Early signs of cognitive deficits among human immunodeficiency virus‐positive hemophiliacs

Abstract

A total of 181 human immunodeficiency virus (HIV)-seropositive hemophiliacs and 28 hemophilic controls were evaluated by psychometric tests and by electroencephalogram (EEG). Patients were classified from stages 1-6 according to the immunological criteria of the Walter Reed staging system. Statistical analysis of psychometric data showed an effect of the stage of the disease on test performances, indicating a decline in attention, accumulation of perceptual interferences, decline in visuoperceptual speed and visuomotor response speed and reduced verbal memory performance, especially in stage 6 patients. Comparison of performance levels with normative test data already revealed cognitive deficits in about 20-30% of the patients in stages 2-5. As regards verbal memory, especially learning and recognition of new verbal information were impaired. In contrast, there was no significant deficit for nonverbal memory processing. Compared with the controls, patients exhibited an increasing number of abnormal EEG findings in stages 2-6. As a conclusion, in the stages before acquired immunodeficiency syndrome (AIDS) develops, EEG findings as well as psychometric findings indicate central nervous system involvement of AIDS in about 20-30% of cases, whereas in full-blown AIDS there is a marked increase to 80%. Besides a more general deficit of attention and psychomotor speed as is seen in subcortical dementia, there is evidence for a particular verbal learning disorder, suggesting additional selective impairment of the brain.

Subcortical Profile of Memory Compromise Among HIV-1-Infected Individuals

“…The work of Riedel et al (1992) further demonstrated support for the subcortical profile of memory deficits reflected by spared recognition but decreased recall of verbal memory. In this study, no significant deficits were noted in visual memory.…”

Auditory brainstem responses in a Rhesus Macaque model of neuro-AIDS

“…This constellation of symptoms is a common feature of AIDS and has been referred to as AIDS related dementia. The existence of early cognitive and motor de®cits associated with the asymptomatic phase of HIV infection is now also clear, although these de®cits may be quite subtle (Borstein et al, 1992;Sinforiani et al, 1991;Clifford et al, 1990;McAllister et al, 1992;Perry et al, 1989;Riedel et al, 1992;Arendt et al, 1990;Martin et al, 1991Martin et al, , 1992aKarlsen et al, 1992a, b). Upon post mortem examination, estimates of the number of AIDS patients with CNS lesions range as high as 80% (Elder et al, 1988).…”

Is There Evidence for Neurocognitive Dysfunctions in Patients with Postnatal HIV Infection? A Review on the Cohort of Hemophilia Patients

“…All such studies have divided HIV+ hemophiliacs into sub-groups according to patients’ immune functioning and the authors of such studies concluded that significant differences in several cognitive functions arise with the decrease of immunological functioning, and especially when the CD4+ cell counts ≤200. For example, Riedel et al (1992) identified a linear association between the scarce neuropsychological function in attention, motor skills, visual performance, and the decrease of CD4+. Similarly, according to Blanchette et al (2002), HIV+ hemophiliacs have shown impairments in motor speed and fine motor skills, in comparison with those shown by HIV− hemophiliacs.…”

“…Studies from different countries, including large cohorts as the HGDS, report a long-term decline in neurocognitive functions in around 15–50% of patients (Loveland et al, 1994; Sirois et al, 1998). Decline seems to be proportional with the decrease of immunological functioning, especially when the CD4+ cell counts ≤200 (Riedel et al, 1992; Nichols et al, 2000; Blanchette et al, 2002), even though other studies have concluded that the decline is related to hemophilia per se (Hilgartner et al, 1993; Whitt et al, 1993; Loveland et al, 1994; Sirois et al, 1998). …”