Charles H. Hinkin

Neuropsychological deficits in abstinent cocaine abusers: preliminary findings after two weeks of abstinence

Sixteen subjects hospitalized for treatment of cocaine dependence were administered a battery of neuropsychological tests within 72 h of last cocaine use and again approximately 2 weeks later. Twenty-one non-cocaine using control subjects, matched for age, gender, ethnicity and education, also received neuropsychological testing. Abstinence from mood altering substances during the 2-week study period was verified for both groups on three occasions using quantitative urine analysis. The results suggest that recent cocaine use is associated with impairment in memory, visuospatial abilities, and concentration during the acute phase of withdrawal, independent of withdrawal-related depression. Furthermore, many of these deficits appear to persist at least 2 weeks beyond cessation of cocaine use.

Frontal/Subcortical Features of Normal Aging: An Empirical Analysis

There has been considerable speculation relating the neuroanatomic changes during normal aging with corresponding neuropsychological sequelae. This paper examines the empirical support for the hypothesis that the greatest structural changes in normal aging occur in the frontal-subcortical axis, and that these produce a similar pattern of neuropsychological performance to that seen in younger individuals with subcortical damage. In this study, 14 normal elderly, 12 younger patients with HIV encephalopathy, and 14 young neurologically intact control subjects were studied with a neuropsychological test battery. The results demonstrated that the normal elderly and HIV encephalopathy patients evidenced a strong similarity in both level and pattern of neuropsychological performance despite their considerable age disparity. These results support the notion that normal aging differentially affects functions subserved by frontal-subcortical brain regions.

Visuospatial and Attentional Abilities Predict Driving Simulator Performance Among Older HIV-infected Adults

Objectives: To examine the effects of aging and neuropsychological (NP) impairment on driving simulator performance within a human immunodeficiency virus (HIV)-infected cohort. Methods: Participants included 79 HIV-infected adults (n = 58 > age 50, n = 21 ≤ 40) who completed a NP battery and a personnel computer-based driving simulator task. Outcome variables included total completion time (time) and number of city blocks to complete the task (blocks). Results: Compared to the younger group, the older group was less efficient in their route finding (blocks over optimum: 25.9 [20.1] vs 14.4 [16.9]; P = .02) and took longer to complete the task (time: 1297.6 [577.6] vs 804.4 [458.5] seconds; P = .001). Regression models within the older adult group indicated that visuospatial abilities (blocks: b = −0.40, P <.001; time: b = −0.40, P = .001) and attention (blocks: b = −0.49, P = .001; time: b = −0.42, P = .006) independently predicted simulator performance. The NP-impaired group performed more poorly on both time and blocks, compared to the NP normal group. Conclusions: Older HIV-infected adults may be at risk of driving-related functional compromise secondary to HIV-associated neurocognitive decline.

A clinical comparison of two forms of the card sorting test

Abstract This study examined 67 older adults with dementia and 157 predominantly younger individuals with HIV-1 infection to determine the comparability of two commonly used forms of the Card Sorting Test: the traditional Wisconsin Card Sorting Test (WCST) and Nelsons Modified Card Sorting Test (MCST). Three frequently used clinical outcome measures were examined: the total number of categories achieved; the ratio of perseverative errors to total trials; and the number of failures to maintain set exhibited in the protocol. Our results indicated that when the number of perseverative errors relative to total trials is used as a clinical indicator, the WCST and MCST appear to be comparable. For the number of categories achieved, the forms appear comparable only in the non-elderly, non-demented sample. Finally, we did not find comparable results between the two forms for the number of failures to maintain set.

Operationalization of the updated diagnostic algorithm for classifying HIV-related cognitive impairment and dementia.

BACKGROUND This study applies the updated HIV-Associated Neurocognitive Disorders (HAND) diagnostic algorithm. METHODS Participants were 210 HIV-infected-adults, classified using proposed HAND criteria: HIV-Associated Dementia (HAD), Mild Neurocognitive Disorder (MND), Asymptomatic Neurocognitive Impairment (ANI). RESULTS The algorithm yielded: normal = 32.8%, ANI = 21.4%, MND = 34.3%, and HAD = 11.4%. Normal participants performed superior to HAND-defined participants on cognition, and HAD participants performed more poorly on global cognition and executive functioning. Two distinct subgroups of interest emerged: (1) functional decline without cognitive impairment; (2) severe cognitive impairment and minimal functional compromise. CONCLUSIONS The algorithm discriminates between HIV-infected cognitively impaired individuals. Diagnosis yields two unique profiles requiring further investigation. Findings largely support the algorithms utility for diagnosing HIV-cognitive-impairment, but suggest distinct subsets of individuals with discrepant cognitive/functional performances that may not be readily apparent by conventional application of HAND diagnosis.

Long-term effects of high-dose zidovudine treatment on neuropsychological performance in mildly symptomatic HIV-positive patients: Results of a randomized, double-blind, placebo-controlled investigation

This study examined the treatment outcome of high-dose (1500 mg/day) zidovudine (AZT) on neuropsychological (NP) functioning (Trailmaking Test A & B, WAIS-R Digit Symbol, and Rey Auditory Verbal Learning Test) across a 12-month period in mildly symptomatic HIV-1 seropositive men (n = 46 at entry) enrolled in a randomized, double-blind, placebo-controlled trial (VA Cooperative Studies Program #298). Neither short-term (0-6 months) nor long-term (0-12 months) AZT administration revealed enhancement in NP performance. The results suggest that, although AZT may afford patients prophylactic benefits, protracted high-dose AZT treatment does not improve NP functioning in mildly symptomatic HIV-positive individuals.