Jean Wilkins

HIV-infected subjects with the E4 allele for APOE have excess dementia and peripheral neuropathy

HIV produces a chronic viral infection of the central nervous system that elicits chronic glial activation and overexpression of glial cytokines1–5 that are also implicated in Alzheimer disease (AD) pathogenesis6–11. A genetic risk factor for AD is the E4 isoform for apolipoprotein E (APOE)12,13. Here we compare the frequency of neurologic symptoms for subjects with and without the E4 isoform (E4(+)and E4(–), respectively) in an HIV cohort14–17. Compared with E4(–) subjects, twice as many E4(+) subjects were demented (30% compared with 15%) or had peripheral neuropathy (70% compared with 39%) at least once, and they had threefold more symptomatic examinations (13% compared with 3% and 42% compared with 14%, respectively)(P < 0.0001). Thus, neurologic symptoms for HIV-infection and AD are linked through an etiologic risk factor. Long-term survivors of HIV infection with E4 may be at high risk for AD; conversely, gene–viral interactions may speed AD pathogenesis.

DRIVER RISK FACTORS FOR SLEEP-RELATED CRASHES

A population-based case-control study was carried out to examine driver risk factors for sleep-related motor vehicle crashes. Cases included 312 drivers involved in recent North Carolina crashes and identified on police reports as asleep at the time of the crash and 155 drivers identified as fatigued. Controls were 529 drivers also involved in recent crashes but not identified as asleep or fatigued, and 407 drivers not involved in recent crashes. All drivers were contacted for brief telephone interviews. Results showed that drivers in sleep-related crashes were more likely to work multiple jobs, night shifts, or other unusual work schedules. They averaged fewer hours sleep per night, reported poorer quality sleep, were less likely to feel they got enough sleep, were sleepier during the day, drove more often late at night, and had more prior instances of drowsy driving. Compared to drivers in non-sleep-related crashes, they had been driving for longer times, been awake more hours, slept fewer hours the night before, and were more likely to have used soporific medications. Knowledge of specific risk factors for sleep-related crashes is an important first step in reducing the thousands of deaths and injuries each year in the US attributed to drowsy driving.

The correlation between neuropsychological and neuroanatomic changes over time in asymptomatic and symptomatic HIV-1-infected individuals.

To determine the relationship between neuroanatomic and neuropsychological changes in both asymptomatic and symptomatic HIV-1-infected individuals, we conducted a longitudinal study of 47 HIV-infected individuals, 15 of whom were asymptomatic and 32 of whom had either AIDS-related complex or AIDS. To measure neuroanatomic change over a 30-month period, we conducted quantitative MRI measures of bicaudate/brain ratio (BCR) and bifrontal/brain ratio. A comparison of change over time between BCR and neuropsychological performance showed a correlation between increase in atrophy and worsening in certain cognitive functions. The correlation held for both asymptomatic and symptomatic groups, with more pronounced changes in the symptomatic group. NEUROLOGY 1996;46: 1697-1702

Organizational quality on the Rey-Osterrieth and Taylor Complex Figure Tests : A new scoring system

A new system for measuring organizational quality on the Complex Figure Test (Rey, 1942; Taylor, 1969) is described. This system extends the traditional use of the test as a measure of constructional ability and figural memory. The new system is easy to learn, quick to score, and shows very good interrater reliability. Organizational quality was found to correlate moderately with copy accuracy, half-hour recall, and percentage retained. In an initial application of the system (N = 63), organizational quality of the Rey-Osterrieth Complex Figure successfully discriminated between symptomatic (those with acquired immunodeficiency syndrome [AIDS] or AIDS-related complex [ARC]) and asymptomatic subjects positive for human immunodeficiency virus (HIV), but organizational quality ratings of the Taylor figure did not

Explicit scoring criteria for the Rey-Osterrieth and Taylor complex figures

Abstract Explicit scoring criteria based on the Taylor-Osterrieth method were developed for the Rey-Osterrieth and Taylor Complex Figure Tests. Without such criteria, clinicians and researchers are left to develop their own idiographic scoring systems, leading to low interrater reliability, especially in the middle range of scores. Criteria were applied to the copy and 30-min recall protocols of 101 subjects infected with HIV. Results indicate that the criteria presented are reliable across a wide range of scores, making them useful for tracking subtle changes over time. Independent raters were within two points of each other on 90.1 % of the copy and 88.1% of recall scores, with a maximum disagreement of five points on two copy protocols. The Taylor figure was also found to be more easily remembered than the Rey-Osterrieth, calling into question their interchangeability. Explicit criteria are particularly useful in research settings. They ensure interrater reliability over time and across examiners in lo...

