Cognitive impairment among older adults with HIV: a systematic review protocol of cohort studies / Transtornos cognitivos em idosos vivendo com HIV: protocolo de revisão sistemática com estudos de coorte

OBJECTIVES: This review will determine whether the incidence of cognitive impairment in HIV patients aged ≥ 50 years is greater than that of their HIV-negative peers. METHODS: The MEDLINE, EMBASE, LILACS, Web of Science, and Scopus databases will be searched for studies with a sample of individuals aged ≥ 50 years or a mixed population with ≥ 50% aged ≥ 50 years). It will include studies that evaluate seropositive patients compared to and an unexposed control group. STUDY DESIGN: Cohort studies with follow-up ≥ 24 months will be included. Three reviewers will independently screen for eligibility criteria, extract data, and assess the risk of bias in the included studies, as well as evaluate the overall quality of evidence. A narrative synthesis will be prepared according to synthesis without meta-analysis guidelines. EXPECTED RESULTS: We expect to find correlations between older age, HIV, and cognitive impairment. RELEVANCE: The association of geriatric syndromes and HIV is becoming an important field of study. Increased life expectancy accompanied by an active sex life is contributing to this public health problem. This protocol is reported according to the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols and is registered in PROSPERO (CRD42022321914). This study was financed in part by the CAPES foundation (financial code: 001)

OBJETIVOS: Esta revisão abordará o questionamento: a incidência de comprometimento cognitivo é maior em pacientes com 50 anos ou mais com o vírus da imunodeficiência humana do que em idosos soronegativos? METODOLOGIA: As bases de dados Medical Literature Analysis and Retrieval System Online (MEDLINE), EMBASE, Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), Web of Science e Scopus serão pesquisadas. A estratégia de busca considerará estudos com amostra de 50 anos ou mais e população mista (pelo menos 50% com 50 anos ou mais). Incluirá estudos que avaliam pacientes soropositivos, e o controle considerará pesquisas que abordem pessoas não expostas. DESENHO DO ESTUDO: Serão incluídos estudos de coorte com seguimento de pelo menos 24 meses. Três revisores, de forma independente, farão a triagem dos artigos quanto aos critérios de elegibilidade, extrairão dados, avaliarão o risco de viés dos trabalhos e avaliarão a qualidade geral das evidências. Uma síntese narrativa será preparada de acordo com a diretriz SWiM. RESULTADOS ESPERADOS: Esperamos encontrar maior incidência de comprometimento cognitivo em idosos que vivem com o vírus da imunodeficiência humana. RELEVÂNCIA: As síndromes geriátricas associadas ao HIV tornam-se um importante escopo de estudo, uma vez que, o aumento da expectativa de vida acompanhado de uma vida sexual ativa sustenta o ciclo de contaminação desse problema de saúde pública. Este protocolo é relatado de acordo com os Itens Preferenciais de Relatórios para Protocolos de Revisão Sistemática e Metanálise e está registrado no International Prospective Register of Systematic Reviews ­ PROSPERO (CRD42022321914). Este estudo foi parcialmente financiado pela Coordenação de Aperfeiçoamento de Pessoal de Nível Superior ­ Brasil ­ Código de financiamento: 001

Neuropsychological performance in patients with asymptomatic HIV-1 infection.

