Effects of traumatic brain injury on cognitive functioning and cerebral metabolites in HIV-infected individuals

Figures & data

TABLE 1 Characteristics of groups with neuropsychological assessment and magnetic resonance spectroscopy subset

	NP assessment				MRS subset
	HIV+TBI+ (N = 110)	HIV+TBI–(N = 590)	t value or χ^2	p value	HIV+TBI+ (N = 17)	HIV+TBI– (N = 84)	t value or χ^2	p value
Age (years)	43.6 (8.4)	43.6 (8.0)	−0.13	.45	47.5 (6.3)	47.1 (5.9)	−0.25	.80
Education (years)	12.3 (2.8)	12.6 (2.3)	1.19	.88	13.2 (3.2)	13.1 (2.1)	−0.15	.88
WRAT–3 Reading	91.5 (17.3)	90.7 (16.7)	−0.47	.32	96.1 (15.9)	93.5 (15.7)	−0.61	.54
Sex (% male)	89.2	74.9	12.10	.001	100.0	84.5	5.17	.08
Ethnicity (% non-White)	56.4	59.5	0.37	.54	58.8	57.1	0.02	.90
No. of ARVs	2.2 (1.5)	2.1 (1.6)	−0.55	.29	2.3 (1.6)	2.4 (1.5)	0.37	.71
ARV history (% currently using)	69.1	65.6	0.51	.47	70.6	75.0	0.14	.70
% on HAART	69.1	64.4	0.91	.34	70.6	73.8	0.07	.78
Nadir CD4	213.3 (188.5)	219.9 (210.7)	0.31	.62	215.2 (212.4)	174.5 (152.6)	−0.93	.35
% AIDS ^a	60.0	61.5	0.08	.77	64.7	70.2	0.20	.65
Plasma HIV ^b (% detectable)	65.1	70.7	1.31	.25	47.1	44.6	0.04	.85
CSF HIV ^b (% detectable)	37.4	38.6	0.05	.83	37.5	29.5	0.39	.53
% HCV seropositive	33.3	31.8	0.10	.75	41.2	33.3	0.38	.54
Note. For t value or χ^2 : Variables with standard deviations have a t value; variables with % values have a χ^2 value. NP = neuropsychological. MRS = magnetic resonance spectroscopy. WRAT–3 = Wide Range Achievement Test–Third Edition. ARV = antiretroviral. HAART = highly active antiretroviral therapy. CSF = cerebrospinal fluid. HCV = hepatitis C virus. Standard deviations in parentheses.
^aBased on 1993 Centers for Disease Control (CDC) classification (Centers for Disease Control, 1992). ^bBased on limit of detection = 50 copies.

TABLE 2 The neuropsychological battery

Ability area	Neuropsychological test	Assesses
Overall vocabulary	WRAT–3 Reading	Premorbid verbal ability
Working memory	Paced Auditory Serial Addition Task	Ability to work with information in short-term store
	WAIS–III Letter–Number Sequencing
Executive functioning	Wisconsin Card Sorting Test	Abstracting ability (abstract reasoning, evaluating, planning, and decision making)
	Trail Making Test Part B
Attention/ speed of information processing	WAIS–III Digit Symbol	Selecting and evaluating input under time pressure; associated with speed of information processing
	WAIS–III Symbol Search
	Trail Making Test Part A
Learning	Hopkins Verbal Learning Test,	Learning of explicit and implicit memories, logical memory, and nonverbal memory
	Immediate Recall Trials 1–3
	Brief Visuospatial Memory Test,
	Immediate Recall Trials 1–3
	Story Memory Test,
	Learning Rate
	Trial 1 Recall
	Figure Memory Test
	Learning Rate
	Trial 1 Recall
Memory	Hopkins Verbal Learning Test,	Delayed recall of explicit and implicit memories, logical memory, and nonverbal memory
	Delayed Recall
	Brief Visuospatial Memory Test,
	Delayed Recall
	Story Memory Test,
	% Loss
	Figure Memory Test
	% Loss
Verbal fluency	Controlled Oral Word Association Test	Fluency (spontaneous generation of words)
	Animal (Category) Fluency Test
Psychomotor	Grooved Pegboard Test	Performance of motor tasks
Note. WRAT–3 = Wide Range Achievement Test–Third Edition. WAIS–III = Wechsler Adult Intelligence Scale–Third Edition.

