1
|
Cysique LA, Brew BJ, Bruning J, Byrd D, Costello J, Daken K, Ellis RJ, Fazeli PL, Goodkin K, Gouse H, Heaton RK, Letendre S, Levin J, Aung HL, Mindt MR, Moore D, Mullens AB, de Almeida SM, Muñoz-Moreno JA, Power C, Robbins RN, Rule J, Rajasuriar R, Savin MJ, Taylor J, Trunfio M, Vance DE, Wong PL, Woods SP, Wright EJ, Rourke SB. Cognitive criteria in HIV: greater consensus is needed. Nat Rev Neurol 2024; 20:127-128. [PMID: 38228906 DOI: 10.1038/s41582-024-00927-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2024]
Affiliation(s)
- Lucette A Cysique
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia.
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael's Hospital (Unity Health Toronto), Toronto, Ontario, Canada.
- Peter Duncan Neuroscience Research Unit, St Vincent's Centre for Applied Medical Research, Sydney, New South Wales, Australia.
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia.
- Sydney St Vincent's Hospital Sydney, Sydney, New South Wales, Australia.
| | - Bruce J Brew
- Peter Duncan Neuroscience Research Unit, St Vincent's Centre for Applied Medical Research, Sydney, New South Wales, Australia
- Sydney St Vincent's Hospital Sydney, Sydney, New South Wales, Australia
| | - Jane Bruning
- Positive Women Inc., Auckland, Aotearoa New Zealand
| | - Desiree Byrd
- Department of Neurology, The Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Psychology, Queens College and the Graduate Center, City University of New York, New York, NY, USA
| | - Jane Costello
- Positive Life New South Wales, Sydney, New South Wales, Australia
| | - Kirstie Daken
- School of Psychology & Wellbeing, Faculty of Health, Engineering and Sciences, Centre for Health Research, Institute for Resilient Regions, University of Southern Queensland, Toowoomba, Queensland, Australia
| | - Ronald J Ellis
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Pariya L Fazeli
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Karl Goodkin
- Department of Psychiatry and Institute of Neuroscience, University of Texas Rio Grande Valley, Edinburg, TX, USA
| | - Hetta Gouse
- Department of Public Health, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Robert K Heaton
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Scott Letendre
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Jules Levin
- National AIDS Treatment Advocacy Project, New York, NY, USA
| | - Htein Linn Aung
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Monica Rivera Mindt
- Department of Neurology, The Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Psychology, Latin American Latino Studies, and African and African American Studies, Fordham University, New York, NY, USA
| | - David Moore
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Amy B Mullens
- School of Psychology & Wellbeing, Faculty of Health, Engineering and Sciences, Centre for Health Research, Institute for Resilient Regions, University of Southern Queensland, Toowoomba, Queensland, Australia
| | | | - Jose A Muñoz-Moreno
- Infectious Diseases Department, Germans Trias Hospital, Spain Open University of Catalonia, Barcalona, Spain
| | - Chrispher Power
- Department of Medical Microbiology and Immunology, University of Alberta, Edmonton, Alberta, Canada
| | - Reuben N Robbins
- HIV Center for Clinical and Behavioral Studies, Columbia University and the New York State Psychiatric Institute, New York, NY, USA
| | - John Rule
- National Association of People with HIV Australia, Newtown, New South Wales, Australia
| | - Reena Rajasuriar
- Department of Medicine and Centre of Excellence for Research in AIDS, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Micah J Savin
- Mailman Department of Public Health, Columbia University, New York, NY, USA
| | - Jeff Taylor
- HIV+Aging Research Project-Palm Springs, Palm Springs, CA, USA
| | - Mattia Trunfio
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
- Infectious Diseases Unit, Amedeo di Savoia Hospital, Department of Medical Sciences, University of Turin, Turin, Italy
| | - David E Vance
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Pui Li Wong
- Department of Medicine and Centre of Excellence for Research in AIDS, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Steven P Woods
- Department of Psychology, University of Houston, Houston, TX, USA
| | - Edwina J Wright
- Department of Infectious Disease, Alfred Health, Melbourne, Victoria, Australia
- Burnet Institute, HIV Elimination Program, Melbourne, Victoria, Australia
- Department of Infectious Diseases, Alfred Health, Monash University, Melbourne, Victoria, Australia
- The Peter Doherty Institute of Infection and Immunity, University of Melbourne, Melbourne, Victoria, Australia
| | - Sean B Rourke
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael's Hospital (Unity Health Toronto), Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
2
|
Bolzenius JD, Goodkin K. Variability in the relationships between auditory processing and neurocognitive status among older adults with HIV. AIDS 2023; 37:2091-2093. [PMID: 37755426 DOI: 10.1097/qad.0000000000003668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/28/2023]
Affiliation(s)
| | - Karl Goodkin
- Department of Psychiatry
- Institute of Neuroscience, The University of Texas Rio Grande Valley, Harlingen, TX, USA
| |
Collapse
|
3
|
White CJ, Goodkin K. Bioenergetics and neuroimaging research: a neuropathophysiological linkage in the setting of cocaine use amongst persons with HIV. AIDS 2023; 37:1001-1003. [PMID: 37017022 PMCID: PMC10101129 DOI: 10.1097/qad.0000000000003535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 02/24/2023] [Indexed: 04/06/2023]
Affiliation(s)
- Cory J. White
- Department of Molecular and Comparative Pathobiology, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Karl Goodkin
- Department of Psychiatry
- Institute of Neuroscience, The University of Texas at Rio Grande Valley, Harlingen, TX, USA
| |
Collapse
|
4
|
Lai H, Celentano DD, Treisman G, Khalsa J, Gerstenblith G, Page B, Mandler RN, Yang Y, Salmeron B, Bhatia S, Chen S, Lai S, Goodkin K, Charurat M. Cocaine Use May Moderate the Associations of HIV and Female Sex with Neurocognitive Impairment in a Predominantly African American Population Disproportionately Impacted by HIV and Substance Use. AIDS Patient Care STDS 2023; 37:243-252. [PMID: 37083446 PMCID: PMC10171950 DOI: 10.1089/apc.2023.0006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/22/2023] Open
Abstract
HIV-associated neurocognitive disorders (HAND) remain a major challenge for people with HIV in the antiretroviral therapy era. Cocaine use may trigger/exacerbate HAND among African American (AA) adults, especially women. Between 2018 and 2019, 922 adults, predominantly AAs, with/without HIV and with/without cocaine use in Baltimore, Maryland, were enrolled in a study investigating the association of HIV and cocaine use with neurocognitive impairment (NCI). Neurocognitive performance was assessed with the NIH Toolbox Cognition Battery (NIHTB-CB). NCI was considered to be present if the fully adjusted standard score for at least two cognitive domains was 1.0 standard deviation below the mean. Although the overall analysis showed HIV and female sex were associated with NCI, the associations were dependent on cocaine use. Neither HIV [adj prevalence ratio (PR): 1.12, confidence interval (95% CI): 0.77-1.64] nor female sex (adj PR: 1.07, 95% CI: 0.71-1.61) was associated with NCI among cocaine nonusers, while both HIV (adj PR: 1.39, 95% CI: 1.06-1.81) and female sex (adj PR: 1.53, 95% CI: 1.18-1.98) were associated with NCI in cocaine users. HIV was associated with two NIHTB-CB measures overall. In addition, HIV was associated with a lower dimensional change card sort score (an executive function measure) in cocaine users and not in nonusers. Cognitive performance was poorer in female than in male cocaine users. The adverse effect of HIV on cognitive performance predominantly affected cocaine users. However, cocaine use may moderate the impact of HIV and female sex on cognitive performance, highlighting the importance of reducing cocaine use in NCI prevention among the AA population.
Collapse
Affiliation(s)
- Hong Lai
- Department of Radiology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - David D. Celentano
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Glenn Treisman
- Department of Psychiatry and Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Jag Khalsa
- Department of Microbiology, Immunology, & Tropical Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Gary Gerstenblith
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Bryan Page
- Department of Anthropology, University of Miami, Miami, Florida, USA
| | - Raul N. Mandler
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, Maryland, USA
| | - Yihong Yang
- Intramural Research Program, National Institute on Drug Abuse, National Institutes of Health, Baltimore, Maryland, USA
| | - Betty Salmeron
- Intramural Research Program, National Institute on Drug Abuse, National Institutes of Health, Baltimore, Maryland, USA
| | - Sandeepan Bhatia
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Shaoguang Chen
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Shenghan Lai
- Department of Radiology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Psychiatry and Johns Hopkins School of Medicine, Baltimore, Maryland, USA
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
- Department of Pathology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Karl Goodkin
- Department of Psychiatry, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Man Charurat
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| |
Collapse
|
5
|
Goodkin K, Evering TH, Anderson AM, Ragin A, Monaco CL, Gavegnano C, Avery RJ, Rourke SB, Cysique LA, Brew BJ. The comorbidity of depression and neurocognitive disorder in persons with HIV infection: call for investigation and treatment. Front Cell Neurosci 2023; 17:1130938. [PMID: 37206666 PMCID: PMC10190964 DOI: 10.3389/fncel.2023.1130938] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 03/07/2023] [Indexed: 05/21/2023] Open
Abstract
Depression and neurocognitive disorder continue to be the major neuropsychiatric disorders affecting persons with HIV (PWH). The prevalence of major depressive disorder is two to fourfold higher among PWH than the general population (∼6.7%). Prevalence estimates of neurocognitive disorder among PWH range from 25 to over 47% - depending upon the definition used (which is currently evolving), the size of the test battery employed, and the demographic and HIV disease characteristics of the participants included, such as age range and sex distribution. Both major depressive disorder and neurocognitive disorder also result in substantial morbidity and premature mortality. However, though anticipated to be relatively common, the comorbidity of these two disorders in PWH has not been formally studied. This is partly due to the clinical overlap of the neurocognitive symptoms of these two disorders. Both also share neurobehavioral aspects - particularly apathy - as well as an increased risk for non-adherence to antiretroviral therapy. Shared pathophysiological mechanisms potentially explain these intersecting phenotypes, including neuroinflammatory, vascular, and microbiomic, as well as neuroendocrine/neurotransmitter dynamic mechanisms. Treatment of either disorder affects the other with respect to symptom reduction as well as medication toxicity. We present a unified model for the comorbidity based upon deficits in dopaminergic transmission that occur in both major depressive disorder and HIV-associated neurocognitive disorder. Specific treatments for the comorbidity that decrease neuroinflammation and/or restore associated deficits in dopaminergic transmission may be indicated and merit study.
