Document 0543
 DOCN  M9550543
 TI    Cognitive performance after progression to AIDS: a longitudinal study
       from the Multicenter AIDS Cohort Study.
 DT    9505
 AU    Selnes OA; Galai N; Bacellar H; Miller EN; Becker JT; Wesch J; Van Gorp
       W; McArthur JC; Johns Hopkins University, Baltimore, MD.
 SO    Neurology. 1995 Feb;45(2):267-75. Unique Identifier : AIDSLINE
       MED/95157744
 AB    OBJECTIVE: To describe changes in cognitive functioning before and after
       development of an acquired immune deficiency syndrome (AIDS)-defining
       illness or CD4+ lymphocyte count < 200/mm3 in participants in the
       Multicenter AIDS Cohort Study. METHODS: The study population included
       participants who either were diagnosed with an AIDS-defining illness (n
       = 52) or had at least one measurement of CD4+ count < 200/mm3 (n = 57)
       and who had at least four neuropsychological (NP) evaluations, two or
       more before and two or more after the AIDS diagnosis. A group of
       subjects with clinical diagnosis of dementia (n = 29) was also included
       for comparison. The NP test battery included measures of attention,
       memory, constructional abilities, and psychomotor speed. Longitudinal
       data analysis, using the generalized estimating equation, was performed
       separately for each NP measure. Time was measured in months from the
       date of clinical AIDS or CD4+ < 200/mm3. RESULTS: Before AIDS< the
       dementia group showed significant decline (slope different from zero)
       only on measures of psychomotor speed. For all other measures, there was
       no evidence of decline in performance before AIDS for the other groups.
       After development of AIDS, the group with clinical AIDS showed
       significant decline on psychomotor speed but none on the other cognitive
       measures. The group with CD4+ < 200/mm3 did not show significant decline
       on any of the cognitive measures after AIDS. As expected, the dementia
       group showed significant decline on all measures. Sensory neuropathy was
       associated with a significant decline in performance on measures of
       psychomotor speed after AIDS. Antiretroviral therapy was not associated
       with any measurable changes in NP performance. CONCLUSION: These results
       are consistent with previous findings showing no significant decline in
       cognitive functions before AIDS, unless overt dementia is present, and
       no decline in immunosuppressed subjects who have had no AIDS-defining
       illness. By contrast, in subjects who have developed clinical AIDS,
       there is mild decline in fine motor skills but no significant change in
       other cognitive domains.
 DE    Acquired Immunodeficiency Syndrome/*PSYCHOLOGY  AIDS Dementia
       Complex/*PSYCHOLOGY  *Cognition  Cohort Studies  Comparative Study  CD4
       Lymphocyte Count  Homosexuality, Male  Human  HIV
       Seropositivity/*PSYCHOLOGY  Laterality  Learning  Longitudinal Studies
       Male  Memory  Neuropsychological Tests  Psychomotor Performance
       Regression Analysis  Support, U.S. Gov't, P.H.S.  Time Factors  CLINICAL
       TRIAL  CONTROLLED CLINICAL TRIAL  JOURNAL ARTICLE  MULTICENTER STUDY

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