TABLE 3 NP and PAOFI data comparisons between TBI and non-TBI groups

	HIV+TBI+ (N = 110)	HIV+TBI– (N = 590)	t value	p value
NP deficit score
Working memory	0.71 (0.97)	0.54 (0.76)	−2.02	.02*
Executive function	0.73 (1.07)	0.56 (0.81)	−1.89	.03*
Attention/speed of information processing	0.36 (0.73)	0.31 (0.63)	−0.77	.22
Learning	0.96 (1.11)	0.83 (1.01)	−1.22	.11
Memory	0.70 (1.01)	0.73 (1.03)	0.33	.63
Verbal fluency	0.39 (0.69)	0.36 (0.70)	−0.38	.35
Psychomotor	0.59 (0.98)	0.53 (0.92)	−0.66	.26
Global	0.62 (0.65)	0.54 (0.57)	−1.31	.09
PAOFI
Memory	3.06 (2.91)	2.19 (2.81)	−2.98	.002*
Cognitive	1.48 (2.23)	1.23 (2.20)	−1.05	.15
Language	2.13 (2.51)	1.71 (2.50)	−1.60	.06
Motor	0.46 (0.86)	0.44 (0.71)	−0.34	.37
Sensory	0.61 (0.84)	0.42 (0.73)	−2.44	.007*
Total score	7.25 (7.36)	5.71 (7.29)	−2.03	.02*
Note. Standard deviations in parentheses. NP = neuropsychological. Patient's Assessment of Own Functioning Inventory. TBI = traumatic brain injury. p < .05.

TABLE 4 MRS data comparison between TBI and no-TBI groups

		HIV+ TBI+ N = 17	HIV+TBI– N = 84	t value	p value
Frontal white matter	N-Acetylaspartate	1.18 (0.13)	1.21 (0.14)	0.85	.20
	myo-inositol	1.71 (0.34)	1.63 (0.40)	−0.84	.20
	Creatine	1.01 (0.20)	0.97 (0.15)	−0.75	.23
	Choline	1.06 (0.17)	0.98 (0.18)	−1.56	.06
Frontal gray matter	N-Acetylaspartate	1.04 (0.16)	1.12 (0.13)	2.18	.02*
	myo-inositol	1.31 (0.33)	1.42 (0.28)	1.48	.93
	Creatine	1.00 (0.19)	1.02 (0.15)	0.56	.29
	Choline	0.79 (0.19)	0.78 (0.14)	−0.39	.35
Basal ganglia	N-Acetylaspartate	1.21 (0.17)	1.29 (0.13)	2.17	.02*
	myo-inositol	1.35 (0.21)	1.41 (0.26)	0.73	.77
	Creatine	1.17 (0.25)	1.21 (0.21)	0.69	.25
	Choline	0.99 (0.18)	0.97 (0.15)	−0.48	.32
Note. Standard deviations in parentheses. MRS = magnetic resonance spectroscopy. TBI = traumatic brain injury. p < .05.

TABLE 5 Depression and substance dependence comparisons in TBI and non-TBI groups

	HIV+TBI+ (N = 110)	HIV+TBI– (N = 590)	t value	χ^2	p value
BDI	15.1 (10.5)	14.1 (13.6)	−0.73		.23
With history of use disorder of:
Alcohol (%)	62.7	51.2		5.02	.03*
Cannabis (%)	3.6	2.5		0.39	.53
Cocaine (%)	6.4	7.3		0.12	.73
Opioid (%)	1.8	5.4		3.26	.07
Meth (%)	0.91	3.1		2.06	.15
Hallucinogen (%)	0.0	0.17		0.34	.56
Sedative (%)	0.0	0.17		0.34	.56
Inhalant (%)	0.0	0.17		0.34	.56
Note. History of use disorder includes “abuse” and “dependency,” as defined by the Diagnostic and Statistical Manual of Mental Disorders–Fourth Edition (DSM–IV) criteria, either currently or in the past (American Psychiatric Association, 1994, 2000). Standard deviations in parentheses. TBI = traumatic brain injury. BDI = Beck Depression Inventory. p < .05.

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