Collapse
Affiliation(s)
- Karl Goodkin
- Department of Psychiatry, School of Medicine, The University of Texas Rio Grande Valley, Harlingen, TX, United States
- Institute of Neuroscience, School of Medicine, The University of Texas Rio Grande Valley, Harlingen, TX, United States
| | - Teresa H. Evering
- Division of Infectious Diseases, Department of Medicine, Weill Cornell Medicine, New York, NY, United States
| | - Albert M. Anderson
- Division of Infectious Diseases, Department of Medicine, School of Medicine, Emory University, Atlanta, GA, United States
| | - Ann Ragin
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Cynthia L. Monaco
- Division of Infectious Diseases, Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY, United States
- Department of Microbiology and Immunology, University of Rochester School of Medicine and Dentistry, Rochester, NY, United States
- Del Monte Institute of Neuroscience, University of Rochester School of Medicine and Dentistry, Rochester, NY, United States
| | - Christina Gavegnano
- Department of Pathology, Emory School of Medicine, Emory University, Atlanta, GA, United States
- Department of Pharmacology, Emory School of Medicine, Emory University, Atlanta, GA, United States
- Department of Chemical Biology, Emory School of Medicine, Emory University, Atlanta, GA, United States
- Center for the Study of Human Health, Emory College of Arts and Sciences, Emory University, Atlanta, GA, United States
- Atlanta Veteran’s Affairs Medical Center, Atlanta, GA, United States
- Center for Bioethics, Harvard Medical School, Harvard University, Boston, MA, United States
| | - Ryan J. Avery
- Division of Nuclear Medicine, Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Sean B. Rourke
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Lucette A. Cysique
- School of Psychology, Faculty of Science, University of New South Wales, Sydney, NSW, Australia
| | - Bruce J. Brew
- Department of Neurology, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
- Department of Neurology, Faculty of Medicine, University of Notre Dame, Sydney, NSW, Australia
| |
Collapse
|
6
|
Manuzak JA, Granche J, Tassiopoulos K, Rower JE, Knox JR, Williams DW, Ellis RJ, Goodkin K, Sharma A, Erlandson KM. Cannabis Use Is Associated With Decreased Antiretroviral Therapy Adherence Among Older Adults With HIV. Open Forum Infect Dis 2023; 10:ofac699. [PMID: 36726540 PMCID: PMC9879711 DOI: 10.1093/ofid/ofac699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 01/03/2023] [Indexed: 01/09/2023] Open
Abstract
Background Conflicting evidence exists on the impact of cannabis use on antiretroviral therapy (ART) adherence among people with human immunodeficiency virus (PWH). We leveraged data collected among older PWH to characterize longitudinal associations between cannabis use and ART adherence. Methods AIDS Clinical Trials Group (ACTG) A5322 study participants were categorized as <100% (≥1 missed dose in past 7 days) or 100% (no missed doses) ART adherent. Participants self-reported current (past month), intermittent (past year but not past month), and no cannabis (in past year) use at each study visit. Generalized linear models using generalized estimating equations were fit and inverse probability weighting was used to adjust for time-varying confounders and loss to follow-up. Results Among 1011 participants (median age, 51 years), 18% reported current, 6% intermittent, and 76% no cannabis use at baseline; 88% reported 100% ART adherence. Current cannabis users were more likely to be <100% adherent than nonusers (adjusted risk ratio [aRR], 1.53 [95% CI, 1.11-2.10]). There was no association between ART adherence and current versus intermittent (aRR, 1.39 [95% CI, .85-2.28]) or intermittent versus no cannabis use (aRR, 1.04 [95% CI, .62-1.73]). Conclusions Among a cohort of older PWH, current cannabis users had a higher risk of <100% ART adherence compared to nonusers. These findings have important clinical implications as suboptimal ART adherence is associated with ART drug resistance, virologic failure, and elevated risk for mortality. Further research is needed to elucidate the mechanisms by which cannabis use decreases ART adherence in older PWH and to advance the development of more efficacious methods to mitigate nonadherence in this vulnerable population.
Collapse
Affiliation(s)
- Jennifer A Manuzak
- Division of Immunology, Tulane National Primate Research Center, Covington, Louisiana, USA
| | - Janeway Granche
- Center for Biostatistics in AIDS Research, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Katherine Tassiopoulos
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Joseph E Rower
- Center for Human Toxicology, Department of Pharmacology and Toxicology, University of Utah, Salt Lake City, Utah, USA
| | - Justin R Knox
- Department of Psychiatry, Columbia University, Irving Medical Center, New York, New York, USA
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, New York, New York, USA
- Department of Sociomedical Science, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Dionna W Williams
- Department of Molecular and Comparative Pathobiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Medicine, Division of Clinical Pharmacology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Ronald J Ellis
- Department of Neurosciences, University of California, San Diego, La Jolla, California, USA
| | - Karl Goodkin
- Consultant, AIDS Clinical Trials Group, Los Angeles, California, USA
- Consultant, Chronic HIV Infection in Aging and NeuroAIDS Center, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Anjali Sharma
- Department of Medicine, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Kristine M Erlandson
- Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | | |
Collapse
|
7
|
Masters MC, Perez J, Wu K, Ellis RJ, Goodkin K, Koletar SL, Andrade A, Yang J, Brown TT, Palella FJ, Sacktor N, Tassiopoulos K, Erlandson KM. Baseline Neurocognitive Impairment (NCI) Is Associated With Incident Frailty but Baseline Frailty Does Not Predict Incident NCI in Older Persons With Human Immunodeficiency Virus (HIV). Clin Infect Dis 2021; 73:680-688. [PMID: 34398957 DOI: 10.1093/cid/ciab122] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 02/08/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Neurocognitive impairment (NCI) and frailty are more prevalent among persons with human immunodeficiency virus (HIV, PWH) compared to those without HIV. Frailty and NCI often overlap with one another. Whether frailty precedes declines in neurocognitive function among PWH or vice versa has not been well established. METHODS AIDS Clinical Trials Group (ACTG) A5322 is an observational cohort study of older PWH. Participants undergo annual assessments for NCI and frailty. ACTG A5322 participants who developed NCI as indexed by tests of impaired executive functioning and processing speed during the first 3 years were compared to persons who maintained normal cognitive function; those who demonstrated resolution of NCI were compared to those who had persistent NCI. Participants were similarly compared by frailty trajectory. We fit multinomial logistic regression models to assess associations between baseline covariates (including NCI) and frailty, and associations between baseline covariates (including frailty) and NCI. RESULTS In total, 929 participants were included with a median age of 51 years (interquartile range [IQR] 46-56). At study entry, 16% had NCI, and 6% were frail. Over 3 years, 6% of participants developed NCI; 5% developed frailty. NCI was associated with development of frailty (odds ratio [OR] = 2.06; 95% confidence interval [CI] = .94, 4.48; P = .07). Further adjustment for confounding strengthened this association (OR = 2.79; 95% CI = 1.21, 6.43; P = .02). Baseline frailty however was not associated with NCI development. CONCLUSIONS NCI was associated with increased risk of frailty, but frailty was not associated with development of NCI. These findings suggest that the presence of NCI in PWH should prompt monitoring for the development of frailty and interventions to prevent frailty in this population.
Collapse
Affiliation(s)
- Mary Clare Masters
- Division of Infectious Diseases, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Jeremiah Perez
- Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Kunling Wu
- Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Ronald J Ellis
- University of California, San Diego, San Diego, California, USA
| | - Karl Goodkin
- University of Nebraska Medical Center, Omaha, Omaha, Nebraska, USA
| | | | | | | | - Todd T Brown
- Johns Hopkins University, Baltimore, Maryland, USA
| | - Frank J Palella
- Division of Infectious Diseases, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Ned Sacktor
- Johns Hopkins University, Baltimore, Maryland, USA
| | | | | |
Collapse
|
8
|
Orimaye SO, Goodkin K, Riaz OA, Salcedo JMM, Al-Khateeb T, Awujoola AO, Sodeke PO. A machine learning-based linguistic battery for diagnosing mild cognitive impairment due to Alzheimer's disease. PLoS One 2020; 15:e0229460. [PMID: 32134942 PMCID: PMC7058300 DOI: 10.1371/journal.pone.0229460] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 02/06/2020] [Indexed: 11/25/2022] Open
Abstract
There is a limited evaluation of an independent linguistic battery for early diagnosis of Mild Cognitive Impairment due to Alzheimer's disease (MCI-AD). We hypothesized that an independent linguistic battery comprising of only the language components or subtests of popular test batteries could give a better clinical diagnosis for MCI-AD compared to using an exhaustive battery of tests. As such, we combined multiple clinical datasets and performed Exploratory Factor Analysis (EFA) to extract the underlying linguistic constructs from a combination of the Consortium to Establish a Registry for Alzheimer's disease (CERAD), Wechsler Memory Scale (WMS) Logical Memory (LM) I and II, and the Boston Naming Test. Furthermore, we trained a machine-learning algorithm that validates the clinical relevance of the independent linguistic battery for differentiating between patients with MCI-AD and cognitive healthy control individuals. Our EFA identified ten linguistic variables with distinct underlying linguistic constructs that show Cronbach's alpha of 0.74 on the MCI-AD group and 0.87 on the healthy control group. Our machine learning evaluation showed a robust AUC of 0.97 when controlled for age, sex, race, and education, and a clinically reliable AUC of 0.88 without controlling for age, sex, race, and education. Overall, the linguistic battery showed a better diagnostic result compared to the Mini-Mental State Examination (MMSE), Clinical Dementia Rating Scale (CDR), and a combination of MMSE and CDR.
