Low education as a possible risk factor for cognitive abnormalities in HIV-1: findings from the multicenter AIDS Cohort Study (MACS).

The present study reports new and unexpected results of cognitive abnormalities among human immunodeficiency virus type 1 (HIV-1) asymptomatic subjects in the Multicenter AIDS Cohort Study. The major purpose of our analyses is to estimate the separate and combined effects of serostatus and education level on the prevalence of cognitive abnormality. Cognitive "abnormality" was defined as performance that deviated > or = 2 SDs below the mean of the total seronegative group on at least one of the five neuropsychological screening tests (Grooved Pegboard, Verbal Fluency, Digit Span, Symbol Digit Modalities, Rey Auditory Verbal Learning). The predicted prevalence of cognitive abnormality was 38% in seropositive individuals with no more than 12 years of education, compared with < 17% in the other education-serostatus groups. This interaction between education level and serostatus remained after controlling for the possible confounding effects of age, ethnicity, CD4 level, depression, prior drug history, and learning disability using logistic regression. To account for these findings, we suggest that low education might reflect an indirect index of lower reserve capacity (i.e., a risk factor) that lowers the threshold for neuropsychological abnormalities in cases of early HIV-1 infection.

Hand preference in homosexual men.

The present study examined the distribution of hand preference and its relationship to immune system functioning and performance on neuropsychological tests in a sample of 993 homosexual men from the Multicenter AIDS Cohort Study comprising 502 HIV-1 seronegatives, 436 asymptomatic HIV-1 seropositives, and 55 men with diagnoses of AIDS or AIDS Related Complex. The prevalence of left-handedness in all of the groups (13.1-14.5%) was consistent with prior published reports of prevalent left-handedness in the general population. The distribution of hand preference scores (on a 5-item self-report questionnaire) was J-shaped and shifted to the right as in the general population. There were no differences between right- and left-handers in the immune system parameter of CD4 counts, nor was there any increase of self-reported allergies among the left-handers. We found a significantly larger number of 'outliers' on the neuropsychological measures for left-handers than for right-handers, both for HIV-1 seronegatives and seropositives. These results failed to replicate Lindesay's (1987) report of a leftward shift in manual preference among homosexual men, and failed to support Geschwind and Galaburda's (1985b) hypothesis of a link between homosexuality, handedness and autoimmune disorder. The differences between right- and left-handers on neuropsychological measures, independent of HIV-1 serostatus, are discussed in terms of Satz's (1972) model of pathological left-handedness.

Clinical tests of memory in dementia, depression, and healthy aging.

In Study 1, carefully screened elderly adults with primary degenerative dementia or major depression were compared to healthy aged control subjects on three tests of learning and memory: the Benton Visual Retention Test, Inglis Paired-Associate Learning Test, and the Fuld Object-Memory Evaluation (OME). The sharpest distinction in performance among the groups was observed on the OME, and discriminant equations based on this test correctly classified a high percentage (greater than or equal to 90%) of participants. Study 2 applied the classification rules derived in the first investigation to an unselected series of geropsychiatry inpatients referred for neuropsychological evaluation. There was agreement between memory test classification and general categories of clinical discharge diagnosis (organic vs. functional) for 21 of 25 patients, and with status at follow-up approximately 18 months later. Predictive value computations suggested that the OME is more accurate in confirming true dementia than in detecting dementia syndromes associated with functional disorders.

Frontal lobe functioning in geriatric and non-geriatric samples: an argument for multimodal analyses.

The present investigation examines specific aspects of frontal functioning across geriatric and nongeriatric cohorts. Subjects included 193 nongeriatric male pilots (mean age: 48.29 (SD = 6.79); mean education: 15.93 years (SD = 1.86)), and 68 geriatric males and females (mean age: 78.38 (SD = 5.07); mean education: 13.68 (SD = 2.53)). The results of a series of general linear model multivariate one-way analyses revealed poorer performance on frontal measures in the geriatric sample, although no differences were noted between the male and female samples. In contrast, variable interrelations, as assessed by a parametric statistic of betweengroup factor similarity, indicated a noteworthy similarity of factors between the geriatric and nongeriatric groups, and dissimilarities between the factor structures for males and geriatric females. These findings not only support the presence of age-related differences in frontal performance for the domains tested, they suggest the need to examine frontal functioning by multiple methods, as differences in frontal functioning may exist between groups that are undetected by analyses based on intergroup score differences or predictor-criterion correlations alone

Children's color trails.

Color Trails for Children was developed in response to the need for instruments which minimize cultural bias in neuropsychological testing. The test, similar in format to Trail Making, was designed to provide an evaluation of speeded visuomotor tracking while minimizing the influence of language. The present research involves two exploratory studies which examine the relationship between Color Trails for Children and Trail Making, factors that may affect performance times, and discriminant validity. Results indicate that the tests appear to measure the same neuropsychological domains, and administration of Trail Making did not significantly alter performance times on Color Trails. Increasing age and IQ were related to quicker completion time for both tests. Females were found to complete Color Trails 2 and Trail Making Part B more quickly than males in this sample. Comparison between children diagnosed with learning disabilities, attention deficits, or mild neurological conditions and a preliminary standardization sample supported the discriminant validity of Color Traits to distinguish between normal controls and children with altered neuropsychological functioning. Comparison between clinical conditions indicated that Color Trails 2 was particularly sensitive in discriminating among the groups. Although further research is needed, results suggest that Color Trails has the potential to be an effective research and clinical tool in child neuropsychological assessment.

