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Central nervous system opportunistic infections (CNS-OI) are a significant cause of morbidity and mortality in AIDS. While current interventions are increasingly successful in treating CNS-OI, little information exists regarding long-term behavioral outcomes among survivors. In this exploratory study we examined neurocognitive data among three groups of adults with different AIDS-related CNS-OI: 15 with past cryptococcal meningitis (CM), 8 with toxoplasmosis encephalitis (TE), and 8 with progressive multifocal leukoencephalopathy (PML). A group of 61 individuals with AIDS, but without CNS-OI, was used as a comparison group. A battery of standardized neuropsychological tests assessing a variety of cognitive domains was administered upon entry. Results indicate that individuals with a history of CNS-OI were most impaired on measures of cognitive and psychomotor speed relative to the HIV+ comparison group. Among the CNS-OI groups, individuals with history of TE had the most severe and varied deficits. The results are discussed in relation to what is known about the neuropathological consequences of the various CNS-OIs. While this is the first systematic group study of residual CNS-OI effects on neurocognitive function, future studies employing more participants, perhaps focusing on specific CNS-OIs, will further characterize the long-term outcomes in AIDS-related CNS-OI. KeywordsOpportunistic infection; AIDS; Neuropsychological functioning; Toxoplasmosis encephalitis; Progressive multifocal leukoencephalopathy; Cryptococcal meningitis Address correspondence to Andrew Levine, National Neurological AIDS Bank, 11645 Wilshire Blvd., Suite 770, Los Angeles, 90025, CA, USA (ajlevine@mednet.ucla.edu). NIH Public Access NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author ManuscriptSince its introduction in 1996, highly active antiretroviral therapy (HAART) has, when used in combination with adjunctive and prophylactic antibiotic therapy, dramatically decreased the incidence of central nervous system opportunistic infections (CNS-OI) and has improved the longevity of people with AIDS (Collier et al., 1999;Neuenburg et al., 2002; San-Andreas et al., 2003). HAART has also contributed to improved survival among those AIDS patients who develop a CNS-OI (Kirk et al., 2002). These conditions, which at one time typically resulted in death, can now be treated. Further, while HIV infection itself may lead to neuropathological changes, the CNS-OIs common among AIDS patients often result in more severe structural brain lesions. Currently, little information exists regarding the long-term cognitive and functional outcomes in individuals who survive AIDS-related CNS-OIs. For example, do most survivors of AIDS-related CNS-OI recover to such a degree that they can return to work or independent living? Examination of the changes in survivors' neuropsychological abilities is necessary to understand the benefits and limitations of current treatments, to identify obstacles in returning affected individuals to independence...

Exploratory eye movements in 20 schizophrenics, 18 patients with frontal lobe lesions (9 right-sided and 9 left-sided) and 20 normal controls were examined with an eye mark recorder while they viewed stationary S-shaped figures. The eye movements made during the subject's first 15-s viewing of an original figure were analyzed. Patients with right frontal lobe lesions (RF) and schizophrenics (S) had lower scores than normal controls (NC) for the number of eye fixations, total eye scanning length and mean eye scanning length. Each subject was then shown two other figures slightly different from the original and was requested to compare them with the original. After comparing them, the subject was asked the question, "Are there any other differences?" The eye movements made over the ensuing 5 s in response to this question were scored using the responsive search score (RSS). The RSS was low only in the S group. The subject was also asked to reproduce the original figure before and after making comparisons between the figures. The RF and S groups were poorer at reproduction than the NC group. These findings suggest that there is disordered function of the right frontal lobe in schizophrenia, and that schizophrenia is due not only to localized damage to one part of the brain but to more widespread damage.

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