| Publication Abstract Display | | Type: Published Abstract | | Title: Cognitive impairment is an independent risk factor for death in HIV-infected individuals. | | Authors: Ellis RJ, Deutsch R, Heaton RK, Marcotte T, Nelson JA, Abramson I, Grant I, and the HNRC Group | | Year: 1996 | | Publication: Neurology | | Volume: 46 Issue: Pages: A268 | | Abstract:OBJECTIVE: To determine if cognitive impairment increases mortality risk in HIV-1 infected individuals.
BACKGROUND: HIV enters the central nervous system early in disease, and cognitive impairment may serve as an early marker of disease progression.
DESIGN/METHODS: We performed comprehensive baseline medical and neuropsychological (NP) evaluations in 414 HIV-infected individuals and followed them for up to seven years. Subjects were rated as globally impaired (two or more NP domains) or unimpaired (NL) using age- and education-corrected NP test norms. We reviewed clinical data to determine if impaired subjects met AAN (1991) criteria for HIV-associated minor cognitive-motor disorder (MCM). Those who did not were designated NP-impaired (NPI).
RESULTS: Of 414 subjects, baseline neurocognitive diagnoses were NL in 236 (61.8%), NPI in 109 (26.3%), and MCM in 49 (11.8%). There were 106 deaths (25.6%) during followup (median 2.4 years; range 0.5-7.4). In a proportional hazards model, mortality risk was increased for MCM (RR 3.9; 95% CI [2.3, 6.5]; p<10^ {-6}) AND NPI (RR 1.2; 95% CI [0.8, 1.9]; p=.40) relative to NL. After adjustment for concurrent predictors (baseline disease stage and CD4T-cell count), mortality risk was significantly increased for both impaired groups (MCM, RR 2.3; 95% CI [1.3, 4.0]; p<.004; NPI, RR 1.8; 95% CI [1.1, 3.0; p<.02)
CONCUSIONS: Our findings suggest that cognitive impairment is an independent risk factor for early death at all stages of HIV disease, and that mortality risk is similarly increased in individuals with syndromic and nonsyndromic impairment. |
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