Neuropsychological testing is an important tool, in the diagnosis and management of HIV associated cognitive disorders, particularly AIDS Dementia Complex (ADC), as well as in research elucidating the CNS complications of HIV infection. With improved medical technologies extending the lives of immunosupressed patients, neuropsychological testing is increasingly useful. However, limitations of current testing methodologies restrict these benefits. Their drawbacks include: practical and economic difficulties in administration, problems in relating results to specific cognitive functions, lack of fine precision on timed tests, (generally the most sensitive to early ADC) and inappropriateness for some populations at high risk for HIV infection, e.g., IV drug abusers. Reaction-time tests are capable of overcoming these limitations. The Sternberg reaction-time task is particularly promising, because by using the additive factors method it can distinguish cognitive from motor slowing. The proposed research has three overall goals. to examine the ability of the Sternberg task to discriminate between three levels of HIV infection (HIV-, HIV+ asymptomatic, HIV+ symptomatic) in a population of IVDAs. Second, to examine the ability of two panels of more standard neuropsychological tests (each using a different assessment strategy) to make the same discriminations. Third, to compare the discriminating ability of the three test approaches. In addition, the Sternberg task will be internally and externally validated for this population and its ability to distinguish motor from cognitive slowing examined. Also, population norms will be generated for both the reaction time tasks and the standard neuropsychological measures. Finally, the demographic, psychiatric, neurological, and medical information gathered in this study will be used to characterize this population and to assess the effect of these variables on their neuropsychological performance. This revised proposal addresses concerns expressed by reviewers of the previous submission regarding the following issues: aspects of data demonstrating the feasibility of using the Sternberg task in our study population, utilization of two test instruments (AMNART and Satz-Mogel short form of the WAIS-R), and the medical inclusion/exclusion criteria. The reviewers also expressed reservations about our use of a consultant, now no longer included.
