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Geier Stephan A.; Perro, Christian; Klau, Volker; Naber, Dieter; Kronawitter, Ursula; Bogner, Johannes R.; Goebel, Frank D.; Lund, Otto-Erich; Hippius, Hanns
Journal of Acquired Immune Deficiency Syndromes: March 1993
CLINICAL SCIENCE: PDF Only
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Ocular microangiopathic syndrome is found frequently in patients with AIDS or severe HIV infection. Symptoms of this microvascular syndrome can include cotton-wool spots, hemorrhages, and Roth's spots. The clinical and functional significance of HIV-related ocular microangiopathic syndrome has not been clarified as yet. The objective of this study was to evaluate a possible association between HIV-related ocular microangiopathic syndrome and cognitive functioning. Thirty-seven patients infected with HIV (24 with AIDS) underwent ophthalmological and neuropsychological examination. HIV-related ocular microangiopathic syndrome was measured by counting the number of cotton-wool spots in both eyes. Neuropsychological examination included five standardized tests, with the first three primarily measuring function of short-term memory; these tests were as follows: the Auditory-Verbal Learning Test, the Benton Test, the Stroop Colour Word Test, the Trail-Making Part B test, and the Vocabulary for Measuring Premorbid Intelligence test. HIV-related ocular microangiopathic syndrome was found in 15 patients with AIDS (62.5%), and in one patient, staged Walter Reed 5. In 10 patients, one eye was affected (mean count of cotton-wool spots 1.5). In six patients, both eyes were affected (mean count of cotton-wool spots 7.0). Univariate correlations between the number of cotton-wool spots in both eyes and test scores were as follows: Auditory-Verbal Learning Test: 0.56 (p < 0.001); Benton Test: 0.51 (p < 0.001); Stroop Colour and Word: 0.50 (p < 0.001); Trail-Making Part B: 0.15 (not significant); Vocabulary for Measuring Premorbid Intelligence: −0.05 (not significant). Multiple correlation between the test scores and the number of cotton-wool spots was 0.70 (p < 0.001). There were a few statistically insignificant correlations between the neuropsychological test scores and the absolute CD4+ lymphocyte count, or the Walter Reed classification. These findings suggest a close association between HIV-related ocular microangiopathic syndrome and a decrease in cognitive functioning—especially alteration of short-term memory—in patients with AIDS. Our results also suggest that microvascular abnormalities in patients with AIDS or HIV disease might contribute not only to the development of cotton-wool spots, but also to functional cerebral impairment.

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