Human immunodeficiency virus (HIV-1) infection and acquired immunodeficiency syndrome (AIDS) lead to neurocognitive disorders; however, there is still much knowledge to be gained regarding HIV-associated neurocognitive disorders. The purpose of this study was to assess the cognitive performance, instrumental activities of daily living, depression, and anxiety in patients with asymptomatic HIV-1 infections compared with seronegative participants without neurocognitive impairment. We studied a sample consisted of 60 patients with asymptomatic HIV-1 infections and 60 seronegative participants without neurocognitive impairment from the city of Barranquilla, Colombia, with a mean age of 36.07 years. A protocol of neuropsychological and psychopathological tests was applied to the participants. The group of patients with asymptomatic HIV infections significantly underperformed on tasks that assessed global cognitive screening, attention span, learning, phonemic verbal fluency, auditory-verbal comprehension, information processing speed, cognitive flexibility, and motor skills compared to the group of seronegative participants. No significant differences were found in memory, visual confrontation naming, vocabulary, inhibition, and instrumental activities of daily living. Additionally, the patients with asymptomatic HIV-1 infection had a higher anxiety index than the seronegative participants, but no significant difference was found in depression. A correlation was found between depression and anxiety. In conclusion, the patients with asymptomatic HIV-1 infection had lower cognitive performances than the seronegative participants in the cognitive functions mentioned above and more anxiety but still performed the instrumental activities of daily living.

Neurocognitive impairment in HIV-1 clade C- versus B-infected individuals in Southern Brazil.

HIV-1 clade C isolates show reduced Tat protein chemoattractant activity compared with clade B. This might influence neuropathogenesis by altering trafficking of monocytes into the CNS. A previous study suggested low rates of HIV-associated dementia in clade C-infected individuals. The present study evaluated neurocognitive impairment rates in clade B- and C-infected individuals from the same local population. HIV+ and HIV- participants were recruited from the same geographic region in Southern Brazil. We evaluated neuropsychological (NP) impairment using a screening instrument (the International HIV Dementia Scale (IHDS)), as well as a Brazilian Portuguese adaptation of a comprehensive battery that has demonstrated sensitivity to HIV-associated neurocognitive disorders (HAND) internationally. NP performance in controls was used to generate T scores and impairment ratings by the global deficit score (GDS) method. Clade assignments were ascertained by sequencing pol and env. Blood and cerebrospinal fluid were collected from all HIV+ participants. HIV+ and HIV- participants were comparable on demographic characteristics. HIV+ participants overall were more likely to be impaired than HIV- by the IHDS and the GDS. Clade B- and C-infected individuals were demographically similar and did not differ significantly in rates of impairment. The prevalence of pleocytosis, a marker of intrathecal cellular chemotaxis, also did not differ between clade B and C infections. Clade B and C HIV-infected individuals from the same geographic region, when ascertained using comparable methods, did not differ in their rates of neurocognitive impairment, and there was no evidence of differences in CNS chemotaxis.

Neurocognitive functioning in antiretroviral therapy-naïve youth with behaviorally acquired human immunodeficiency virus.

PURPOSE: Youth living with human immunodeficiency virus (HIV) account for over one third of new HIV infections and are at high risk of adverse psychosocial, everyday living, and health outcomes. Human immunodeficiency virus-associated neurocognitive disorders (HAND) are known to affect health outcomes of HIV-infected adults even in the era of combination antiretroviral therapy. Thus, the current study aimed to characterize the prevalence and clinical correlates of HAND in youth living with HIV. Here, we report baseline neurocognitive data for behaviorally HIV-infected youth enrolled in a prospective study evaluating strategies of antiretroviral treatment initiation and use. METHODS: A total of 220 participants, age 18-24 years, who were naive to treatment (except for prevention of mother-to-child HIV transmission; n = 3), completed a comprehensive neurocognitive, substance use, and behavioral health assessment battery. RESULTS: Sixty-seven percent of youth met criteria for HAND (96.4% were asymptomatic and 3.5% were syndromic); deficits in episodic memory and fine-motor skills emerged as the most commonly affected ability areas. Multivariable models showed that lower CD4 count, longer time since HIV diagnosis, and high-risk alcohol use were uniquely associated with neurocognitive deficits. CONCLUSIONS: Over two thirds of youth with behaviorally acquired HIV evidence neurocognitive deficits, which have modest associations with more advanced HIV disease as well as other factors. Research is needed to determine the impact of such neuropsychiatric morbidity on mental health and HIV disease treatment outcomes (e.g., nonadherence) and transition to independent living responsibilities in HIV-infected youth, as well as its long-term trajectory and possible responsiveness to cognitive rehabilitation and pharmacotherapy.