Human visual function in the North Carolina clinical study on possible estuary-associated syndrome.

The U.S. Environmental Protection Agency assisted the North Carolina Department of Health and Human Services in conducting a study to investigate the potential for an association between fish kills in the North Carolina estuary system and the risk for persistent health effects. Impetus for the study was recent evidence suggesting that estuarine dinoflagellates, including members of the toxic Pfiesteria complex (TPC), P. piscicida and P. schumwayae, may release a toxin(s) that kills fish and adversely affects human health. This report describes one component of the study in which visual system function was assessed. Participants working primarily in estuaries inhabited by TPC or in offshore waters thought not to contain TPC were studied. The potentially exposed estuary (n = 22) and unexposed offshore (n = 20) workers were matched for age, gender, and education. Visual acuity did not differ significantly between the cohorts, but visual contrast sensitivity (VCS), an indicator of visual pattern-detection ability for stimuli of various sizes, was significantly reduced by about 30% in the estuary relative to the offshore cohort. A further analysis that excluded participants having a history possibly predictive of neuropsychological impairment showed a similar VCS reduction. Additional analyses indicated that differences between the cohorts in age, education, smoking, alcohol consumption, and total time spent on any water did not account for the difference in VCS. Exploratory analyses suggested a possible association between the magnitude of VCS reduction and hours spent in contact with a fish kill. The profile of VCS deficit across stimulus sizes resembled that seen in organic solvent-exposed workers, but an assessment of occupational solvent, and other neurotoxicant, exposures did not indicate differences between the cohorts. These results suggest that factor(s) associated with the North Carolina estuaries, including the possibility of exposure to TPC toxin(s), may impair visual system function.

PREMATURE REDUCTION AND CESSATION OF DRIVING: PRELIMINARY STUDY OF WOMEN WHO CHOOSE NOT TO DRIVE OR TO DRIVE INFREQUENTLY

Some senior women prematurely stop or markedly reduce their driving. Although not restricted by medical or financial limitations, they drive infrequently or not at all. Through focus groups, a sample of these women were asked why they limit their driving, how they feel about their current mobility, and whether they have considered a future when they might need to drive more. On-road driving evaluations assessed their driving abilities. This research suggests that some of these senior women want to drive more and can do so capably. On-road assessments and refresher lessons may be effective interventions for them.

Psychoimmunology and aids: Psychological distress and herpes simplex virus in human immunodeficiency virus infected individuals

Abstract No studies investigating the relationship of herpesviruses and psychological distress in Human Immunodeficiency Virus (HIV) infection are available in the literature. Antibody titers for Cytomegalovirus (CMV), Epstein-Barr (EBV) and Herpes Simplex virus (HSV) were assessed from sera drawn at the lime of psychological testing for one hundred HIV seropositive subjects. Increased psychological distress was correlated with increased titers of antibody to HSV, but not to CMV or EBV. Psychological distress may play a role in the devastating HSV infections experienced by immune deficient individuals. A stress mediated reactivation/potentiation hypothesis is discussed, where distress reactivates latent HSV which in turn potentiates HIV replication. These results may have implications for treatment of individuals co-infected with HIV and HSV.

The Profile of Mood States as a Screening Test for Major Depression in HIV+ Patients

Major Depression is a common, potentially treatable disorder among people infected with the human immunodeficiency virus (HIV). An accurate screening test would allow primary care professionals to identify patients who need psychiatric evaluation and possible treatment. Subjects were 100 HIV+ volunteers evaluated at entry into a longitudinal neurologic study. Subjects were not selected for the presence or absence of psychiatric or neurologic symptoms. The Diagnostic Interview Schedule (DIS) was the “gold standard” for the diagnosis of current Major Depression. Our screening test was the Profile of Mood States (POMS). Logistic regression, followed by calculations of sensitivities and specificities, was used to determine the best use of the screening test. One third of the subjects met criteria for current Major Depression. The POMS Depression-Dejection Scale was a useful screening test with a cutoff score of ≥7. This cutoff correctly classified 92% of subjects with and 67% of subjects without current Major Depression.