A NOVEL-APPROACH TO THE DETERMINATION AND CHARACTERIZATION OF HIV DEMENTIA

Background: Neuropsychological studies of the pattern and extent of co gnitive impairment in HIV-infected patients have mostly used deviation s from control values and/or cut-off scores as criteria for classifica tion of dementia. There is, however, no agreement as to how to define impairment, and classification is imprecise. Method: The current study used a dementia classification matrix, developed with a step-wise lin ear discriminant analysis of neuropsychological data from patients wit h primary neurodegenerative dementias, to classify symptomatic HIV pat ients as demented or non-demented, and furher to differentiate cortica l and subcortical dementia patterns. Thirty-two male and 2 female pati ents (mean age 39 +/- 2) with symptomatic HIV disease (mean absolute C d4 count 195 +/- 41) participated in the study. Results: Thirty-fie pe r cent of patients were classified as demented. Of these, 83% showed a subcortical pattern and 17% a cortical profile of deficits. Significa nt differences between patients classified as subcortically demented a nd those categorized as normal on neuropsychological measures associat ed with subcortical integrity further validated the classification. Me asures of psychiatric status between subgroups were similar. Conclusio n: Since certain treatments may delay or reverse cognitive deficits, t he use of an objective classification method based on discriminant ana lysis may help to identify patients who may benefit from therapy.