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The Edinburgh Cohort of HIV-Positive Drug Users: Pattern of Cognitive Impairment in Relation to Progression of Disease

Published online by Cambridge University Press:  02 January 2018

Vincent Egan ,
Ray P. Brettle  and
Guy M. Goodwin
Vincent Egan
Affiliation:
Edinburgh University Department of Psychiatry, Royal Edinburgh Hospital, Morningside Park, Edinburgh EH10 5HF
Ray P. Brettle
Affiliation:
Regional Infectious Diseases Unit, Ward 17, City Hospital, Greenbank Drive, Edinburgh EH10 5AJ
Guy M. Goodwin*
Affiliation:
Brain Metabolism Unit, Royal Edinburgh Hospital, Morningside Park, Edinburgh EH10 5HF
*
∗Correspondence
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Abstract

To examine the neuropsychiatric effects of infection with HIV, 220 drug users (27 HIV negative, 193 HIV positive) completed tests evaluating premorbid intelligence, memory, non-verbal performance, information processing speed, and mood. When these measures were compared cross-sectionally by the severity of HIV illness, symptomatic patients (in CDC stage IV) were impaired on Trails B, two-choice decision time, delayed recall of the Wechsler Logical Memory Test and most components of the Auditory Verbal Learning Test. These findings imply reduced capacity for concentration, speed of thought and memory. When 101 patients were retested a mean of 16 months after their initial assessment, performance on Trails A and B, Block Design and delayed recall of the Wechsler Logical Memory Test deteriorated more for patients at, or progressing within, CDC stage IV, than performance of patients at stage III. The results broadly correspond to the cross-sectional findings. However, there was a decline in all tests of memory function for the sample independent of clinical staging. This may be evidence of brain involvement before the appearance of other symptoms. Self-rated measures of mood did not change cross-sectionally, progressively, or interactively with time and stage of HIV illness, and cannot account for the changes in cognitive function observed. Change in drug use, similarly, does not account for the cognitive findings. Four (5%) of the retested subjects developed AIDS dementia complex, but most of the performance and memory impairments seen were subclinical despite the destructive neuropathology presumed to underlie intellectual decline in patients with HIV infection. An exploratory analysis of treatment with zidovudine in 65 patients with stage IV disease showed no demonstrable benefit for cognitive function.

Type
Papers
Information
The British Journal of Psychiatry , Volume 161 , Issue 4 , October 1992 , pp. 522 - 531
Copyright
Copyright © 1992 The Royal College of Psychiatrists 

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