mental health AIDS

Winter 2007 Newsletter / Volume 8, Issue 2

HIV Assessment News

Neuropsychological Assessment

Martin et al. (2006) investigated the relationship 

between cognitive functioning and medical markers in HIV-infected children and adolescents treated with highly active antiretroviral therapy (HAART) with varying levels of computed tomography (CT) brain scan abnormalities. The Wechsler Intelligence Scale for Children Third Edition [WISC-III] was administered to 41 vertically infected children (mean age = 11.2 years) treated with HAART for at least 1 year. Other procedures at the time of testing included CT brain scans and collection of CD4 cell counts and plasma ... [viral loads]. (p. 633)

"Although global cognitive functioning among participants was in the Average range, children with minimal to moderate CT brain scan abnormalities scored significantly lower than children with normal scans on composite measures of cognitive functioning and five specific subtests, especially tasks involving executive functions. Furthermore, children with worse immune status (CD4+ counts < 500) scored lower on subtests measuring processing speed. Viral load was unrelated to cognitive test scores" (pp. 633-634).

In summarizing these findings, Martin and colleagues suggest that, "whereas many HIV-infected children being treated with HAART are functioning within normal limits, a subset of children with CNS [central nervous system] disease continues to follow a distinct pattern of low average to below average cognitive functioning. The cognitive deficits in these children may be a result of ongoing viral replication in the CNS despite virologic control in the periphery ..., or residual effects of static HIV-related CNS disease" (p. 649). The investigators conclude that "children with HIV being treated with HAART remain at risk for developing CNS disease. Findings emphasize the importance of conducting neuropsychological [NP] assessments in this population, particularly for children with cortical atrophy and absolute CD4+ cell counts < 500" (p. 634).

Given the fact that many clinicians and researchers use abbreviated test batteries when assessing children and adolescents with HIV infection, it is important to be aware of the specific subtests that are most closely related to disease parameters. Based on results of this study, it would be advisable to include subtests assessing processing speed (Coding and Symbol Search), working memory (Arithmetic and Digit Span, interpreting separate span lengths for Digits Forward and Backward),2 as well as Block Design and Picture Completion. In addition, although this study offers a comprehensive picture of cognitive functioning on the WISC-III, it would be useful for future research to utilize other measures to investigate specific areas such as executive functioning (e.g., Trails, Wisconsin Card Sort Test), verbal fluency, and attention (e.g., continuous performance tasks). (pp. 651-652)

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