Neurocognitive function in HIV-positive children in a developing country.

OBJECTIVES: We aimed to characterize neurological outcomes and determine the prevalence of HIV encephalopathy in a cohort of HIV-infected children in Jamaica. METHODS: Data for 287 HIV-infected children presenting between 2002 and 2008 were reviewed and neurological outcomes characterized. A nested case-control study was conducted between July and September 2009 used 15 randomly selected encephalopathic HIV-infected children aged 7-10 years and 15 matched controls (non-encephalopathic HIV-infected). Their neurocognitive functions were evaluated using clinical assessment and standardized tests for intelligence, short term memory (visuo-spatial and auditory), selective attention, and fine motor and coordination functions. Outcomes were compared using Fisher's exact test and the Mann-Whitney U-test. RESULTS: Sixty-seven (23.3%) children were encephalopathic. The median age at diagnosis of HIV encephalopathy was 1.6 years (interquartile range (IQR) 1.1-3.4 years). Predominant abnormalities were delayed milestones (59, 88.1%), hyperreflexia (59, 86.5%), spasticity (50, 74.6%), microcephaly (42, 61.7%), and quadriparesis (21, 31.3%). The median age of tested children was 8.7 years (IQR 7.6-10.8 years) in the encephalopathic group and 9 years (IQR 7.4-10.7 years) in the non-encephalopathic group. Encephalopathic children performed worse in all domains of neurocognitive function (p<0.05). CONCLUSIONS: A high prevalence of HIV encephalopathy was noted, and significant neurocognitive dysfunction identified in encephalopathic children. Optimized management through the early identification of neurological impairment and implementation of appropriate interventions is recommended to improve quality of life.

Tick-borne encephalitis carries a high risk of incomplete recovery in children.

OBJECTIVE: To examine long-term outcome after tick-borne encephalitis (TBE) in children. STUDY DESIGN: In this population-based cohort, 55 children with TBE with central nervous system involvement infected during 2004-2008 were evaluated 2-7 years later using the Rivermead post-concussion symptoms questionnaire (n = 42) and the Behavior Rating Inventory of Executive Functioning for parents and teachers (n = 32, n = 22, respectively). General cognitive ability was investigated in a subgroup (n = 20) using the Wechsler Intelligence Scale for Children, 4th edition. RESULTS: At long-term follow-up, two-thirds of the children experienced residual problems, the main complaints being cognitive problems, headache, fatigue, and irritability. More than one-third of the children were reported by parents or teachers to have problems with executive functioning on the Behavior Rating Inventory of Executive Functioning, mainly in areas involving initiating and organizing activities and working memory. Children who underwent Wechsler Intelligence Scale for Children, 4th edition testing had a significantly lower working memory index compared with reference norms. CONCLUSION: A large proportion of children experience an incomplete recovery after TBE with central nervous system involvement. Cognitive problems in areas of executive function and working memory are the most prevalent. Even if mortality and severe sequelae are low in children after TBE, all children should be followed after TBE to detect cognitive deficits.

Co-morbidities in persons infected with HIV: increased burden with older age and negative effects on health-related quality of life.

This study sought to determine the synergistic effects of age and HIV infection on medical co-morbidity burden, along with its clinical correlates and impact on health-related quality of life (HRQoL) across the lifespan in HIV. Participants included 262 individuals across four groups stratified by age (≤40 and ≥50 years) and HIV serostatus. Medical co-morbidity burden was assessed using a modified version of the Charlson Co-morbidity Index (CCI). Multiple regression accounting for potentially confounding demographic, psychiatric, and medical factors revealed an interaction between age and HIV infection on the CCI, with the highest medical co-morbidity burden in the older HIV+cohort. Nearly half of the older HIV+group had at least one major medical co-morbidity, with the most prevalent being diabetes (17.8%), syndromic neurocognitive impairment (15.4%), and malignancy (12.2%). Affective distress and detectable plasma viral load were significantly associated with the CCI in the younger and older HIV-infected groups, respectively. Greater co-morbidity burden was uniquely associated with lower physical HRQoL across the lifespan. These findings highlight the prevalence and clinical impact of co-morbidities in older HIV-infected adults and underscore the importance of early detection and treatment efforts that might enhance HIV disease outcomes.

