Memory Performance in HIV/AIDS - A Prospective Case Control Study

Abstract

154Neuropsychological impairments in HIV/AIDS have been extensively researched and reported in developed countries, usually reflecting the prominence of initial sub-cortical involvement and characterized by memory loss (usually impaired retrieval), general slowing of psychomotor speed and thought processes and impaired manipulation of acquired knowledge. 1,2 Memory impairment, both verbal and non-verbal, is characteristic of HIV-associated dementia. 3 During the early years of the HIV epidemic, cognitive symptoms were thought to be common even during the initial ABSTRACT: Background: Memory impairment, usually impaired retrieval of information, has been described in HIV/AIDS, especially among those with severe illness. Neuro-cognitive disturbances in HIV/AIDS have been linked to poor quality of life and medication adherence. This prospective, case-control study was designed to assess the verbal and non-verbal memory as well as the attention abilities of Nigerian Africans with HIV/AIDS and correlate their performances with their CD4+ T lymphocytes (CD4+) counts. Methods: A total of 288 randomly selected subjects, comprising 96 HIV-positive symptomatic patients, 96 HIV-positive asymptomatic patients and 96 HIV-negative controls, participated in the study. The subjects were age-, sex-, and level of education matched. The Recognition Memory Test and Choice Reaction Time tasks, components of the computer-assisted neuropsychological tests battery-the Iron Psychology 'FePsy' were used for cognitive assessments. Results: The mean memory scores of the HIV-positive asymptomatic subjects did not differ significantly from the controls (p>0.05) but the HIV-positive symptomatic subjects' scores were significantly lower than the controls (p<0.05). Both HIV-positive groups had psychomotor slowing and impaired attention (p<0.05). The HIVpositive subjects with CD4+ counts <200/µl and between 200 and 499/µl had significant memory impairment (p<0.001 and p<0.001 respectively) but there was no significant impairment among those with count ≥500/µl. Impaired ability for sustained attention was however present irrespective of the CD4+ level relative to controls (p<0.001). Conclusions: We concluded that there was no significant memory disturbance among HIV-positive asymptomatic subjects despite the presence of impaired attention and psychomotor slowing, and that the severity of immune suppression (as indicated by the CD4+ T lymphocytes count) is a strong determinant of cognitive decline in HIV/AIDS. RÉSUMÉ: Étude prospective cas-témoin du fonctionnement mnésique chez les patients atteints du VIH/SIDA. Contexte : Une atteinte de la mémoire, habituellement de la récupération de l'information, a été décrite chez les patients atteints du VIH/SIDA, spécialement chez ceux dont la maladie est sévère. Les perturbations neuro-cognitives dans le VIH/SIDA ont été associées à une faible qualité de vie et de fidélité à la médication. . Il n'existait pas d'atteinte significative chez ceux dont le décompte était ? 500/Ìl. Cependant, ils avaient un déf...

Effects of highly active antiretroviral therapy on cognitive functions in severely immune-compromised HIV-seropositive patients

“…Acquired immune deficiency syndrome (AIDS) can be complicated by a range of cognitive impairments and behavioral symptoms [1][2][3]. These HIV associated neurocognitive disorders (HAND) manifest in its mild forms as asymptomatic neurocognitive impairment (ANI) and mild neurocognitive disorder (MND) or grossly as HIV-associated dementia (HAD) [4,5].…”

Could differential virological characteristics account for ongoing viral replication and insidious damage of the brain during HIV 1 infection of the central nervous system?

“…12 The incidence of all acquired immuno-deficiency syndrome (AIDS)-related CNS diseases has markedly reduced since the use of highly active anti-retroviral therapy (HAART). 13 However, neurocognitive impairment may persist despite successful treatment with anti-retroviral therapy, [14][15][16][17][18] Therefore, HAART may incompletely treat HIV-1 infection present in the CNS. 2,13 There are several possibilities why HAART may not be able to prevent deterioration of cognitive function.…”

Estudo dos transtornos cognitivos decorrentes da infecção pelo HIV-1

“…Ao longo dos anos, surgem de forma lenta e progressiva manifestações clínicas discretas, como baixa capacidade de concentração, lentificação mental, apatia, baixa atividade psicomotora e modificações da memó-ria verbal e não verbal, além da possibilidade de mudanças na personalidade (Paul, Cohen & Stern, 2002;Odiase, Ogurin & Ogunniyi, 2007). Posteriormente, com o agravamento do processo, alterações mais significativas aparecem, como perdas expressivas de memória e afasia.…”

“…A presença do HIV-1 no SNC pode ser a principal responsável pelas manifestações neuropsicológicas e por alterações na qualidade de vida do indivíduo (Hinkin et al, 2002;Mehan & Brush, 2001;Odiase, Ogurin & Ogunniyi, 2007). Estas ocorrem como distúrbios de diversos graus nas áreas motora, comportamental e cognitiva (Vitiello et al, 2007 Nos estágios precoces do complexo demencial da AIDS, os resultados de exames neurológicos podem ser normais (Cohen, Perlstein & Braver, 1997;MacArthur et al, 2003).…”

“…-Memória: estudos realizados utilizando méto-dos de imagem demonstraram o aumento da atividade cerebral durante tarefas relacionadas à memória de trabalho em pacientes HIV-1 + com demência leve (Grant et al, 1987;Odiase, et al, 2007). …”