Collapse
Affiliation(s)
- Sylvester Olubolu Orimaye
- Department of Health Services Management and Policy, College of Public Health, East Tennessee State University, Johnson City, TN, United States of America
- Psychiatry Research Division, Department of Psychiatry and Behavioral Sciences, Quillen College of Medicine, East Tennessee State University, Johnson City, TN, United States of America
| | - Karl Goodkin
- Psychiatry Research Division, Department of Psychiatry and Behavioral Sciences, Quillen College of Medicine, East Tennessee State University, Johnson City, TN, United States of America
| | - Ossama Abid Riaz
- Psychiatry Research Division, Department of Psychiatry and Behavioral Sciences, Quillen College of Medicine, East Tennessee State University, Johnson City, TN, United States of America
| | - Jean-Maurice Miranda Salcedo
- Psychiatry Research Division, Department of Psychiatry and Behavioral Sciences, Quillen College of Medicine, East Tennessee State University, Johnson City, TN, United States of America
| | - Thabit Al-Khateeb
- Psychiatry Research Division, Department of Psychiatry and Behavioral Sciences, Quillen College of Medicine, East Tennessee State University, Johnson City, TN, United States of America
| | - Adeola Olubukola Awujoola
- Psychiatry Research Division, Department of Psychiatry and Behavioral Sciences, Quillen College of Medicine, East Tennessee State University, Johnson City, TN, United States of America
| | - Patrick Olumuyiwa Sodeke
- Psychiatry Research Division, Department of Psychiatry and Behavioral Sciences, Quillen College of Medicine, East Tennessee State University, Johnson City, TN, United States of America
| |
Collapse
|
9
|
Mathur S, Roberts-Toler C, Tassiopoulos K, Goodkin K, McLaughlin M, Bares S, Koletar SL, Erlandson KM. Detrimental Effects of Psychotropic Medications Differ by Sex in Aging People With HIV. J Acquir Immune Defic Syndr 2019; 82:88-95. [PMID: 31169770 PMCID: PMC6692226 DOI: 10.1097/qai.0000000000002100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Mental health conditions are common among persons with HIV (PWH). An understanding of factors associated with prescription medication use for these conditions and clinical impact of the prescription medications may improve care of mental health disorders in PWH. METHODS Psychotropic medication use was examined among PWH within the AIDS Clinical Trials Group A5322 (HAILO) study. Multivariable logistic models and Cox regression models estimated the association between psychotropic medications (any/none) with baseline and incident slow gait (>1 s/m) and neurocognitive impairment (NCI) for more than 4 years. RESULTS Of 1035 participants, the median age was 51 years.81% were men, 30% black, non-Hispanic, and 20% Hispanic. Psychotropic medication use was similar between men (34%) and women (38%; P = 0.19). PWH using psychotropic medications had greater odds of baseline slow gait {odds ratio 1.61, [95% confidence interval (CI): 1.23 to 2.10]; P < 0.001}. Men but not women using psychotropic medications had an increased risk of developing slow gait [hazard ratio 1.85; (1.29 to 2.65) vs 0.77; (CI: 0.35 to 1.68), P interaction = 0.045]. The sex-specific odds ratios for medication use and NCI were qualitatively but not statistically different [men: 1.79; (1.14-2.80); women: 1.27; (0.56-2.90); P interaction = 0.47]. Psychotropic medication use was associated with an increased risk of incident NCI [hazard ratio 2.18; (95% CI: 1.23 to 3.84), P = 0.007] in both men and women. CONCLUSIONS Psychotropic medications are associated with impairment in functional outcomes of aging, with a greater risk of baseline NCI and incident slow gait among men. Further investigation is needed to optimize outcomes in PWH and prescription of psychotropic medications among both men and women.
Collapse
Affiliation(s)
- Swati Mathur
- University of Colorado, Department of Medicine, Aurora, CO
| | - Carla Roberts-Toler
- Harvard T. H. Chan School of Public Health, Center for Biostatistics in AIDS Research, Boston, MA
| | | | - Karl Goodkin
- East Tennessee State University, Department of Psychiatry and Behavioral Sciences, Johnson City, TN
| | - Milena McLaughlin
- Northwestern Memorial Hospital, Chicago, IL
- Midwestern University, Chicago College of Pharmacy, Downers Grove, IL
| | - Sara Bares
- University of Nebraska Medical Center, Department of Medicine, Omaha, NB
| | - Susan L. Koletar
- The Ohio State University Medical Center, Department of Medicine, Columbus, OH
| | | | | |
Collapse
|
10
|
Abstract
This review article addresses end-of-life care issues characterizing human immunodeficiency virus progression by delineating associated stages of medical and nursing care. The initial progression from primary medical and nursing care aimed at functional cure to palliative care is discussed. This transition is considered in accord with the major symptoms experienced, including fatigue, pain, insomnia; decreased libido, hypogonadism, memory, and concentration; depression; and distorted body image. From the stage of palliative care, progression is delineated onward through the stages of hospice care, death and dying, and the subsequent bereavement process.
Collapse
Affiliation(s)
- Karl Goodkin
- Department of Psychiatry and Behavioral Sciences, James H. Quillen College of Medicine, East Tennessee State University, PO Box 70567, Johnson City, TN 37614, USA.
| | - Sindhura Kompella
- Department of Psychiatry and Behavioral Sciences, James H. Quillen College of Medicine, East Tennessee State University, PO Box 70567, Johnson City, TN 37614, USA
| | - Steven F Kendell
- Department of Psychiatry and Behavioral Sciences, James H. Quillen College of Medicine, East Tennessee State University, PO Box 70567, Johnson City, TN 37614, USA
| |
Collapse
|
11
|
Mathur S, Roberts-Toler C, Tassiopoulos K, Goodkin K, McLaughin M, Koletar S, Erlandson K. 583. Demographic Factors and Clinical Outcomes Associated with Mental Health Medication Use in People Living with HIV. Open Forum Infect Dis 2018. [PMCID: PMC6254767 DOI: 10.1093/ofid/ofy210.590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Background Mental health (MH) conditions and pain are common among people living with HIV (PLWH). An understanding of factors associated with prescriptions for these conditions and clinical impact of the prescriptions may improve care of MH disorders in PLWH. Methods The use of mental health/pain-related medications was examined among PLWH within the AIDS Clinical Trials Group A5322 (HAILO) study. Use of medications (any use and class) was compared by sex. Multivariable logistic models estimated the association between MH medications (any/none) with (i) insurance status and race/ethnicity and (ii) baseline and incident slow gait (>1 second/m) and neurocognitive impairment (NCI) over 4 years. Results Of 1035 participants, the median age was 51. 81% were men, 30% black, and 20% Hispanic. Similar numbers of men (34%) and women (38%) were on MH medications (P = 0.19).Women were more likely to be prescribed opioids (12% vs. 5%; P < 0.001); other classes were similar. In multivariable models, MH-medicated PLWH were more likely to have Medicare (odds ratio [OR] 2.50, 95% CI 1.50–4.16, P < 0.001) or public insurance (1.85; 1.23–2.78, P = 0.003) vs. no/unknown insurance; and less likely to be Hispanic vs. white (0.48; 0.33–0.69; P < 0.001). MH-medicated PLWH had greater odds of baseline slow gait (1.80; 1.34–2.40; P < 0.001). The sex-specific ORs for NCI were qualitatively different (men: 1.70; 1.09–2.66; women: 0.96; 0.43–2.18); but this difference was not significant in the multivariable model (P interaction = 0.227). There was an increased risk of incident slow gait among MH-medicated men but not women (hazard ratio 1.74; 1.22–2.48 vs. 0.76; 0.38–1.52, P interaction = 0.038), and a trend toward increased risk of incident NCI (1.76; 0.91, 3.39, P = 0.09) for both sexes. Conclusion Our results highlight socioeconomic and ethnic differences in prescription of MH medications. The higher proportion of opiate prescriptions among women needs confirmation and should be a priority for intervention. The greater risk of baseline NCI and incident slow gait among men may be the result of differences in toxicity, drug interactions, or persistent mental health symptoms; further investigation is needed to optimize outcomes in PLWH and prescription of mental health medications. Disclosures All authors: No reported disclosures.
Collapse
Affiliation(s)
- Swati Mathur
- Internal Medicine, University of Colorado School of Medicine, Denver, Colorado
| | | | | | - Karl Goodkin
- East Tennessee State University, Johnson City, Tennessee
| | | | - Susan Koletar
- Division of Infectious Diseases, The Ohio State University College of Medicine, Columbus, Ohio
| | | |
Collapse
|
12
|
Goodkin K, Patten SB. Depressive Symptomatology, Syndromal Depression, and HIV-Associated Neurocognitive Disorder (HAND). Can J Psychiatry 2018; 63:284-286. [PMID: 29668329 PMCID: PMC5912305 DOI: 10.1177/0706743718754537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Karl Goodkin
- 1 Department of Psychiatry and Behavioral Sciences, Quillen College of Medicine, East Tennessee State University, Johnson City, TN, USA
| | - Scott B Patten
- 2 Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| |
Collapse
|
13
|
Abstract
Purpose of review This article critically reviews the utility of “phenotypes” as behavioral descriptors in aging/HIV research that inform biological underpinnings and treatment development. We adopt a phenotypic redefinition of aging conceptualized within a broader context of HIV infection and of aging. Phenotypes are defined as dimensions of behavior, closely related to fundamental mechanisms, and, thus, may be more informative than chronological age. Primary emphasis in this review is given to comorbid aging and cognitive aging, though other phenotypes (i.e., disability, frailty, accelerated aging, successful aging) are also discussed in relation to comorbid aging and cognitive aging. Recent findings The main findings that emerged from this review are as follows: (1) the phenotypes, comorbid aging and cognitive aging, are distinct from each other, yet overlapping; (2) associative relationships are the rule in HIV for comorbid and cognitive aging phenotypes; and (3) HIV behavioral interventions for both comorbid aging and cognitive aging have been limited. Summary Three paths for research progress are identified for phenotype-defined aging/HIV research (i.e., clinical and behavioral specification, biological mechanisms, intervention targets), and some important research questions are suggested within each of these research paths.
Collapse
Affiliation(s)
- David M Stoff
- AIDS Research Training-Health Disparities and HIV Aging/Comorbidity Research Programs, Division of AIDS Research, National Institute of Mental Health, 5601 Fishers Lane Room 9E25, MSC 9831, Bethesda, MD, 20892, USA.
| | - Karl Goodkin
- East Tennessee State University, Johnson City, TN, USA
| | - Dilip Jeste
- University of California San Diego, La Jolla, CA, USA
| | | |
Collapse
|
14
|
López E, Steiner AJ, Smith K, Thaler NS, Hardy DJ, Levine AJ, Al-Kharafi HT, Yamakawa C, Goodkin K. Diagnostic utility of the HIV dementia scale and the international HIV dementia scale in screening for HIV-associated neurocognitive disorders among Spanish-speaking adults. Appl Neuropsychol Adult 2017; 24:512-521. [PMID: 27712132 PMCID: PMC5938065 DOI: 10.1080/23279095.2016.1214835] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Given that neurocognitive impairment is a frequent complication of HIV-1 infection in Spanish-speaking adults, the limited number of studies assessing HIV-associated neurocognitive disorders (HAND) in this population raises serious clinical concern. In addition to being appropriately translated, instruments need to be modified, normed, and validated accordingly. The purpose of the current study was to examine the diagnostic utility of the HIV Dementia Scale (HDS) and International HIV Dementia Scale (IHDS) to screen for HAND in Spanish-speaking adults living with HIV infection. Participants were classified as either HAND (N = 47) or No-HAND (N = 53) after completing a comprehensive neuropsychological evaluation. Receiver operating characteristic analyses found the HDS (AUC = .706) was more sensitive to detecting HAND than the IHDS (AUC = .600). Optimal cutoff scores were 9.5 for the HDS (PPV = 65.2%, NPV = 71.4%) and 9.0 for the IHDS (PPV = 59.4%, NPV = 59.1%). Canonical Correlation Analysis found the HDS converged with attention and executive functioning. Findings suggest that while the IHDS may not be an appropriate screening instrument with this population, the HDS retains sufficient statistical validity and clinical utility to screen for HAND in Spanish-speaking adults as a time-efficient and cost-effective measure in clinical settings with limited resources.