Alternate forms of the Auditory-Verbal Learning Test: issues of test comparability, longitudinal reliability, and moderating demographic variables.

The present investigation examines the alternate-form and longitudinal reliability of two versions of the Auditory-Verbal Learning Test (AVLT) on a large, multiregional, healthy male sample. Subjects included 2,059 bisexual and homosexual HIV-seronegative males recruited from the Multicenter AIDS Cohort Study from centers in Baltimore, Chicago, Los Angeles, and Pittsburgh. The findings revealed no significant differences between forms upon initial or 1-year longitudinal administration, supporting the equivalence of the two versions. However, significant practice effects were noted longitudinally, arguing for the need of appropriate retest normative data. Furthermore, as age, ethnicity, and education were found to significantly affect test performance, it is recommended that normative data be interpreted according to these variables. In addition to providing normative and longitudinal data, this investigation presents information concerning the use and limitations of the alternate forms of the AVLT.

Anxiety and problem solving in middle-aged and elderly adults.

This study was designed to examine effects of differences in age, health, education, and sex on state and trait anxiety, and to assess interrelations between anxiety and performance on reasoning and problem solving tests. A significant main effect of health status was obtained for trait anxiety, but age, education, and sex effects were nonsignificant for both anxiety variables. Anxiety ratings were inversely correlated with performance on tests of reasoning and problem solving (traditional and practical Piagetian tasks, matrices, and similarities), but the pattern of intercorrelations was stronger within the middle-aged (40-59 years) as opposed to the elderly (60-79 years) groups. The findings fail to support the hypothesis that anxiety increases with age, or that the elderly are disproportionately affected by anxiety in testing situations.

Normative data stratified by age and education for the Neuropsychological Screening Battery for Hispanics (NeSBHIS): Initial report.

Neuropsychological assessment of monolingual Spanish-speaking people in the United States is both a common practice and an ethical dilemma. Lack of appropriate tests, the absence of norms, use of interpreters, and the multiplicity of in-house translations of commonly used measures add to the problem of accurate assessment. This paper helps address the lack of appropriate measures for the neuropsychological assessment of Latinos in the United States by providing a standardization of the Neuropsychological Screening Battery for Hispanics (NeSBHIS). Normative data on a sample of 300 Hispanic subjects stratified by gender, age, and education are provided. Current results reveal that not one measure of cognitive functioning is free from education effects. Both nonverbal measures and psychomotor speed measures were highly related to education. Age effects were noted on measures of psychomotor speed, visuospatial reasoning, and visuoconstructive skills. Gender effects were found on measures of psychomotor speed and language, with males achieving higher scores than females. The limitations of the current findings are considered. Further research for the validation of the NeSBHIS with clinical populations, as well as further normative data collection at the national and international levels, is needed.

Confounding factors in the measurement of depression in HIV.

Our study investigates the nature of elevated depression scores on the MMPI-168 in human-immunodeficiency-virus- (HIV-)infected individuals. Comparison of MMPI scales, factor scores, and individual depression item endorsement rates were made between three groups of homosexual/bisexual men: asymptomatic HIV-1 seropositives (n = 156), symptomatic HIV-1 seropositives (n = 156), and a comparison group of HIV-1 seronegatives (n = 117). Elevated scores were found on the MMPI depression scale for all three groups, with HIV infection and the presence of symptoms being associated with significant elevations in depression. Analyses of these elevated scores through the use of factor scores and individual item analyses strongly suggest that endorsement of items related to physical symptoms and neuropsychological complaints accounted for much of the difference in overall depression scores between samples. Implications are discussed for measurement and diagnosis of depression in HIV populations.

Slowed information processing in HIV-1 disease. The Multicenter AIDS Cohort Study (MACS).

This investigation examined the effects of HIV-1 infection on speeded complex cognitive processing in a group of HIV-negative (n = 666), HIV-positive symptomatic (n = 156), and HIV-positive asymptomatic (n = 623) participants while controlling for the effects of slowed motor functioning, peripheral neuropathy, and several other putative confounds. Stroop Interference and reaction-time tasks served as anchor procedures to assess cognitive processing. The present findings suggest that HIV-1 infection is capable of compromising CNS-mediated cognitive processes (speeded processing) infringing upon their efficacy in the symptomatic stages of the disease while sparing individuals in the asymptomatic stage. The detrimental effects observed on information-processing mechanisms associated with HIV infection persisted despite the use of procedures to control for peripheral nerve integrity and other potential confounds.