[Cognitive alterations associated with HIV-1 infection and AIDS]. / Alterações cognitivas na infecção pelo HIV e Aids.

Primary neurological complications of AIDS include cognitive deficits such as HIV-associated dementia and milder forms such as cognitive/motor disorders, which cause changes in daily activities and reduce the quality of life of patients. Infection with HIV-1 is the most common, predictable and treatable cause of cognitive deficits in individuals with less than 50 years of age. Despite advances in the understanding of clinical characteristics, pathogenesis and neurobiological aspects and widespread use of highly active antiretroviral therapy (HAART), neurological complications and cognitive deficits still persist with serious personal and socioeconomic consequences, thus representing a great therapeutic challenge. In the pre-HAART era dementia was a common complication of infection whose incidence declined during the HAART era. However, prevalence of dementia has increased, especially that of milder forms due to the increased number of infected individuals and increased life expectancy. Cognitive alterations associated with HIV are typically sub cortical and can be associated with behavioral and motor disorders. These syndromes are clinically diagnosed by neuropsychological tests, while neuroimaging and analysis of cerebrospinal fluid contribute to diagnosis. This review is an update on current epidemiological status, clinical characteristics and diagnosis of cognitive complications observed during the course of HIV infection.

Alterações cognitivas na infecção pelo HIV e Aids / Cognitive alterations associated with HIV-1 infection and Aids

Dentre as complicações neurológicas primária da Aids temos déficits cognitivos como a demência associada ao HIV e formas mais leves, como o transtorno cognitivo/motor menor, sendo que ambas podem alterar as atividades da vida diária e reduzir a qualidade de vida dos pacientes. Infecção pelo HIV-1 é a mais comum, previsível e tratável causa de déficits cognitivos em indivíduos com menos de 50 anos. A despeito do avanço no conhecimento das características clínicas, patogênese, aspectos neurobiológicos e ao amplo uso de terapia antirretroviral altamente ativa (HAART), complicações neurológicas e déficits cognitivos ainda persistem levando a graves consequências pessoais e socioeconômicas tornando-se um grande desafio terapêutico. Na era pré- HAART, a demência era uma complicação comum da infecção, entretanto na era HAART a incidência da demência diminuiu, mas a prevalência tem aumentado principalmente das formas mais leves devido ao aumento do número de pessoas infectadas e ao aumento da expectativa de vida. Alterações cognitivas associadas ao HIV são tipicamente subcorticais e podem estar associadas a comprometimentos comportamentais e motores. Estas síndromes são de diagnóstico clínico, sendo que testes neuropsicológicos, neuroimagem e líquido cerebrorraquidiano corroboram no diagnóstico. Esta revisão faz uma atualização do estado atual da epidemiologia, características clínicas e diagnóstico das complicações cognitivas no curso da infecção pelo HIV.