Collapse
Affiliation(s)
- Enrique López
- Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center, Los Angeles, California, USA
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Alexander J. Steiner
- Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center, Los Angeles, California, USA
- Department of Psychology, California School of Professional Psychology, Alliant International University, Alhambra, California, USA
| | - Kimberly Smith
- Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Nicholas S. Thaler
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - David J. Hardy
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
- Department of Psychology, Loyola Marymount University, Los Angeles, California, USA
| | - Andrew J. Levine
- Department of Neurology, David Geffen School of Medicine, University of California Los Angeles (UCLA), Los Angeles, California, USA
| | - Hussah T. Al-Kharafi
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
- Graduate School of Education and Psychology, Pepperdine University, Los Angeles, California, USA
| | - Cristina Yamakawa
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Karl Goodkin
- Department of Psychiatry and Behavioral Sciences, Quillen College of Medicine, East Tennessee State University, Johnson City, Tennessee, USA
| |
Collapse
|
15
|
Hines LJ, Miller EN, Hinkin CH, Alger JR, Barker P, Goodkin K, Martin EM, Maruca V, Ragin A, Sacktor N, Sanders J, Selnes O, Becker JT. Cortical brain atrophy and intra-individual variability in neuropsychological test performance in HIV disease. Brain Imaging Behav 2017; 10:640-51. [PMID: 26303224 DOI: 10.1007/s11682-015-9441-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
To characterize the relationship between dispersion-based intra-individual variability (IIVd) in neuropsychological test performance and brain volume among HIV seropositive and seronegative men and to determine the effects of cardiovascular risk and HIV infection on this relationship. Magnetic Resonance Imaging (MRI) was used to acquire high-resolution neuroanatomic data from 147 men age 50 and over, including 80 HIV seropositive (HIV+) and 67 seronegative controls (HIV-) in this cross-sectional cohort study. Voxel Based Morphometry was used to derive volumetric measurements at the level of the individual voxel. These brain structure maps were analyzed using Statistical Parametric Mapping (SPM2). IIVd was measured by computing intra-individual standard deviations (ISD's) from the standardized performance scores of five neuropsychological tests: Wechsler Memory Scale-III Visual Reproduction I and II, Logical Memory I and II, Wechsler Adult Intelligence Scale-III Letter Number Sequencing. Total gray matter (GM) volume was inversely associated with IIVd. Among all subjects, IIVd -related GM atrophy was observed primarily in: 1) the inferior frontal gyrus bilaterally, the left inferior temporal gyrus extending to the supramarginal gyrus, spanning the lateral sulcus; 2) the right superior parietal lobule and intraparietal sulcus; and, 3) dorsal/ventral regions of the posterior section of the transverse temporal gyrus. HIV status, biological, and cardiovascular disease (CVD) variables were not linked to IIVd -related GM atrophy. IIVd in neuropsychological test performance may be a sensitive marker of cortical integrity in older adults, regardless of HIV infection status or CVD risk factors, and degree of intra-individual variability links with volume loss in specific cortical regions; independent of mean-level performance on neuropsychological tests.
Collapse
Affiliation(s)
- Lindsay J Hines
- Semel Institute for Neurosciences, University of California Los Angeles, Los Angeles, CA, USA. .,Sanford Brain and Spine Center, Sanford Health, Fargo, ND, USA. .,Department of Psychology, University of North Dakota, Fargo, ND, USA.
| | - Eric N Miller
- Semel Institute for Neurosciences, University of California Los Angeles, Los Angeles, CA, USA
| | - Charles H Hinkin
- Semel Institute for Neurosciences, University of California Los Angeles, Los Angeles, CA, USA
| | - Jeffery R Alger
- The Department of Neurology, University of California Los Angeles, Los Angeles, CA, USA
| | - Peter Barker
- Department of Radiology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Karl Goodkin
- Department of Psychiatry and Behavioral Sciences, East Tennessee State University, Johnson City, TN, USA
| | | | - Victoria Maruca
- Department of Psychology, Spalding University, Louisville, KY, USA
| | - Ann Ragin
- Department of Neurology, Feinberg School of Medicine, Northwestern University, Evanston, IL, USA
| | - Ned Sacktor
- Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Joanne Sanders
- Department of Epidemiology, Bloomberg School of Public Health, The Johns Hopkins University, Baltimore, MD, USA
| | - Ola Selnes
- Department of Epidemiology, Bloomberg School of Public Health, The Johns Hopkins University, Baltimore, MD, USA
| | - James T Becker
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.,Department of Neurology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.,Department of Psychology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | | |
Collapse
|
16
|
Goodkin K, Miller EN, Cox C, Reynolds S, Becker JT, Martin E, Selnes OA, Ostrow DG, Sacktor NC. Effect of ageing on neurocognitive function by stage of HIV infection: evidence from the Multicenter AIDS Cohort Study. Lancet HIV 2017; 4:e411-e422. [PMID: 28716545 DOI: 10.1016/s2352-3018(17)30098-x] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Revised: 05/16/2017] [Accepted: 05/16/2017] [Indexed: 12/25/2022]
Abstract
BACKGROUND The demographics of the HIV epidemic in the USA have shifted towards older age. We aimed to establish the relationship between the processes of ageing and HIV infection in neurocognitive impairment. METHODS With longitudinal data from the Multicenter AIDS Cohort Study, a long-term prospective cohort study of the natural and treated history of HIV infection among men who have sex with men in the USA, we examined the effect of ageing, HIV infection (by disease stage), and their interaction on five neurocognitive domains: information processing speed, executive function, episodic memory, working memory, and motor function. We controlled for duration of serostatus in a subanalysis, as well as comorbidities and other factors that affect cognition. Analyses were by linear mixed models for longitudinal data. FINDINGS 5086 participants (47 886 visits) were included in the analytic sample (2278 HIV-seropositive participants contributed 20 477 visits and 2808 HIV-seronegative control participants contributed 27 409 visits). In an a-priori multivariate analysis with control variables including comorbidities and time since seroconversion, significant, direct negative effects of ageing were noted on all neurocognitive domains (p<0·0001 for all). Similar effects were noted for late-stage HIV disease progression on information processing speed (p=0·002), executive function (p<0·0001), motor function (p<0·0001), and working memory (p=0·001). Deleterious interaction effects were also noted in the domains of episodic memory (p=0·03) and motor function (p=0·02). INTERPRETATION A greater than expected effect of ageing on episodic memory and motor function with advanced stages of HIV infection suggests that these two domains are most susceptible to the progression of neurocognitive impairment caused by ageing in individuals with HIV. This deficit pattern suggests differential damage to the hippocampus and basal ganglia (specifically nigrostriatal pathways). Older individuals with HIV infection should be targeted for regular screening for HIV-associate neurocognitive disorder, particularly with tests referable to the episodic memory and motor domains. FUNDING National Institute of Mental Health.
Collapse
Affiliation(s)
- Karl Goodkin
- Department of Psychiatry and Behavioral Sciences, James H Quillen College of Medicine, East Tennessee State University, Johnson City, TN, USA.
| | - Eric N Miller
- University of California, Los Angeles, Los Angeles, CA, USA
| | | | | | | | | | - Ola A Selnes
- Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - David G Ostrow
- David G Ostrow & Associates Consulting, Chicago, IL, USA
| | - Ned C Sacktor
- Johns Hopkins School of Medicine, Baltimore, MD, USA
| | | |
Collapse
|
17
|
Abstract
We have reviewed the articles submitted by Walter (2006), Neimeyer (2005–2006, this issue), Stroebe and Schut (2005–2006, this issue), and Prigerson and Maciejewski (2005–2006, thiss issue). Walter (2005–2006, this issue) assumes a social constructivist perspective of complicated grief. His article focuses on a number of issues that we believe to be extrinsic to the primary issue of the definition of complicated grief. We do not view the movement toward a new diagnosis of complicated grief as a normalization of grief as a construct of psychiatry (“psychiatric medicine” is a redundant term), an operational requirement of “bereavement agencies,” a concept through which society can discipline the bereaved, a label applied to those who actively resist cultural grieving norms, a product of societal obsession with risk, or a result of “negotiating participants in the bereavement field.” We also do not assume that complicated grief is a “psychological disorder” but, rather, a type of psychopathology (without reference to professional discipline).
Collapse
Affiliation(s)
| | - Diana Lee
- University of Miami School of Medicine, Florida
| | | | | | - Wenli Zheng
- University of Miami School of Medicine, Florida
| | | | | | - Imad Khamis
- University of Miami School of Medicine, Florida
| |
Collapse
|
18
|
Goodkin K, Lee D, Molina R, Zheng W, Frasca A, O'Mellan S, Asthana D, Shapshak P, Khamis I. Complicated Bereavement: Disease State or State of Being? Omega (Westport) 2016. [DOI: 10.2190/29hw-6knd-wfep-t9l0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The point at which the experience of grief in response to bereavement becomes “pathological” has been debated for many years without resolution. This article reviews the current status of this debate. The debate centers around the extent to which “complicated grief” represents a truly unique pathological entity, when contrasted with major depressive disorder, posttraumatic stress disorder, and “uncomplicated grief.” Significant research findings suggest it may be possible to distinguish grief from depressed as well as traumatic forms of distress, with acceptable reliability and validity. Yet, “complicated grief” relates to both of these types of distress as well as to a unique aspect—separation distress. It is at the intersection of these types of distress with significant disruption of daily life functioning that we find the proposed diagnosis of “complicated grief.” The question is whether this diagnosis should be designated at this time, and, if so, how. This article concludes in favor of a compromise position that the diagnosis should be incorporated into DSM-V but relegated to its Appendix B [disorders proposed for further study] due to the lack of clarity surrounding its diagnostic criteria.
Collapse
Affiliation(s)
| | - Diana Lee
- University of Miami School of Medicine, Florida
| | | | - Wenli Zheng
- University of Miami School of Medicine, Florida
| | | | | | | | | | - Imad Khamis
- University of Miami School of Medicine, Florida
| |
Collapse
|
19
|
Abstract
To develop hypotheses about psychological influences that may favorably affect tumor behavior, 11 patients were recruited who evinced spontaneous regression of histologically diagnosed and reviewed adenocarcinoma ( n = 3), lymphoma ( n =2), melanoma, chorion carcinoma, ovarian carcinoma, mesothelioma, liver carcinoma or sarcoma, and malignant giant cell tumor (a child). The authors studied retrospectively what had happened to these patients prior to the first signs of their clinical improvement. These patients seemed to have gained access to poignant activities and experiences, shortly prior to their tumor regression. Change involved an increased dystonic reaction to limited aspects of the personality and an increased syntonic reaction to a wider set of characteristics than normally accessed. These changes either followed other persons’ abusive behavior that “went beyond the pale” and elicited a different coping response than previously had been manifested by the patient, or were otherwise facilitated by particular events, independent of the patient’s behavior.
