Previous behavioral studies indicate that reduced speed of information processing and impaired learning and attention are often observed in HIV- infected individuals. The psychomotor slowing and impaired attention are suggestive of cortico-striatal, particularly fronto-striatal dysfunction. Although the learning deficits in some ways resemble those experienced by patients with subcortical damage, pilot data indicate that even recognition memory is sometimes affected, suggesting cortico-limbic dysfunction as well. Evidence from pathological studies supports the existence of damage in both cortico-striatal and cortico-limbic systems, and raises questions about the role of a number of putative HIV-related neurotoxic mechanisms. This project has two overall objectives: first, to employ experimental behavioral paradigms and MRI morphometrics to better define two forms of HIV-related CNS dysfunction - namely cortico-striatal and cortico-limbic; and second, to gamer evidence regarding the pathological mechanisms involved in these forms of dysfunction by examining relationships between MRI morphometrics and neuropathological data obtained in autopsy studies. To pursue these general aims we propose two studies: an MRI/Behavior study of 150 patients meeting criteria for AIDS and 50 matched controls; and an MRI/Neuropathology study of approximately 60 subjects, involving antemortem and postmortem MRI examinations as well as detailed neuropathological examinations of brain specimens. The individuals studied in the MRI/Neuropathology study will be screened at autopsy for the presence of opportunistic infections of the CNS other than CMV.
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