Primary neurological complications of AIDS include cognitive deficits such as HIV-associated dementia and milder forms such as cognitive/motor disorders, which cause changes in daily activities and reduce the quality of life of patients. Infection with HIV-1 is the most common, predictable and treatable cause of cognitive deficits in individuals with less than 50 years of age. . Despite advances in the understanding of clinical characteristics, pathogenesis and neurobiological aspects and widespread use of highly active antiretroviral therapy (HAART), neurological complications and cognitive deficits still persist with serious personal and socioeconomic consequences, thus representing a great therapeutic challenge. In the pre-HAART era dementia was a common complication of infection whose incidence declined during the HAART era. However, prevalence of dementia has increased, especially that of milder forms due to the increased number of infected individuals and increased life expectancy. Cognitive alterations associated with HIV are typically sub cortical and can be associated with behavioral and motor disorders. These syndromes are clinically diagnosed by neuropsychological tests, while neuroimaging and analysis of cerebrospinal fluid contribute to diagnosis. This review is an update on current epidemiological status, clinical characteristics and diagnosis of cognitive complications observed during the course of HIV infection.

Proteomic analyses of monocyte-derived macrophages infected with human immunodeficiency virus type 1 primary isolates from Hispanic women with and without cognitive impairment.

The signature for human immunodeficiency virus type 1 (HIV-1) neurovirulence remains a subject of intense debate. Macrophage viral tropism is one prerequisite but others, including virus-induced alterations in innate and adaptive immunity, remain under investigation. HIV-1-infected mononuclear phagocytes (MPs; perivascular macrophages and microglia) secrete toxins that affect neurons. The authors hypothesize that neurovirulent HIV-1 variants affect the MP proteome by inducing a signature of neurotoxic proteins and thus affect cognitive function. To test this hypothesis, HIV-1 isolates obtained from peripheral blood of women with normal cognition (NC) were compared to isolates obtained from women with cognitive impairment (CI) and to the laboratory adapted SF162, a spinal fluid R5 isolate from a patient with HIV-1-associated dementia. HIV-1 isolates were used to infect monocyte-derived macrophages (MDMs) and infection monitored by secreted HIV-1 p24 by enzyme-linked immunosorbent assay (ELISA). Cell lysates of uninfected and HIV-1-infected MDMs at 14 days post infection were fractionated by cationic exchange chromatography and analyzed by surface enhanced laser desorption ionization time of flight (SELDI-TOF) using generalized estimating equations statistics. Proteins were separated by one-dimensional sodium dodecyl sulfate-polyacrylamide gel electrophoresis (1D SDS-PAGE) and identified by tandem mass spectrometry. Levels of viral replication were similar amongst the HIV-1 isolates, although higher levels were obtained from one viral strain obtained from a patient with CI. Significant differences were found in protein profiles between virus-infected MDMs with NC, CI, and SF162 isolates (adjusted P value after multiple testing corrections, or q value <.10). The authors identified 6 unique proteins in NC, 7 in SF162, and 20 in CI. Three proteins were common to SF162 and CI strains. The MDM proteins linked to infection with CI strains were related to apoptosis, chemotaxis, inflammation, and redox metabolism. These findings support the hypothesis that the macrophage proteome differ when infected with viral isolates of women with and without CI.

Associations of cigarette smoking with viral immune and cognitive function in human immunodeficiency virus-seropositive women.

Cigarette smoking alters the immune system and may improve cognitive deficits in neuropsychiatric disorders. Smoking prevalence is high in human immunodeficiency virus (HIV)-infected patients; however, its effect on HIV-associated cognitive impairment remains unknown in the era of antiretroviral treatment. The authors examined associations of smoking with viral immune profile and cognitive function in a cohort of HIV-seropositive women. This observational cross-sectional study included 56 women (36 HIV-seropositive and 20 HIV-seronegative) surveyed with a tobacco questionnaire: the Fagerström Test for Nicotine Dependency. Viral immune status was obtained 6 to 12 months before questioned. Neurocognitive testing (NP) assessed verbal memory, frontal/executive function, psychomotor speed, and motor speed. A reference group of HIV-seronegative women was used to calculate standardized z-scores. Cognitive impairment was classified using a modified American Academy of Neurology criteria, adding an asymptomatic group based on NP tests. Statistics included parametric and nonparametric tests. HIV-seropositive women were more likely to report a history of smoking (P = 0.028). Among them, current smoking correlated with higher plasma viral load (P = 0.048), and history of smoking correlated with lower CD4 cell count (P = 0.027). The authors observed no associations between cognitive impairment and either current or past history of smoking and no differences in neurocognitive domain scores between HIV-seropositive and -seronegative women or between those with and without a history of smoking. However, restricting analysis to HIV-seropositives showed a significant better performance on the frontal/executive domain in those with history of smoking. In summary, history of smoking correlated with better frontal/executive cognitive domain performance in HIV-seropositive women and with worse viral immune profile.

