Abstracts

We investigated the association between the presence of HIV-1 associated minor cognitive-motor disorder (MCMD) (AAN, 1991), impairment on the Figural Visual Scanning Task (FVST), which measures information processing speed (Wilkie et al, 1990), and performance on the Mini-Mental Status Examination (MMSE) (Folstein et al., 1975) with self-reported and interviewer-defined cocaine use and use disorder (First et al., 1995) measures. Subjects were homosexual men having sustained the loss of a significant other in the prior six months who were at the baseline assessment of a randomized clinical trial of a bereavement support group intervention (Goodkin et al., 1999). Subjects with MCMD also had confirmation of decreased functional status by the Sickness Impact Profile (Bergner et al., 1981).

Among 123 HIV-1+ subjects, 44 had MCMD and 79 did not meet MCMD criteria. HIV associated dementia was an exclusion criterion. Controlling for age, educational level, and psychological distress, there was an association between lifetime history of cocaine use and the presence of MCMD with higher risk for MCMD being associated with higher cocaine use. Cocaine dependence also showed a trend toward an increased risk for MCMD. For the Figural Visual Scanning Task (FVST) outcome, the N was 205, including HIV-1- subjects. Lifetime cocaine use similarly showed a significant association with increased likelihood of impairment. In a separate analysis, a trend toward this association being modified by HIV-1 serostatus was observed. In contrast to the results with MCMD, cocaine abuse disorder showed a statistically significant increase in risk for impaired performance on the FVST. Cocaine dependence also showed a trend in this direction, as above with MCMD. These analyses showed that both the effect of abuse disorder and the trend with dependence were modified by HIV-1 serostatus.

For the MMSE score, no statistically significant effects were observed, though trends were uncovered in the same direction for cocaine use over the prior six months and for a history of abuse or dependence. We conclude that we have obtained preliminary evidence to support the hypotheses that increased level of cocaine use and the presence of use disorders are associated with deleterious effects documented with the three cognitive outcome measures tested. In order to have more definitive evidence of these associations, it would be necessary to conduct a larger study allowing for entry of more impaired individuals to increase the statistical power and to control for antiretroviral medication usage, ethnicity, closed head trauma history, history of non-substance use psychopathology, pain, fatigue (and constitutional symptoms more generally), motivation, sensory impairment, and level/use disorder of other psychoactive substances.

References

1. American Academy of Neurology. Nomenclature and research case definitions for neurological manifestations of human immunodeficiency virus Type-1 (HIV-1) infection. Neurology 1991;41:778-785.

2. Bergner M, Bobbitt RA, Carter WB, Gilson BS. The Sickness Impact Profile development and final revision of a health status measure. Med Care 1981; 19:787-805.

3. First MB, Spitzer RL, Gibbon M, Williams JBW: Structured Clinical Interview for DSM-IV Axis I Disorders. Biometric Research Dept., NY State Psychiatric Institute: NY, 1995.

4. Folstein, MF, Folstein, SE, and McHugh, PR. "Mini Mental State": A practical method for grading the mental status of patients for the clinician. Journal of Psychiatry Research, 1975; 12: 189-198.

5. Goodkin K, Blaney NT, Feaster DJ, Baldewicz T, Burkhalter JE, Leeds B: A randomized controlled trial of a bereavement support group intervention in human immunodeficiency virus type 1-seropositive and seronegative homosexual men. Arch Gen Psychiatry 1999; 55(1):52-59.

6. Wilkie FL, Eisdorfer C, Morgan R et al: Cognition in early human immunodeficiency virus infection. Arch Neurol 1990;47:433-440.

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