Collapse
|
20
|
Goodkin K. Assessing the prevalence of HIV, HBV, and HCV infection among people with severe mental illness. Lancet Psychiatry 2016; 3:4-6. [PMID: 26772053 DOI: 10.1016/s2215-0366(15)00569-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Accepted: 12/09/2015] [Indexed: 12/20/2022]
Affiliation(s)
- Karl Goodkin
- Department of Psychiatry and Behavioral Sciences, Quillen College of Medicine, East Tennessee State University, PO BOX 70567, TN 37614, USA.
| |
Collapse
|
21
|
Molsberry SA, Lecci F, Kingsley L, Junker B, Reynolds S, Goodkin K, Levine AJ, Martin E, Miller EN, Munro CA, Ragin A, Sacktor N, Becker JT. Mixed membership trajectory models of cognitive impairment in the multicenter AIDS cohort study. AIDS 2015; 29:713-21. [PMID: 25565498 PMCID: PMC4743499 DOI: 10.1097/qad.0000000000000561] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVE The longitudinal trajectories that individuals may take from a state of normal cognition to HIV-associated dementia are unknown. We applied a novel statistical methodology to identify trajectories to cognitive impairment, and factors that affected the 'closeness' of an individual to one of the canonical trajectories. DESIGN The Multicenter AIDS Cohort Study (MACS) is a four-site longitudinal study of the natural and treated history of HIV disease among gay and bisexual men. METHODS Using data from 3892 men (both HIV-infected and HIV-uninfected) enrolled in the neuropsychology substudy of the MACS, a Mixed Membership Trajectory Model (MMTM) was applied to capture the pathways from normal cognitive function to mild impairment to severe impairment. MMTMs allow the data to identify canonical pathways and to model the effects of risk factors on an individual's 'closeness' to these trajectories. RESULTS First, we identified three distinct trajectories to cognitive impairment: 'normal aging' (low probability of mild impairment until age 60); 'premature aging' (mild impairment starting at age 45-50); and 'unhealthy' (mild impairment in 20s and 30s) profiles. Second, clinically defined AIDS, and not simply HIV disease, was associated with closeness to the premature aging trajectory, and, third, hepatitis-C infection, depression, race, recruitment cohort and confounding conditions all affected individual's closeness to these trajectories. CONCLUSION These results provide new insight into the natural history of cognitive dysfunction in HIV disease and provide evidence for a potential difference in the pathophysiology of the development of cognitive impairment based on trajectories to impairment.
Collapse
Affiliation(s)
- Samantha A Molsberry
- aDepartment of Psychiatry, University of Pittsburgh bDepartment of Statistics, Carnegie Mellon University, Pittsburgh cInfectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania dDepartment of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland eAIDS Healthcare Foundation, Los Angeles fDepartment of Neurology, University of California Los Angeles, California gDepartment of Psychiatry, Rush University School of Medicine, Chicago, Illinois hDepartment of Psychiatry, University of California Los Angeles, California iDepartment of Psychiatry jDepartment of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland kDepartment of Radiology Northwestern University, Evanston, Illinois lDepartment of Neurology mDepartment of Psychology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
22
|
Becker JT, Martinson JJ, Penugonda S, Kingsley L, Molsberry S, Reynolds S, Aronow A, Goodkin K, Levine A, Martin E, Miller EN, Munro CA, Ragin A, Sacktor N. No association between Apoε4 alleles, HIV infection, age, neuropsychological outcome, or death. J Neurovirol 2014; 21:24-31. [PMID: 25388225 DOI: 10.1007/s13365-014-0290-2] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Revised: 09/16/2014] [Accepted: 09/18/2014] [Indexed: 01/18/2023]
Abstract
The ε4 allele of the apolipoprotein E (ApoE) gene may have important interactions with physical health and cognitive function among individuals with HIV disease. The purpose of this study is to examine the relationships between ε4, HIV disease, age, neuropsychological impairment, and death in a large, well-characterized study sample. A total of 2846 men participating in the Multicenter AIDS Cohort Study had ApoE genotyping and neuropsychological test data available for analysis. We found a significant association between HIV infection and time to death (from any cause), as well as older age, race, and education. But, ApoE status was not significantly associated with time to death. Similarly, we found a significant association between HIV infection and time to incident cognitive impairment, as well as age, education, and HIV serostatus; Apoε4 status was not related to incident cognitive impairment. There were no significant interactions between ApoE, HIV infection, and age on cognitive impairment. These data replicate and strengthen prior findings of the lack of association between ApoE ε4 and cognitive outcomes in HIV disease. We conclude that within the specific constraints of an exclusively male study in which the majority of participants were less than 65 years of age (range 22-87 years), it appears reasonable to conclude that the ε4 allele is not significantly interacting with HIV serostatus.
Collapse
Affiliation(s)
- James T Becker
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA,
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
23
|
Goodkin K, Hardy D, Singh D, Lopez E. Diagnostic Utility of the International HIV Dementia Scale for HIV-Associated Neurocognitive Impairment and Disorder in South Africa. J Neuropsychiatry Clin Neurosci 2014; 26:352-8. [PMID: 26037857 PMCID: PMC5805556 DOI: 10.1176/appi.neuropsych.13080178] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Studies in sub-Saharan Africa indicate that most HIV seropositive persons have HIV-associated neurocognitive disorder (HAND). HAND diagnosis is facilitated by specific screening. Seventy participants were recruited from an HIV voluntary counseling and testing clinic in Durban, South Africa. The diagnostic utility of the International HIV Dementia Scale (IHDS) was analyzed using a receiver operating characteristic (ROC) model. The ROC analysis comparing any HAND diagnosis (based on two neuropsychological tests) versus no diagnosis was statistically significant, with an optimal cut-off score of 10.5, sensitivity of 69%, and specificity of 74%. Sensitivity of the IHDS was highest for HIV-associated dementia.
Collapse
Affiliation(s)
- K. Goodkin
- East Tennessee State University, Department of Mental Health, Los Angeles, United States
| | - D.J. Hardy
- University of California at Los Angeles, Department of Psychiatry and Biobehavioral Sciences, Los Angeles, United States,Loyola Marymount University, Department of Psychology, Los Angeles, United States
| | - D. Singh
- McCord Hospital, Department of Psychiatry, Durban, South Africa
| | - E. Lopez
- University of California at Los Angeles, Department of Psychiatry and Biobehavioral Sciences, Los Angeles, United States,Cedars-Sinai Medical Center, Department of Psychiatry and Behavioral Neurosciences, Los Angeles, United States
| |
Collapse
|
24
|
|
25
|
|
26
|
|
27
|
Goodkin K, Alger JR, Maudsley AA, Govind V, Sheriff S, Zhang JM. Clinical utility of magnetic resonance spectroscopy to enhance diagnosis of HIV-associated mild neurocognitive disorder. Neuropsychiatry (London) 2012; 2:379-383. [PMID: 23682297 PMCID: PMC3652484 DOI: 10.2217/npy.12.50] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- Karl Goodkin
- Department of Mental Health, AIDS Healthcare Foundation (AHF), 6255 W Sunset Boulevard, 21st Floor, Los Angeles, CA 90028, USA
| | - Jeffry R Alger
- Department of Neurology & Department of Radiological Sciences, Ahmanson-Lovelace Brain Mapping Center, David Geffen School of Medicine at UCLA, University of California, Los Angeles, CA, USA
| | - Andrew A Maudsley
- Department of Radiology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Varan Govind
- Department of Radiology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Sulaiman Sheriff
- Department of Radiology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Jingjing Michele Zhang
- Department of Neurology & Department of Radiological Sciences, Ahmanson-Lovelace Brain Mapping Center, David Geffen School of Medicine at UCLA, University of California, Los Angeles, CA, USA
| |
Collapse
|
28
|
Goodkin K, Fernandez F, Forstein M, Miller EN, Becker JT, Douaihy A, Cubano L, Santos FH, Filho NS, Zirulnik J, Singh D. A perspective on the proposal for neurocognitive disorder criteria in DSM-5 as applied to HIV-associated neurocognitive disorders. Neuropsychiatry (London) 2011; 1:431-440. [PMID: 22844348 PMCID: PMC3405847 DOI: 10.2217/npy.11.57] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
HIV-associated neurocognitive disorders remain common in the current era of effective antiretroviral therapy. However, the severity at presentation of these disorders has been reduced, and the typical manifestations have changed. A revision of the American Academy of Neurology (AAN) criteria has been made on this basis, and a revision of the analogous criteria by the American Psychiatric Association will be forthcoming in the Diagnostic and Statistical Manual of Mental Disorders (DSM)-5. This article compares the relevant sets of diagnostic criteria that will be employed. It is concluded that a greater degree of integration of the revised, HIV-specific AAN criteria for HIV-associated neurocognitive disorders with the criteria proposed for the DSM-5 would prove advantageous for research, clinical, educational and administrative purposes.
Collapse
Affiliation(s)
- Karl Goodkin
- Author for correspondence: AIDS Healthcare Foundation, 6255 W Sunset Blvd, 21st Floor, Los Angeles, CA 90028, USA; Tel.: +1 323 860 5250; Fax: +1 323 962 8513;
| | - Francisco Fernandez
- Department of Psychiatry & Neurosciences, Institute for Research in Psychiatry, University of South Florida, Tampa, FL, USA
| | | | - Eric N Miller
- UCLA Semel Institute for Neuroscience, Department of Psychology, University of California at Los Angeles, Los Angeles, CA, USA
| | - James T Becker
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Antoine Douaihy
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Luis Cubano
- Department of Microbiology & Immunology, Research & Graduate Studies, School of Medicine, Universidad Central del Caribe, Bayamón, Puerto Rico, USA
| | - Flavia H Santos
- Laboratory of Neuropsychology, Department of Experimental Psychology, University of the State of São Paulo, Brazil
| | - Nelson Silva Filho
- Department of Clinical Psychology, University of the State of São Paulo, Brazil
| | - Jorge Zirulnik
- Infectious Diseases & HIV/AIDS Unit, Hospital Juan A Fernandez, Buenos Aires, Argentina
| | - Dinesh Singh
- Department of Psychiatry, University of Kwa-Zulu Natal, South African Research Council, Durban, South Africa
| |
Collapse
|
29
|
Becker JT, Sanders J, Madsen SK, Ragin A, Kingsley L, Maruca V, Cohen B, Goodkin K, Martin E, Miller EN, Sacktor N, Alger JR, Barker PB, Saharan P, Carmichael OT, Thompson PM. Subcortical brain atrophy persists even in HAART-regulated HIV disease. Brain Imaging Behav 2011; 5:77-85. [PMID: 21264551 PMCID: PMC3082694 DOI: 10.1007/s11682-011-9113-8] [Citation(s) in RCA: 144] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The purpose of this study was to determine the pattern and extent of caudate nucleus and putamen atrophy in HIV-infected men with well-controlled immune status and viral replication. 155 men underwent structural brain magnetic resonance imaging; 84 were HIV-infected and 71 were uninfected controls. MRI data were processed using the Fully Deformable Segmentation routine, producing volumes for the right and left caudate nucleus and putamen, and 3-D maps of spatial patterns of thickness. There was significant atrophy in the HIV-infected men in both the caudate and putamen, principally in the anterior regions. The volume of the basal ganglia was inversely associated with the time since first seropositivity, suggesting that either there is a chronic, subclinical process that continues in spite of therapy, or that the extent of the initial insult caused the extent of atrophy.
