Journal of the International Neuropsychological Society



Neuropsychiatric disturbance is associated with executive dysfunction in HIV-1 infection


STEVEN A.  CASTELLON a1c1, CHARLES H.  HINKIN a1a2 and HECTOR F.  MYERS a3
a1 Department of Psychiatry, UCLA School of Medicine, Los Angeles, California
a2 VA Medical Center, West Los Angeles
a3 Department of Psychology, UCLA, Los Angeles, California

Abstract

Prominent apathy and/or irritability are frequently observed among individuals infected with the human immunodeficiency virus (HIV). Although these symptoms often occur as part of a mood disorder, compelling evidence suggests that they may occur independently of depression in neurologic disease/disorder. The current study examined the prevalence of both apathy and irritability among a sample of HIV-infected individuals and explored the degree to which these neuropsychiatric (NP) phenomena were associated with performance on neurocognitive measures thought to be sensitive to the potential CNS effects of HIV-1. Clinician-administered rating scales assessing apathy and irritability were administered to 65 HIV-seropositive (HIV+) and 21 HIV-seronegative (HIV−) participants who also completed a dual-task reaction time paradigm and the Stroop task. NP disturbance was significantly more prevalent among HIV+ participants compared with HIV− controls and was associated with specific neurocognitive deficits suggestive of executive dysfunction. Relative to both HIV− controls and to neuropsychiatrically intact HIV+ participants, those HIV+ individuals with evidence of prominent apathy and/or irritability showed deficits in dual-task, but not single-task, performance and on the interference condition of the Stroop. Unexpectedly, NP disturbance did not show a robust relationship with HIV disease stage. These results suggest that the presence of prominent apathy and/or irritability among HIV+ individuals may signify greater HIV-associated CNS involvement. In HIV/AIDS, the disruption of frontal–subcortical circuits may be a common mechanism causing both executive dysfunction and NP disturbance. (JINS, 2000, 6, 336–347.)

(Received April 29 1999)
(Revised August 5 1999)
(Accepted August 6 1999)


Key Words: HIV/AIDS; Apathy; Irritability; Neurocognitive; Executive; Dual-task; Stroop.

Correspondence:
c1 Reprint requests to: Steven A. Castellon, 760 Westwood Plaza, C8-747, Los Angeles, CA 90024. E-mail: scastell@ucla.edu