NeuroAIDS in Brazil.

Brazil has the largest number of HIV cases of any single country in Latin America - over 600,000. Recently, investigators have begun to characterize the extent of neurological morbidity due to HIV in this country. During 2005 and 2006, the U.S. National Institute of Mental Health cosponsored two meetings of experts aimed at summarizing existing knowledge of HIV and its neurological complications in Brazil. Topics addressed ranged from clinical neurobehavioral aspects to molecular biology. Experts attending the meeting considered fruitful directions for future research.

Prevalence of human immunodeficiency virus-associated cognitive impairment in a group of Hispanic women at risk for neurological impairment.

Human immunodeficiency virus (HIV)-associated cognitive impairment, a significant cause of morbidity, affects up to 30% of HIV-infected people. Its prevalence doubled as patients began to live longer after the introduction of highly active retroviral therapy. Women are now one of the fastest growing groups with acquired immunodeficiency syndrome (AIDS) in the United States and Puerto Rico, but relatively little is known about the prevalence and characteristics of cognitive dysfunction in HIV-infected women. In this study the authors investigated its prevalence in a group of HIV-1-seropositive Hispanic women in Puerto Rico. Forty-nine women with a nadir CD4 cell count of < or = 500 cells/mm3 were enrolled. Cognitive impairment was defined according to the American Academy of Neurology criteria for HIV dementia as modified to identify an "asymptomatic cognitively impaired" group. Observed prevalence was compared with prevalence in other populations in United States, Europe, and Australia. Differences in clinical markers and neuropsychological test performance among the cohort stratified by cognitive impairment were tested. Cognitive impairment was observed in 77.6% (38/49) of cases; asymptomatic cognitive impairment in 32.7% (16/49); minor cognitive motor disorders in 16.3% (8/49); and HIV-associated dementia (HAD) in 28.6% (14/49). Cognitive impairment did not correlate with age, CD4 cell count, viral load, or treatment modality. The cross-sectional prevalence of HIV-associated cognitive impairment was 77.6% (28.6% for HAD). These findings should enhance awareness of the prevalence of HIV-associated cognitive impairment, both clinically apparent and "asymptomatic," in Hispanic women and lead to improvements in areas such as education and compliance and to reevaluation of treatment interventions.

Enlentecimiento cognitivo en sujetos seropositivos asintomàticos al virus de inmunodeficiencia humana tipo 1 / Cognitive slowing in asymptomatic individuals who are seropositive for human immunodeficiency virus type 1

Las medidas de tiempo de reacción (TR) se consideran como las más sensibles para identificar déficit cognitivos en las etapas iniciales de la infección por el virus de inmunodeficiencia humana (VIH-1), debido a que el enlentecimiento cognitivo parece ser el signo más temprano del trastorno cognitivomotor asociado. Las evidencias indican, en general, que a mayores demandas de procesamiento de la tarea, mayor es la probabilidad de que ésta sea sensible a los efectos de la infección por VIH-1. Objetivo. Evaluar la relación entre TR y demandas cognitivas de la tarea en individuos seropositivos al VIH-1. Sujetos y métodos. 50 seropositivos neurológicamente asintomáticos se compararon con 34 controles seronegativos en cuatro tareas de TR discriminativo, con diferente nivel de demandas de procesamiento central y con iguales demandas de respuesta motora. Resultados. En la tarea de mayor demanda de procesamiento los seropositivos fueron más lentos y cometieron más errores. En las de menores demandas no se observaron diferencias de TR ni de calidad de ejecución. En la tarea con un nivel significativo de demandas de codificación sensorial se observaron diferencias de TR, pero no de calidad de la ejecución...(AU)