Collapse
Affiliation(s)
- James T Becker
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
30
|
Becker JT, Maruca V, Kingsley LA, Sanders JM, Alger JR, Barker PB, Goodkin K, Martin E, Miller EN, Ragin A, Sacktor N, Selnes O. Factors affecting brain structure in men with HIV disease in the post-HAART era. Neuroradiology 2011; 54:113-21. [PMID: 21424708 DOI: 10.1007/s00234-011-0854-2] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2011] [Accepted: 02/22/2011] [Indexed: 10/18/2022]
Abstract
INTRODUCTION The purpose of this study was to characterize brain volumetric differences in HIV seropositive and seronegative men and to determine effects of age, cardiovascular risk, and HIV infection on structural integrity. METHODS Magnetic resonance imaging was used to acquire high-resolution neuroanatomic data in 160 men aged 50 years and over, including 84 HIV seropositive and 76 seronegative controls. Voxel-based morphometry was used to derive volumetric measurements at the level of the individual voxel. Data from a detailed neuropsychological test battery were recombined into four summary scores representing psychomotor speed, visual memory, verbal memory, and verbal fluency. RESULTS Both age and HIV status had a significant effect on both gray matter (GM) and white matter (WM) volume. The age-related GM atrophy was primarily in the superior temporal and inferior frontal regions; the HIV-related GM loss included the posterior and inferior temporal lobes, the parietal lobes, and the cerebellum. Among all subjects, the performance on neuropsychological tests, as indexed by a summary variable, was related to the volume of both the GM and WM. Contrary to our predictions, the CVD variables were not linked to brain volume in statistically adjusted models. CONCLUSION In the post-HAART era, having HIV infection is still linked to atrophy in both GM and WM. Secondly, advancing age, even in this relatively young cohort, is also linked to changes in GM and WM volume. Thirdly, CNS structural integrity is associated with overall cognitive functions, regardless of the HIV infection status of the study volunteers.
Collapse
Affiliation(s)
- James T Becker
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
31
|
Singh D, Joska JA, Goodkin K, Lopez E, Myer L, Paul RH, John S, Sunpath H. Normative scores for a brief neuropsychological battery for the detection of HIV-associated neurocognitive disorder (HAND) among South Africans. BMC Res Notes 2010; 3:28. [PMID: 20181051 PMCID: PMC2843737 DOI: 10.1186/1756-0500-3-28] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2009] [Accepted: 01/29/2010] [Indexed: 12/01/2022] Open
Abstract
Background There is an urgent need to more accurately diagnose HIV-associated neurocognitive disorder (HAND) in Africa. Rapid screening tests for HIV-associated dementia are of limited utility due to variable sensitivity and specificity. The use of selected neuropsychological tests is more appropriate, but norms for HIV seronegative people are not readily available for sub-Saharan African populations. We sought to derive normative scores for two commonly used neuropsychological tests that generate four test scores -- namely the Trail-Making Test (Parts A and B) and the Digit Span Test [Forward (DSF) and Backward (DSB)]. To assess memory and recall, we used the memory item of the International HIV Dementia Scale (IHDS). Findings One hundred and ten HIV seronegative participants were assessed at McCord Hospital, Durban, South Africa between March 3rd and October 31st, 2008. We excluded people with major depressive disorder, substance use abuse and dependence and head injuries (with or without loss of consciousness). All the participants in this study were African and predominantly female with an average age of 28.5 years and 10 years of education. Age and gender influenced neuropsychological functioning, with older people performing worse. The effect of gender was not uniform across all the tests. Conclusion These two neuropsychological tests can be administered with the IHDS in busy antiretroviral clinics. Their performance can be measured against these norms to more accurately diagnose the spectrum and progression of HAND.
Collapse
Affiliation(s)
- Dinesh Singh
- Department of Psychiatry, University of Kwa-Zulu Natal, Durban, South Africa.
| | | | | | | | | | | | | | | |
Collapse
|
32
|
López E, Morales G, Saucedo C, Aguirre-Girón L, Mack S, Goodkin K. A proposition against using the terms "Hispanic" and "Latino" in research on HIV-associated neurocognitive disorders. Ethn Dis 2010; 20:479-84. [PMID: 21305841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023] Open
Abstract
In the United States, the term "Hispanic" has been used to refer to a person or groups of persons who originate from Spanish-speaking countries. However, this term fails to account for variables such as nationality, ethnicity, race, and cultural origin as well as the extent of assimilation to a new culture. In addition, factors such as the individual's generation, specific migratory status, years of education in each country, fluency, and day-to-day language usage contribute to variance in neuropsychological testing outcomes, which are sensitive to these factors. We have noted that the usage of the terms "Hispanic" and "Latino" is problematic in HIV-associated neurocognitive disorder (HAND) research; therefore, we propose grouping individuals by nationality or by the Spanish-speaking culture to which they belong. The rationale for not using these terms is based upon the sociodemographic findings among Spanish speakers infected with HIV and how these terms inadequately describe the rich heterogeneity of this population.
Collapse
Affiliation(s)
- Enrique López
- Department of Psychiatry at Cedars Sinai Medical Center, 8730 Alden Dr, E-106, Los Angeles, CA 90048, USA.
| | | | | | | | | | | |
Collapse
|
33
|
Prigerson HG, Horowitz MJ, Jacobs SC, Parkes CM, Aslan M, Goodkin K, Raphael B, Marwit SJ, Wortman C, Neimeyer RA, Bonanno GA, Bonanno G, Block SD, Kissane D, Boelen P, Maercker A, Litz BT, Johnson JG, First MB, Maciejewski PK. Prolonged grief disorder: Psychometric validation of criteria proposed for DSM-V and ICD-11. PLoS Med 2009; 6:e1000121. [PMID: 19652695 PMCID: PMC2711304 DOI: 10.1371/journal.pmed.1000121] [Citation(s) in RCA: 1016] [Impact Index Per Article: 67.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2008] [Accepted: 06/25/2009] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Bereavement is a universal experience, and its association with excess morbidity and mortality is well established. Nevertheless, grief becomes a serious health concern for a relative few. For such individuals, intense grief persists, is distressing and disabling, and may meet criteria as a distinct mental disorder. At present, grief is not recognized as a mental disorder in the DSM-IV or ICD-10. The goal of this study was to determine the psychometric validity of criteria for prolonged grief disorder (PGD) to enhance the detection and potential treatment of bereaved individuals at heightened risk of persistent distress and dysfunction. METHODS AND FINDINGS A total of 291 bereaved respondents were interviewed three times, grouped as 0-6, 6-12, and 12-24 mo post-loss. Item response theory (IRT) analyses derived the most informative, unbiased PGD symptoms. Combinatoric analyses identified the most sensitive and specific PGD algorithm that was then tested to evaluate its psychometric validity. Criteria require reactions to a significant loss that involve the experience of yearning (e.g., physical or emotional suffering as a result of the desired, but unfulfilled, reunion with the deceased) and at least five of the following nine symptoms experienced at least daily or to a disabling degree: feeling emotionally numb, stunned, or that life is meaningless; experiencing mistrust; bitterness over the loss; difficulty accepting the loss; identity confusion; avoidance of the reality of the loss; or difficulty moving on with life. Symptoms must be present at sufficiently high levels at least six mo from the death and be associated with functional impairment. CONCLUSIONS The criteria set for PGD appear able to identify bereaved persons at heightened risk for enduring distress and dysfunction. The results support the psychometric validity of the criteria for PGD that we propose for inclusion in DSM-V and ICD-11. Please see later in the article for Editors' Summary.
Collapse
Affiliation(s)
- Holly G Prigerson
- Department of Psychiatry, Brigham and Women's Hospital, Boston, Massachusetts, United States of America.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
34
|
Evans SR, Clifford DB, Kitch DW, Goodkin K, Schifitto G, McArthur JC, Simpson DM. Simplification of the research diagnosis of HIV-associated sensory neuropathy. HIV Clin Trials 2009; 9:434-9. [PMID: 19203909 DOI: 10.1310/hct0906-434] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Peripheral neuropathy (PN) is the most common neurological complication of HIV infection,affecting over one third of patients. The research diagnosis of PN is complicated by the need for expensive, time-consuming, and noxious diagnostic tests. We investigated whether nerve conduction studies (NSC) and quantitative sensory tests (QST) provide added value for the diagnosis of PN for research purposes or whether the easily obtainable clinical measures (sensory and motor symptoms, sensitivity to pain and vibration, tendon reflexes, motor function) are sufficient.
Collapse
Affiliation(s)
- Scott R Evans
- Harvard School of Public Health, Boston, Massachusetts 02115, USA.
| | | | | | | | | | | | | |
Collapse
|
35
|
|
36
|
Antinori A, Arendt G, Becker JT, Brew BJ, Byrd DA, Cherner M, Clifford DB, Cinque P, Epstein LG, Goodkin K, Gisslen M, Grant I, Heaton RK, Joseph J, Marder K, Marra CM, McArthur JC, Nunn M, Price RW, Pulliam L, Robertson KR, Sacktor N, Valcour V, Wojna VE. Updated research nosology for HIV-associated neurocognitive disorders. Neurology 2007; 69:1789-99. [PMID: 17914061 PMCID: PMC4472366 DOI: 10.1212/01.wnl.0000287431.88658.8b] [Citation(s) in RCA: 1898] [Impact Index Per Article: 111.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
In 1991, the AIDS Task Force of the American Academy of Neurology published nomenclature and research case definitions to guide the diagnosis of neurologic manifestations of HIV-1 infection. Now, 16 years later, the National Institute of Mental Health and the National Institute of Neurological Diseases and Stroke have charged a working group to critically review the adequacy and utility of these definitional criteria and to identify aspects that require updating. This report represents a majority view, and unanimity was not reached on all points. It reviews our collective experience with HIV-associated neurocognitive disorders (HAND), particularly since the advent of highly active antiretroviral treatment, and their definitional criteria; discusses the impact of comorbidities; and suggests inclusion of the term asymptomatic neurocognitive impairment to categorize individuals with subclinical impairment. An algorithm is proposed to assist in standardized diagnostic classification of HAND.
