HIV-seropositive (HIV+) drug users show impaired performance on measures of integrity of prefrontal–subcortical systems. The Iowa Gambling Task (GT) is mediated primarily through ventromedial–prefrontal systems, and poor performance on this measure (“cognitive impulsivity”) is common among substance dependent individuals (SDIs) as well as patients with disease involving prefrontal–subcortical systems (e.g., Huntington disease). We hypothesized that HIV+ SDIs might be more vulnerable to cognitive impulsivity when compared with HIV-seronegative (HIV−) SDIs because recent studies report evidence of additive effects of HIV serostatus and drug dependence on cognition. Further, working memory is considered a key component of GT performance and is reliably impaired among HIV+ SDIs compared to controls. We administered the GT to 46 HIV+ and 47 well-matched HIV− males with a past or current history of substance dependence. In addition, we evaluated correlations between subjects' scores on the GT and on a delayed nonmatch to sample (DNMS) task in order to test if working memory deficits accounted for cognitive impulsivity among the HIV+ subjects. The HIV+ subjects performed significantly more poorly on the GT compared to the HIV− group but this effect could not be explained by working memory deficits. Implications of these findings for future basic and applied studies of HIV and substance dependence are discussed. (JINS, 2004, 10, 931–938.)
The construct of "prospective memory" (PM) refers to a type of episodic memory for a future intention or "remembering what one must do." This function has been proposed as a candidate mechanism underlying behaviors of critical importance in HIV disease, including adherence with medication regimens and continued engagement in risk behavior. We administered tasks of time-based and event-based prospective memory and control tasks of retrospective and working memory to 31 HIV-seropositive and 35 HIV-seronegative substance-dependent individuals (SDIs). We found that compared with HIV- controls HIV+ participants showed deficits in time-based but not event-based PM. Retrospective, but not working, memory performance correlated significantly with time-based PM performance. In addition, performance on the time-based PM task was a significant predictor of scores on a self-report measure of risky sexual and injection practices. These preliminary data provide new and unique findings regarding the components of executive function mediated by prefrontal cortical systems that are impaired among HIV+ SDIs and their relevance to "real-world" behaviors.
When compared to amputation, limb salvage procedures for extremity sarcomas have been advocated because of potential functional benefits and presumed psychological-outcome advantages. The purpose of this study was to compare psychological outcomes between survivors who underwent either amputation or limb salvage procedures for extremity sarcomas. Fifteen amputees and 20 patients with salvaged limbs (mean age, 37.9 years; range, 15 to 71 years) were evaluated 1 to 5 years after surgery for extremity sarcomas. Demographic and medical information was obtained and cognitive functioning, affect, mood, body image, physical functioning, global psychological adjustment to illness and surgery, and lifetime prevalence of psychiatric disorders before and after surgery were assessed. Two patients were excluded because of the presence of an incapacitating organic mental syndrome. The remaining patients, 14 amputees and 19 patients with salvaged limbs, had a variety of soft-tissue and bone sarcomas. No significant differences were found between the groups in age, sex, marital status, surgically involved extremity, chemotherapy status, and social class at the time of surgery and interviews. There were no significant differences between the groups in scores of cognitive capacity, symptoms, mood, body image changes, global physical functioning, global adjustment to illness and surgery, and lifetime prevalence of psychiatric disorders before or after surgery. Most patients revealed only mild psychological symptoms and 55% demonstrated good to excellent adjustment to their surgeries and diseases. There were no significant differences in measures of psychological outcome for patients with extremity sarcomas who underwent limb salvage procedures compared to those who underwent amputation. A psychological-outcome advantage of limb-salvage surgery compared to amputation has yet to be demonstrated.
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