropositivity, suggesting that either there is a chronic, subclinical process that continues in spite of therapy, or that the extent of the initial insult caused the extent of atrophy.Electronic supplementary materialThe online version of this article (doi:10.1007/s11682-011-9113-8) contains supplementary material, which is available to authorized users.

Background:The purpose of this study was to evaluate the relationship between cognitive perfor-

Objective: In the largest cohort study of neuropsychological outcomes among HIV-infected women to date, we examined the association between HIV status and cognition in relation to other determinants of cognitive function (aim 1) and the pattern and magnitude of impairment across cognitive outcomes (aim 2).Methods: From 2009 participants from the Women's Interagency HIV Study (WIHS) completed a comprehensive neuropsychological test battery. We used multivariable regression on raw test scores for the first aim and normative regression-based analyses (t scores) for the second aim. The design was cross-sectional. Results:The effect sizes for HIV status on cognition were very small, accounting for only 0.05 to 0.09 SD units. The effect of HIV status was smaller than that of years of education, age, race, income, and reading level. In adjusted analyses, HIV-infected women performed worse than uninfected women on verbal learning, delayed recall and recognition, and psychomotor speed and attention. The largest deficit was observed in delayed memory. The association of low reading level with cognition was greater in HIV-infected compared to HIV-uninfected women. HIV biomarkers (CD4 count, history of AIDS-defining illness, viral load) were associated with cognitive dysfunction. Conclusions:The effect of HIV on cognition in women is very small except among women with low reading level or HIV-related comorbidities. Direct comparisons of rates of impairment in wellmatched groups of HIV-infected men and women are needed to evaluate possible sex differences in cognition. Compared to HIV-infected men, HIV-infected women may be at greater risk for cognitive decline due to a higher prevalence of risk factors common in predominantly minority, urbandwelling women, such as poverty, low literacy levels, low education, substance abuse, poor mental health, early life stressors and trauma, barriers to health care service utilization, and environmental exposures.1,2 These factors might contribute to low cognitive reserve and confer increased risks of cognitive dysfunction. Several studies have examined cognition in HIVinfected women, 3-11 but the maximum sample size has been 237. Larger studies are needed to understand the determinants and patterns of cognitive function in HIV-infected women.The Women's Interagency HIV Study (WIHS) is the largest longitudinal study of the natural and treated history of HIV infection and clinical outcomes in women residing in the United States.12,13 Here we present the first findings from the largest comprehensive cohort study of cognitive function in HIV-infected (n 5 1,019) and demographically similar HIVuninfected women (n 5 502). Our first aim was to investigate the association between HIV status and cognition in relation to other determinants of cognition. We predicted that low socioeconomic status, low reading level, illicit substance use, and depressive symptoms would contribute to decrements across a range of cognitive domains, and would more strongly influence cognition in HIV-infected wo...