Proton MRS and neuropsychological correlates in AIDS dementia complex: evidence of subcortical specificity.

TitleProton MRS and neuropsychological correlates in AIDS dementia complex: evidence of subcortical specificity.
Publication TypeJournal Article
Year of Publication2007
AuthorsPaul RH, Yiannoutsos CT, Miller EN, Chang L, Marra CM, Schifitto G, Ernst T, Singer E, Richards T, G Jarvik J, Price R, Meyerhoff DJ, Kolson D, Ellis RJ, Gonzalez G, Lenkinski RE, Cohen RA, Navia BA
JournalJ Neuropsychiatry Clin Neurosci
Volume19
Issue3
Pagination283-92
Date Published2007 Summer
ISSN0895-0172
KeywordsAIDS Dementia Complex, Antiparkinson Agents, Aspartic Acid, Basal Ganglia, Creatine, Female, Humans, Magnetic Resonance Spectroscopy, Male, Memantine, Memory, Motor Skills, Neuropsychological Tests, Protons, Retrospective Studies, Statistics, Nonparametric, Verbal Behavior
Abstract

Few studies have described the metabolic substrates underlying neuropsychological performance in HIV infection or examined the specificity of these relationships. The authors performed magnetic resonance spectroscopic and neuropsychological evaluations on 61 patients with AIDS dementia complex (stages 1-3) and 39 HIV-positive neurologically asymptomatic individuals. N-acetylaspartate, a marker of mature neurons, choline and myoinositol, both markers of gliosis, and creatine, a reference marker, were measured in the basal ganglia, frontal white matter, and parietal cortex. The neuropsychological evaluation consisted of tests that measured gross and fine motor skills, psychomotor function, information processing speed, and verbal memory. The authors examined performance on individual subtests and an aggregate Z score based on eight subtests (NPZ-8), adjusted for age and education. The NPZ-8 was significantly higher in subjects with greater N-acetylaspartate/creatine in the frontal white matter and was lower in subjects with higher myoinositol/creatine in the basal ganglia. Particularly strong associations were found between measures of gross and fine motor function, which correlated positively with N-acetylaspartate/creatine in the frontal white matter and negatively with myoinositol/creatine in the basal ganglia. Similarly, cognitive processing speed was negatively correlated with myoinositol/creatine in the basal ganglia. In contrast, there were no statistically significant relationships between brain metabolite levels in the parietal cortex and neuropsychological function. This study provides convincing evidence that neuropsychological impairment is associated with reduced markers of mature neurons and increased markers of gliosis in the basal ganglia and frontal white matter. Neural changes as reflected by these metabolite levels may prove useful in identifying individuals at risk for neuropsychological impairment. Prospective studies are needed to elucidate the evolution of these changes in the setting of antiretroviral therapy.

DOI10.1176/jnp.2007.19.3.283
Alternate JournalJ Neuropsychiatry Clin Neurosci
PubMed ID17827413
Grant List5-M01-RR-00722 / RR / NCRR NIH HHS / United States
AI38855 / AI / NIAID NIH HHS / United States
K23MH65857 / MH / NIMH NIH HHS / United States
NS36524 / NS / NINDS NIH HHS / United States
R01-NS-36524 / NS / NINDS NIH HHS / United States
R03-MH-60565 / MH / NIMH NIH HHS / United States
R03MH60565 / MH / NIMH NIH HHS / United States
U01-AI-35039 / AI / NIAID NIH HHS / United States
U01-AI-35040 / AI / NIAID NIH HHS / United States
U01-AI-35041 / AI / NIAID NIH HHS / United States
U01-AI-35042 / AI / NIAID NIH HHS / United States
U01-AI-35043 / AI / NIAID NIH HHS / United States
U01-AI-37613 / AI / NIAID NIH HHS / United States
U01-AI-37984 / AI / NIAID NIH HHS / United States
U01-AI-38855 / AI / NIAID NIH HHS / United States
U01-AI-38858 / AI / NIAID NIH HHS / United States