Журнал «Актуальная инфектология» Том 9, №1, 2021
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Cognitive dysfunction in HIV patients
Авторы: Moskaliuk V.D., Boiko Iu.I.
Bukovinian State Medical University, Chernivtsy, Ukraine
Рубрики: Инфекционные заболевания
Разделы: Медицинские форумы
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Background. It is known that HIV-infected patients have cognitive impairment (memory, intelligence, learning), disorders of consciousness and attention, emotional and behavioral disorders up to severe CNS damage — HIV-associated dementia. It has been reported that 15 % of patients with AIDS have common symptoms of HIV-associated dementia. With the successful introduction of antiretroviral therapy (ART), HIV-associated dementia has become significantly less registered, but mild forms of cognitive impairment have begun to attract attention, affecting 50 % of people living with HIV. At present, given that people with HIV-positive status are aging, the number of people living with HIV (PLHIV) with symptoms of neurocognitive disorders is likely to increase. Purpose was to establish features of disorders of cognitive functions in patients with HIV infection.
Materials and methods. The study involved 116 HIV-infected people. All patients underwent neuropsychological examination. Formalized screening techniques with quantitative assessment of the obtained results were chosen, which allow to assess the main cognitive functions (memory, attention, language, visual-spatial functions and regulation of voluntary activity): scale of general cognitive impairment (GDS), short scale of mental status assessment (MMSE), frontal dysfunction battery, clock drawing test, test “Literal Associations”. For in-depth study of cognitive functions in the examined patients also used more detailed tests, which in addition to quantitative assessment allowed to conduct a qualitative analysis of the detected deviations, tests of learning 10 words, test 12 words of Grober and Bushke, Schulte test. The control group consisted of 39 practically healthy volunteers, whose average age was (33.8 ± 5.5) years, of which 23 (59.0 %) were men and 16 (41.0 %) were women. The same tests were offered as for HIV-infected patients. The survey was performed twice in order to obtain more accurate results. Mental condition was assessed using the minimum mental status assessment (MMSE). According to V.V. Zakharov, H.H. Yakhno (2005): the presence of 28–30 points characterizes the absence of cognitive impairment or mild cognitive impairment, 25–27 points — moderate cognitive impairment. This study included patients who had an MMSE (26.52 ± 0.64) score.
Results and discussion. It was found that in 26 patients (22.4 %) psychological testing revealed clinical signs of HIV-associated CNS damage in the form of a moderate decrease in neurocognitive functions. Other researchers point to a similar frequency of such disorders. The “Literary Associations” test found that HIV patients generally called fewer words per letter of the alphabet per minute than members of the comparison group. Thus, in III–IV clinical stages of HIV infection (91.7 ± 5.6) % of patients were able to name no more than 10 words per minute, which significantly exceeded the number of relevant representatives of the control group — (10.3 ± 4.9) % (P < 0.001). The 10-word memorization test indicated that with the deepening of immunodeficiency, moderate memory impairment (memorization of no more than 5–6 words before the 3rd reproduction) is characteristic of as many as (37.5 ± 9.9) % of patients. However, none of the healthy individuals had such a memory impairment (P < 0.001). Grober and Bushke’s test (memorization of 12 words using a semantic hint; direct and delayed reproduction, with a hint and without a hint) allowed to divide memory disorders in patients of the compared groups into amnestic and non-amnestic. According to the results of this test, it was found that memory impairments were more common in patients with HIV infection, with a predominance of non-amnestic disorders in HIV infection — (75.0 ± 8.8) %, which was statistically significantly higher than the number of relevant representatives comparison groups — (23.1 ± 6.7) % (P < 0.001). According to the results of testing on the scale of general depravation of cognitive functions (GDS) in patients did not show significant cognitive deficits, but HIV-infected with severe immunodeficiency in more cases corresponded to stage 3 GDS than the control group (P < 0.001). Significant deviations of cognitive functions in HIV patients were also found according to the results of MMSE tests and battery frontal dysfunction (BPD). Differences in groups were obtained during the GDS test, clock drawing, Schulte test.
Conclusions. Thus, with the deepening of immunodeficiency, a general deterioration of cognitive functions (GDS-test), short-term and operative memory, ability to concentrate, comprehension of spoken language, perception of speech by ear and in writing, praxis (short scale for assessing the mental status of MMSE) are established, such persons performed the clock drawing test worse and the Schulte test slower. Neuropsychological examination of HIV-infected patients and healthy individuals showed that patients perform significantly worse on the Schulte test, the test “Literary Associations”, that is mostly there is a violation of attention, mental pace, speed of speech. Also, people living with HIV are more likely to have visual-spatial disorders (according to the results of the clock drawing test) than healthy people and memory impairment. The last in most cases are secondary, as a result of impaired attention. The detected changes correspond to mild and moderate cognitive impairment of a neurodynamic nature. With the deepening of immunodeficiency, neurodynamic disorders increase mainly due to the slowing down of mental processes. At the same time weakening of attention and decrease in rate of speech activity change insignificantly. In addition, with the deepening of immunodeficiency, visual-spatial disorders and mnestic disorders increase.