Neuropsychological Impairment in AIDS
Susan Tross, Ph.D. Clinical Assistant Psychologist, Psychiatry Service, Memorial Sloan Kettering Cancer Center; Assistant Professor of Psychology in Psychiatry Cornell University Medical College University of California, San Francisco
Neurological impairment is now recognized as a serious and common complication of HIV brain infection in the setting of frank AIDS ( Navia, Jordan, & Price, 1986). By the final phase of illness, approximately two thirds of all people with AIDS (PWAs) manifest a pattern of diffuse impairment, known as the AIDS dementia complex (ADC). An additional quarter manifest more limited symptoms ( Price et al., 1988). Furthermore, at autopsy, neuropathological evidence of CNS disease has been detected in 78% of the brains studied ( Nielsen, Petito, Urmacher and Posner, 1984).
As the most common neurological complication of AIDS, ADC has also been the best characterized -- on clinical, neuropsychological, and neuropathological terms. Early clinical reports described the presence of global organic brain syndromes, marked by highly variable cognitive, motor, and behavioral symptoms ( Bredesen & Messing, 1983; Britton, Marquardt, Koppel, Garvey and Miller, 1982; Horowitz Benson, Gottlieb, Davos, & Bentson, 1982). Initially, these were characterized as subacute encephalitis (SE; Nielsen et al., 1984; Snider et al., 1983). However, the assumptions of subacuteness and encephalitis are less appropriate for a condition now generally recognized as chronically progressive and sometimes unassociated with encephalitic inflammation ( Price et al. 1988).