Reaction time (RT) is thought to be the most suitable measure to detect cognitive deficits in neurologically asymptomatic human immunodeficiency virus type I (HIV-1) infected individual since cognitive slowing is the earliest signal of cognitive-motor disorder related to HIV-1 infection. There is evidence suggesting that the greater the degree of central processing demands required by a task, the more likely that it will be sensitive to the effect of HIV-1 infection. Such statement suggests that the RT deficits exhibited by HIV-1 infected individuals at initial stages could be caused by the slowing of central information processing mechanisms. AIM: To assess the relationships between demands of central information processing and RT in HIV-1 seropositive individuals. 50 neurologically asymptomatic HIV-1 individuals were compared with 34 seronegative controls on four discriminative RT tasks of different levels of central processing demands except by the motor response requirements. Seropositive group was slower in RT and performed worse on the higher demanding task. On the lesser demanding tasks no differences in RT nor in accuracy were observed. For the task demanding sensory coding efforts seropositive individual were slower but achieved the same level of accuracy...(AU)

[Cognitive slowing in asymptomatic individuals who are seropositive for human immunodeficiency virus type 1]. / Enlentecimiento cognitivo en sujetos seropositivos asintomáticos al virus de inmunodeficiencia humana tipo 1.

INTRODUCTION: Reaction time (RT) is thought to be the most suitable measure to detect cognitive deficits in neurologically asymptomatic human immunodeficiency virus type I (HIV-1) infected individual since cognitive slowing is the earliest signal of cognitive-motor disorder related to HIV-1 infection. There is evidence suggesting that the greater the degree of central processing demands required by a task, the more likely that it will be sensitive to the effect of HIV-1 infection. Such statement suggests that the RT deficits exhibited by HIV-1 infected individuals at initial stages could be caused by the slowing of central information processing mechanisms. AIM: To assess the relationships between demands of central information processing and RT in HIV-1 seropositive individuals. SUBJECTS AND METHODS: 50 neurologically asymptomatic HIV-1 individuals were compared with 34 seronegative controls on four discriminative RT tasks of different levels of central processing demands except by the motor response requirements. RESULTS: Seropositive group was slower in RT and performed worse on the higher demanding task. On the lesser demanding tasks no differences in RT nor in accuracy were observed. For the task demanding sensory coding efforts seropositive individual were slower but achieved the same level of accuracy. CONCLUSIONS: Even when these results point to that RT slowing in HIV-1 asymptomatic individuals emerged with the increase in cognitive demands, the fact that RT slowing without accuracy declining can also appear in some tasks demanding sensory processing, preclude ruling out a peripheral deficit as the locus of the RT slowing in these subjects.

Cognitive rehabilitation of naming deficits following viral meningo-encephalitis.

OBJECTIVE: This case study describes the neuropsychological assessment and cognitive rehabilitation of a patient who developed word retrieval deficits for objects and people's names, following an episode of viral meningo-encephalitits. It shows the implementation and outcome of two techniques adapted to the patient's individual characteristics and context providing a more ecologically valid approach. METHODS: In the first technique, "verbal semantic association", the patient was required to describe what she knew about an object as a strategy to help her retrieve its name. In the second one, "face-name association" she was taught to apply a visual-imagery technique in order to retrieve relevant people's names. RESULTS: Following the implementation of these procedures there was a decrease in the number of episodes of failure to retrieve objects and people's names in her everyday life context. CONCLUSION: The improvement found in the patient's ability to retrieve words is discussed in terms of the utility of cognitive rehabilitation programmes and cognitive models of language processing