Collapse
Affiliation(s)
- A Antinori
- Clinical Department, National Institute for Infectious Diseases Lazzaro Spallanzani, Instituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
37
|
Zhou L, Kitch DW, Evans SR, Hauer P, Raman S, Ebenezer GJ, Gerschenson M, Marra CM, Valcour V, Diaz-Arrastia R, Goodkin K, Millar L, Shriver S, Asmuth DM, Clifford DB, Simpson DM, McArthur JC. Correlates of epidermal nerve fiber densities in HIV-associated distal sensory polyneuropathy. Neurology 2007; 68:2113-9. [PMID: 17562831 DOI: 10.1212/01.wnl.0000264888.87918.a1] [Citation(s) in RCA: 95] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To demonstrate the relationship between epidermal nerve fiber density (ENFD) in the leg and the phenotype of HIV-associated distal sensory polyneuropathy (HIV-DSP) in a multicenter prospective study (ACTG A5117). METHODS A total of 101 HIV-infected adults, with CD4 cell count <300 cells/mm(3) and who had received antiretroviral therapy (ART) for at least 15 consecutive weeks, underwent standardized clinical and electrophysiologic assessment. All 101 subjects were biopsied at the distal leg (DL) and 99 at the proximal thigh (PT) at baseline. ENFD was assessed by skin biopsy using PGP9.5 immunostaining. Associations of ENFD with demographics, ART treatment, Total Neuropathy Score (TNS), sural sensory nerve action potential (SNAP) amplitude and conduction velocity, quantitative sensory testing (QST) measures, and neuropathic pain were explored. RESULTS ENFD at the DL site correlated with neuropathy severity as gauged by TNS (p < 0.01), the level of neuropathic pain quantified by the Gracely Pain Scale (GPS) (p = 0.01) and Visual Analogue Scale (VAS) (p = 0.01), sural SNAP amplitude (p < 0.01), and toe cooling (p < 0.01) and vibration (p = 0.02) detection thresholds. ENFD did not correlate with neurotoxic ART exposure, CD4 cell count, or plasma HIV-1 viral load. CONCLUSIONS In subjects with advanced HIV-1 infection, epidermal nerve fiber density (ENFD) assessment correlates with the clinical and electrophysiologic severity of distal sensory polyneuropathy (DSP). ENFD did not correlate with previously established risk factors for HIV-DSP, including CD4 cell count, plasma HIV-1 viral load, and neurotoxic antiretroviral therapy exposure.
Collapse
Affiliation(s)
- L Zhou
- Department of Neurology, Johns Hopkins University, Baltimore, MD 21287-7609, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
38
|
Vitiello B, Goodkin K, Ashtana D, Shapshak P, Atkinson JH, Heseltine PN, Eaton E, Heaton R, Lyman WD. HIV-1 RNA concentration and cognitive performance in a cohort of HIV-positive people. AIDS 2007; 21:1415-22. [PMID: 17589187 DOI: 10.1097/qad.0b013e328220e71a] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine whether higher viral concentrations in the cerebrospinal fluid (CSF) and/or peripheral blood were associated with greater severity of cognitive impairment in HIV-1-seropositive subjects with cognitive-motor impairment. METHODS Cognitive performance measurements and viral load were obtained from HIV-1-seropositive individuals with cognitive-motor impairment entering a clinical trial before the introduction of highly active antiretroviral therapy (HAART). CSF viral load (UltraSensitive Roche HIV-1 Monitor test with detection limit of 50 copies/ml) was available from 179 patients, and peripheral (plasma or serum) viral load from 111 patients. Of these patients, 62% met the 1993 Centers for Disease Control (CDC) criteria for AIDS, and 19% had clinically significant cognitive impairment (i.e., global deficit score > or = 0.5). Possible associations between viral load and cognitive scores were examined with general linear regression models with and without adjustment for age, education, study site, antiretroviral use, CD4 cell count, and CDC stage. RESULTS The mean CSF viral load was 2.83 log(10)/ml +/- 0.94 (SD) (undetectable in 19.5%). Mean peripheral viral load was 4.11 log(10)/ml +/- 0.90 (SD). No statistically significant associations emerged between either CSF or peripheral viral load and the global deficit score, or any of the seven cognitive domain deficit scores. CONCLUSIONS Among these HIV-1-sero-positive individuals with mainly minor HIV-1-associated cognitive deficits and not receiving HAART, no association between CSF or blood concentration of HIV-1 RNA and cognitive performance could be found. These results suggest that the severity of HIV-1-associated cognitive impairment is not directly related to concurrent viral concentration in the CSF or the peripheral blood.
Collapse
|
39
|
Sachdeva N, Yoon HS, Oshima K, Garcia D, Goodkin K, Asthana D. Biochip array-based analysis of plasma cytokines in HIV patients with immunological and virological discordance. Scand J Immunol 2007; 65:549-54. [PMID: 17523947 DOI: 10.1111/j.1365-3083.2007.01906.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Assessment of cytokines in body fluids or cells provides important information in understanding the disease process and designing treatment strategies. Recent introduction of antibody-based protein arrays have provided investigators simultaneous and specific detection of multiple analytes in a single sample using minimum volumes. In this study, we used a biochip array system capable of measuring 12 cytokines and growth factors (IL-2, IL-4, IL-6, IL-8, IL-10, IL-1alpha, IL-1beta, IFN-gamma, TNF-alpha, monocyte chemoattractant protein-1 (MCP-1), vascular endothelial growth factor (VEGF) and epidermal growth factor (EGF)) in HIV patients with immunological and virological discordance (discordant) to find out differences if any, in their plasma cytokine profiles when compared with concordant HIV-infected individuals. A sandwich chemiluminescent assay was performed with plasma specimens of 110 HIV patients (55 discordant, 55 concordant) and 22 normal healthy individuals followed by enzyme-linked immunosorbent assay (ELISA) to the confirm levels of cytokines and growth factors that showed significant differences in the two groups. The discordant HIV patients showed significantly higher levels of plasma VEGF (P = 0.001) and EGF (P = 0.034) levels when compared with concordant patients. Overall, the patients showed significantly higher levels of TNF-alpha, MCP-1 and VEGF when compared with the normal healthy controls (P < 0.05). ELISA for VEGF (P < 0.001) and EGF (P = 0.004) confirmed the comparison obtained with biochip array, between the discordant and concordant patients. The results of cytokine quantitation by biochip array and ELISA confirmed that this technology is not only comparable but also has a good potential in the future applications involving measurement of multiple cytokines with limiting specimens.
Collapse
Affiliation(s)
- N Sachdeva
- Laboratory for Clinical and Biological Studies, University of Miami-Miller School of Medicine, Miami, FL 33136, USA
| | | | | | | | | | | |
Collapse
|
40
|
Affiliation(s)
- Dinesh Singh
- HIV Prevention Research Unit, South African Medical Research Council, Durban, South Africa
| | | |
Collapse
|
41
|
Affiliation(s)
- Dinesh Singh
- HIV Prevention Research Unit, South African Medical Research Council, Durban, South Africa
| | | |
Collapse
|
42
|
Kumar AM, Fernandez JB, Schneiderman N, Goodkin K, Eisdorfer C, Kumar M. SIMULTANEOUS DETERMINATION OF 5-HYDROXYTRYPTAMINE, 5-HYDROXY-TRYPTOPHAN, 5-HYDROXYINDOLEACETIC ACID, DOPAMINE, AND HOMOVANILLIC ACID IN WHOLE BLOOD, USING ISOCRATIC HPLC WITH ELECTROCHEMICAL DETECTION. J LIQ CHROMATOGR R T 2007. [DOI: 10.1081/jlc-100101796] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Adarsh M. Kumar
- a Department of Psychiatry and Behavioral Sciences , University of Miami School of Medicine , P. O. Box 016960, Miami , FL , 33101 , U.S.A
| | - Jesus B. Fernandez
- a Department of Psychiatry and Behavioral Sciences , University of Miami School of Medicine , P. O. Box 016960, Miami , FL , 33101 , U.S.A
| | - Neil Schneiderman
- b Department of Neurology , University of Miami School of Medicine , P. O. Box 016960, Miami , FL , 33101 , U.S.A
| | - Karl Goodkin
- a Department of Psychiatry and Behavioral Sciences , University of Miami School of Medicine , P. O. Box 016960, Miami , FL , 33101 , U.S.A
| | - Carl Eisdorfer
- a Department of Psychiatry and Behavioral Sciences , University of Miami School of Medicine , P. O. Box 016960, Miami , FL , 33101 , U.S.A
| | - Mahendra Kumar
- a Department of Psychiatry and Behavioral Sciences , University of Miami School of Medicine , P. O. Box 016960, Miami , FL , 33101 , U.S.A
| |
Collapse
|
43
|
Fujimura RK, Khamis I, Shapshak P, Goodkin K. Regional quantitative comparison of multispliced to unspliced ratios of HIV-1 RNA copy number in infected human brain. ACTA ACUST UNITED AC 2006; 2:45-60. [PMID: 16873205 DOI: 10.1300/j128v02n04_04] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Infection of the brain by HIV-1 often results in cognitive- motor disorders, the most severe form being HIV-1 associated dimentia (HAD). However, the etiology and pathogenesis of neuroAIDS at the molecular level is still not fully understood and controversial issues remain, including the significance of abortive infection and localized viral load. This paper proposes that quantitative comparison of HIV-1 proviral and RNAloads across the brain will clarify some of these issues. It was hypothesized that there are differences in ratios of multispliced and unspliced HIV RNA in different regions of brain by analogy with prior findings of brain regional differences in virus and strains of HIV-1. A competitive RT-PCR method was used to compare ratios of multispliced to unspliced HIV-1 RNA's across brain regions of one case with HAD. Statistical analysis results showed that data obtained by repeated assays for each RNA preparation were not significantly different. Significant differences were detected between specimens obtained from different regions of the brain. The ratio of MS/US RNA in the frontal lobe was significantly greater than in the basal ganglia, medial temporal lobe, and another site in the temporal lobe. It must be noted that our approach has been the analysis of macroscopic brain regions separated by several centimeters; future studies will analyze microscopic analysis of these brain regions. The current study was preformed to produce results on gross differences in neuroanatomical locations at cm distances. Future studies will be performed to compare different regions with microscopic anatomic specificity.
