The Stability of Neurocognitive Patterns in HIV Infected Men: Classification Considerations

Abstract

For the neuropsychological impairment which takes place in HIV-1 infection, various classification systems, based on either neuropathological criteria, severity of the disorder or functional criteria, have been suggested in the literature. This study identifies the patterns of neurocognitive disorders in HIV-1 infection and investigates their stability at one-year follow-up. Two hundred and seventeen HIV-1-positive subjects in various stages of infection and 55 HIV-1-negative subjects were evaluated. Our results suggest that there is considerable diversity in the neuropsychological functioning of HIV patients but the patterns are relatively stable, functionally distinct, and differ with respect to the severity of the deficit. The overall pattern is consistent with existing neuropsychological knowledge on HIV infection. Comparison of the patterns identified in this study with other classification systems posed several problems, however, and these problems may have important implications for the theory and methodology of neuropsychological HIV research.

Variable patterns of neuropsychological performance in HIV-1 infection

“…In this respect they are consistent with the variable patterns of neuropathology seen in patients who die with AIDS (Ellis, Merdes, Masliah, & Langford, 2005). In addition, using different methods, we have confirmed the findings of Lojek and Bornstein (2005) regarding multiple patterns of neuropsychological performance and impairment in HIV infection. The specific nature of these patterns did differ somewhat between our study and theirs, most likely due to differences in the test batteries, statistical methods, and our use of ipsative scoring of the neuropsychological factors in order to deemphasize overall level of performance on identified clusters.…”

“…Another, more recently published attempt to discern the number and stability of HIVassociated cognitive patterns using cluster analysis found four profiles, based on a reduced number of variables from a factor analysis (Lojek & Bornstein, 2005 Although this work is of considerable interest, the results must be considered preliminary because the cluster analysis was not conducted according to recommended methodologies. First, the sample size (n=165) was substantially lower than the minimum of 300 participants recommended by Meehl (1995) for cluster analysis.…”

“…These medications have had a dramatic effect on HIV-related mortality and morbidity, and there are indications that they have reduced the incidence of neurocognitive impairment and may even improve cognitive impairment in some infected persons (Letendre et al, 2004). Considering the widespread implementation of combination antiretroviral therapy, as well as changes in demographic and cofactors (e.g., increased substance use disorders) in the HIV infected population of the US (Centers for Disease Control and Prevention, 2001, 2004), the application of these earlier results to current HIV+ populations may be misleading.Another, more recently published attempt to discern the number and stability of HIVassociated cognitive patterns using cluster analysis found four profiles, based on a reduced number of variables from a factor analysis (Lojek & Bornstein, 2005 Although this work is of considerable interest, the results must be considered preliminary because the cluster analysis was not conducted according to recommended methodologies. First, the sample size (n=165) was substantially lower than the minimum of 300 participants recommended by Meehl (1995) for cluster analysis.…”

“…Another, more recently published attempt to discern the number and stability of HIVassociated cognitive patterns using cluster analysis found four profiles, based on a reduced number of variables from a factor analysis (Lojek & Bornstein, 2005). Cluster 1 was described as having poor psychomotor speed (n=12, Grooved Pegboard), Cluster 2 had poor memory and learning (n=48; Selective Reminding Test), Cluster 3 showed various cognitive deficits (n=17; all tests), and Cluster 4 was normal on all cognitive measures (n=98).…”

HIV/AIDS og risikoen for selvmordsatferd

“…Lettere kognitiv-motorisk svikt (MCMD) kan forekomme i tidlige stadier av hivinfeksjonen (Anderson, 2005;Bartlett, et al, 2004). Sørafrikanske (Schlebusch, Schweitzer & Bosch, 1998), indiske (Yepthomi, et al, 2006) og andre studier (Anderson, 2005;Lojek & Bornstein, 2005;Paul, et al, 2002) har rapportert om svekkelse av kognitive funksjoner hos hivpositive personer med fremskreden immunsvikt. De første tegnene på dette kan vaere psykomotorisk retardasjon, nedsatt finmotorisk hastighet og fingerferdighet, problemer med kognitiv fleksibilitet, konsentrasjonsvansker, hukommelsesproblemer, problemer med visuospatiale ferdigheter/visuell skanning, humørsving-ninger, samt uforklarlige anfall.…”