Collapse
Affiliation(s)
- Robert K Fujimura
- Geriatric Research, Education, Clinical Center, Veterans Administration Medical Center, and the Department of Psychiatry and Behavioral Sciences, University of Miami School of Medicine, FL 33125, USA.
| | | | | | | |
Collapse
|
44
|
Goodkin K, Vitiello B, Lyman WD, Asthana D, Atkinson JH, Heseltine PNR, Molina R, Zheng W, Khamis I, Wilkie FL, Shapshak P. Cerebrospinal and peripheral human immunodeficiency virus type 1 load in a multisite, randomized, double-blind, placebo-controlled trial of D-Ala1-peptide T-amide for HIV-1-associated cognitive-motor impairment. J Neurovirol 2006; 12:178-89. [PMID: 16877299 DOI: 10.1080/13550280600827344] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
D-Ala1-peptide T-amide (DAPTA) has shown neuroprotection in vitro against gp120-induced loss of dendritic arborization and is promulgated as a CCR5 antagonist. A multisite, randomized, double-blind clinical trial of DAPTA versus placebo prior to combination antiretroviral therapy conducted with human immunodeficiency virus (HIV)-1 seropositive participants having cognitive impairment showed no overall cognitive effect, though subgroups with greater impairment and CD4 cell counts of 201 to 500 cells/mm3 at baseline showed significant improvement. The objective of this study was to examine whether intranasal administration of DAPTA at a dose of 2 mg three times per day (tid) was associated with a reduction of cerebrospinal fluid (CSF) and peripheral (plasma and serum) viral load among a subgroup of participants completing 6 months of treatment. Baseline and 6-month CSF (n = 92) and peripheral (plasma n = 33; serum n = 24) viral load were measured by the Roche Ultrasensitive assay, version 1.5, with reflexive use of the AMPLICOR assay and preservation of the blind. A DAPTA treatment indicator variable was tested using generalized linear models on change in viral load. Peripheral load (combined plasma and serum) was significantly reduced in the DAPTA-treated group. No group differences in CSF viral load were found. This retrospective study on a limited subgroup of the original trial sample indicated that DAPTA treatment may reduce peripheral viral load without concomitant CSF effects. Future studies should be undertaken to confirm the existence of this result and the CSF-periphery dissociation observed with respect to HIV-1-associated cognitive-motor impairment.
Collapse
Affiliation(s)
- Karl Goodkin
- Department of Psychiatry and Behavioral Sciences, University if Miami School of Medicine, Miami, Florida 33136, USA.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
45
|
|
46
|
Kumar AM, Fernandez JB, Goodkin K, Schneiderman N, Eisdorfer C. An Isocratic Concurrent Assay of Free Metabolites, 4-Hydroxy-3-methoxy Mandelic Acid, 3-Methoxy-4-hydroxy-phenylglycol, Normetanephrine, Metanephrine, and 5-Hydroxy-Indoleacetic Acid in Same Sample of Urine Extract Using HPLC-ECD. J LIQ CHROMATOGR R T 2006. [DOI: 10.1080/10826079708005553] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Adarsh M. Kumar
- a Departments of Psychiatry and Behavioral Sciences and Behavioral Medicine Research Center , University of Miami School of Medicine , P.O. Box 016960, Miami, FL, 33101
| | - Jesus B. Fernandez
- a Departments of Psychiatry and Behavioral Sciences and Behavioral Medicine Research Center , University of Miami School of Medicine , P.O. Box 016960, Miami, FL, 33101
| | - Karl Goodkin
- a Departments of Psychiatry and Behavioral Sciences and Behavioral Medicine Research Center , University of Miami School of Medicine , P.O. Box 016960, Miami, FL, 33101
| | - Neil Schneiderman
- a Departments of Psychiatry and Behavioral Sciences and Behavioral Medicine Research Center , University of Miami School of Medicine , P.O. Box 016960, Miami, FL, 33101
| | - Carl Eisdorfer
- a Departments of Psychiatry and Behavioral Sciences and Behavioral Medicine Research Center , University of Miami School of Medicine , P.O. Box 016960, Miami, FL, 33101
| |
Collapse
|
47
|
Simpson DM, Kitch D, Evans SR, McArthur JC, Asmuth DM, Cohen B, Goodkin K, Gerschenson M, So Y, Marra CM, Diaz-Arrastia R, Shriver S, Millar L, Clifford DB. HIV neuropathy natural history cohort study: assessment measures and risk factors. Neurology 2006; 66:1679-87. [PMID: 16769940 DOI: 10.1212/01.wnl.0000218303.48113.5d] [Citation(s) in RCA: 121] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Distal sensory polyneuropathy (DSP) is the most common neurologic complication of human immunodeficiency virus (HIV) infection. Risk factors for DSP have not been adequately defined in the era of highly active antiretroviral therapy. METHODS The authors evaluated 101 subjects with advanced HIV infection over 48 weeks. Assessments included a brief peripheral neuropathy (PN) screen (BPNS), neurologic examination, nerve conduction studies, quantitative sensory testing (QST), and skin biopsies with quantitation of epidermal nerve fiber density. Data were summed into a Total Neuropathy Score (TNS). The presence, severity, and progression of DSP were related to clinical and laboratory results. RESULTS The mean TNS (range 0 to 36) was 8.9, with 38% of subjects classified as PN-free, 10% classified as having asymptomatic DSP, and 52% classified as having symptomatic DSP. Progression in TNS from baseline to week 48 occurred only in the PN-free group at baseline (mean TNS change = 1.16 +/- 2.76, p = 0.03). Factors associated with progression in TNS were lower current TNS, distal epidermal denervation, and white race. As compared with the TNS diagnosis of PN at baseline, the BPNS had a sensitivity of 34.9% and a specificity of 89.5%. CONCLUSIONS In this cohort of advanced human immunodeficiency virus (HIV)-infected subjects, distal sensory polyneuropathy was common and relatively stable over 48 weeks. Previously established risk factors, including CD4 cell count, plasma HIV RNA, and use of dideoxynucleoside antiretrovirals were not predictive of the progression of distal sensory polyneuropathy (DSP). Distal epidermal denervation was associated with worsening of DSP. As compared with the Total Neuropathy Score, the brief peripheral neuropathy screen had relatively low sensitivity and high specificity for the diagnosis of DSP.
Collapse
|
48
|
Fujimura RK, Shapshak P, Goodkin K, Petito CK. Re: Distribution of brain HIV load in AIDS, Wiley CA et al., Brain Pathology 8: 277-284, 1998. Brain Pathol 2006; 8:811-2. [PMID: 9804386 PMCID: PMC8098163 DOI: 10.1111/j.1750-3639.1998.tb00203.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
|
49
|
Clifford DB, Evans S, Yang Y, Acosta EP, Goodkin K, Tashima K, Simpson D, Dorfman D, Ribaudo H, Gulick RM. Impact of efavirenz on neuropsychological performance and symptoms in HIV-infected individuals. Ann Intern Med 2005; 143:714-21. [PMID: 16287792 DOI: 10.7326/0003-4819-143-10-200511150-00008] [Citation(s) in RCA: 186] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Efavirenz is a commonly used antiretroviral drug that causes neurologic side effects in more than 50% of patients. OBJECTIVE To characterize efavirenz-associated neurologic symptoms in a randomized, controlled study of initial antiretroviral treatment. DESIGN Substudy of a randomized, double-blind, controlled trial of combination antiretroviral regimens (A5095) that was performed between March 2001 and January 2002. SETTING Multicenter academic clinical trial units. PARTICIPANTS HIV-infected patients who were initiating therapy in the context of a controlled trial. MEASUREMENTS Neuropsychological performance measures, including the Digit Symbol Substitution Test and the Trail Making Test (Parts A and B); symptom questionnaires; standardized assessments of sleep quality, anxiety, and depression; and efavirenz plasma concentrations. RESULTS Twenty of 303 (6.6%) enrolled participants prematurely discontinued the study. Neuropsychological performance improved in both groups over time without significant differences between patients who were receiving efavirenz and those who were not. The efavirenz group experienced more neurologic symptoms at week 1 (P < 0.001) but not at weeks 4, 12, or 24. A sleep index revealed that participants receiving efavirenz had more "bad dreams" during the first week of therapy (P = 0.038). No significant changes in anxiety or depressed mood were noted. Changes in efavirenz-associated neurologic symptoms were correlated to efavirenz plasma concentrations at week 1 but not at later time points. Twelve (6%) patients receiving efavirenz stopped taking the drug before the end of the study because of central nervous system symptoms. LIMITATIONS Participant selection may have been biased in favor of patients with fewer psychiatric complications. The study design permitted substitution of a new drug in place of efavirenz in cases of treatment-limiting toxicity. CONCLUSIONS In a large controlled trial, efavirenz use was associated with neurologic symptoms distinct from depression and anxiety that began early in therapy but resolved by week 4. Improvement in neuropsychological performance was comparable in patients who were receiving efavirenz and those who were not.
Collapse
Affiliation(s)
- David B Clifford
- Washington University School of Medicine, Neurology Department, St. Louis, Missouri 63110, USA
| | | | | | | | | | | | | | | | | | | |
Collapse
|
50
|
Tiersma ESM, van der Lee ML, Garssen B, Peters AAW, Visser AP, Fleuren GJ, van Leeuwen KM, le Cessie S, Goodkin K. Psychosocial factors and the course of cervical intra-epithelial neoplasia: a prospective study. Gynecol Oncol 2005; 97:879-86. [PMID: 15894367 DOI: 10.1016/j.ygyno.2005.03.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2004] [Revised: 12/24/2004] [Accepted: 03/02/2005] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To investigate the influence of psychosocial factors on the course of cervical intra-epithelial neoplasia (CIN). METHODS A group of 93 patients with CIN 1 or 2 was followed for 2.25 years by half-yearly colposcopy and cytology. Negatively-rated life events, social support, and coping style were studied in relation to distress during follow-up and in relation to time till progression and regression of CIN. Human papillomavirus (HPV) infection was controlled for as well as sick role bias caused by suspicion of having cervical cancer and distress due to the abnormal cervical smear. RESULTS During follow-up, progression was found in 20 patients (22%), stable disease in 22 patients (24%), and regression in 51 patients (55%). Negatively-rated life events and lack of social support predicted distress longitudinally. No association was found between progression or regression of CIN and negatively-rated life events, lack of social support, coping style, and distress. CONCLUSION We found no evidence that psychosocial factors influence the course of CIN.
Collapse
Affiliation(s)
- E S M Tiersma
- Helen Dowling Institute, Center for Psycho-oncology, Utrecht, The Netherlands.
| | | | | | | | | | | | | | | | | |
Collapse
|