Biomedical subjects

Robert A Bornstein

Publications and source records attributed to Robert A Bornstein.

9 recordsLinked to original sources

PubMed2005

The stability of neurocognitive patterns in HIV infected men: classification considerations.

For the neuropsychological impairment which takes place in HIV-1 infection, various classification systems, based on either neuropathological criteria, severity of the disorder or functional criteria, have been suggested in the literature. This study identifies the patterns of neurocognitive disorders in HIV-1 infection and investigates their stability at one-year follow-up. Two hundred and seventeen HIV-1-positive subjects in various stages of infection and 55 HIV-1-negative subjects were evaluated. Our results suggest that there is considerable diversity in the neuropsychological functioning of HIV patients but the patterns are relatively stable, functionally distinct, and differ with respect to the severity of the deficit. The overall pattern is consistent with existing neuropsychological knowledge on HIV infection. Comparison of the patterns identified in this study with other classification systems posed several problems, however, and these problems may have important implications for the theory and methodology of neuropsychological HIV research.

Adult↗

PubMed2005

The relationship between age and cognitive function in HIV-infected men.

Several studies have identified increased age as a risk factor for the development of cognitive impairment in human immunodeficiency virus (HIV)-infected subjects, but few have examined the potential synergistic effect of age and HIV serostatus on cognitive decline. The authors examined the possible combined effect of age and HIV serostatus on cognitive decline in 254 subjects stratified by age group and HIV status. After controlling for the effect of education, there were significant effects for serostatus and age group on overall cognitive impairment and a number of neuropsychological measures but no interaction effects. These data suggest that older seropositive individuals are not at an increased risk for HIV-related cognitive impairment when normal age-related cognitive changes are considered.

Adult↗

PubMed2004

Effect of anxiolytics on cognitive flexibility in problem solving.

OBJECTIVE: Our purpose is to examine the effect of different classes of anxiolytics on cognitive flexibility. BACKGROUND: Situational stressors and anxiety impede performance on "creativity" tests requiring cognitive flexibility. Noradrenergic agents have been shown to modulate cognitive flexibility as assessed by performance on anagrams. To determine whether these findings on noradrenergic modulation of cognitive flexibility are specific to the noradrenergic system or are a nonspecific anxiety effect, we compared the effects of propranolol, lorazepam, and placebo on the anagram task. METHODS: Subjects attended 3 test sessions. Prior to each session, subjects were given 1 of the 3 drugs. As in previous research, the natural log of the solution latency of each test item was summed for each test session and compared across drug conditions. RESULTS: For subjects able to solve the anagrams, solution times after propranolol, but not lorazepam, were significantly lower than after placebo. CONCLUSIONS: Therefore, this suggests that the phenomenon of noradrenergic modulation of cognitive flexibility does not result from a nonspecific anxiolytic effect, but rather is specific to the noradrenergic system.

Administration, Oral↗

PubMed2004

The effect of previous alcohol abuse on cognitive function in HIV infection.

OBJECTIVE: The authors' goal was to study the potential effect on cognitive function of an interaction of HIV infection and a history of alcohol abuse. METHOD: The subjects were 30 HIV-negative and 50 HIV-positive men with and without a past history of alcohol abuse. Thirty-three of the men (12 HIV negative and 21 HIV positive) had a past history of alcohol abuse, and 47 (18 HIV negative and 29 HIV positive) had never abused alcohol. Each subject's history of alcohol use was obtained by using a syndromal approach based on the Structured Clinical Interview for DSM-III-R and a quantitative approach. Each subject was given a battery of neuropsychological tests assessing verbal reasoning, reaction time, intelligence, memory, and dexterity. The subjects were then compared on a summary neuropsychological impairment rating. RESULTS: There were no significant differences in CD4 level, age, education, depression, anxiety, or other drug abuse history between the HIV-positive and HIV-negative groups with and without a history of alcohol abuse. Significant effects on cognitive function were found for past alcohol abuse and HIV infection, with significant interactions in verbal reasoning, auditory processing, and reaction time. This demonstrates that HIV infection and a history of alcohol abuse have independent effects on some aspects of higher cognitive function but may have synergistic effects on other cognitive domains. In the HIV-negative subjects there were no differences in cognitive function between subjects with and without a history of alcohol abuse. Among the HIV-positive subjects, those with a history of alcohol abuse performed more poorly on tests of verbal IQ, verbal reasoning, and reaction time. CONCLUSIONS: There are both additive and interactive effects of previous alcohol abuse and HIV infection on cognition. Individuals with a history of past alcohol abuse may be at greater risk for cognitive dysfunction in the context of HIV infection.

Adult↗

PubMed2004

Marijuana use and cognitive function in HIV-infected people.

The effect of marijuana use on cognitive function is controversial. Although marijuana use is common in HIV-infected individuals for recreational and medicinal purposes, there have been no studies of the impact of marijuana on cognitive function in these subjects. Marijuana also has known immunologic effects, which increases the relevance in HIV-infected patients. We examined the interaction of HIV disease-stage and marijuana use in 282 subjects, stratified by disease stage and frequency of marijuana use. After controlling for the effects of depression, anxiety, and alcohol use, a significant interaction was observed on an overall measure of cognitive impairment. The effect of marijuana use was greatest in subjects with symptomatic HIV infection. Further inspection suggested that this effect was due primarily to performance on memory tasks. These data suggest that although there is minimal impact of marijuana on uninfected individuals or those at early stages of HIV infection, there is a synergistic effect of HIV and marijuana use in patients with advanced HIV disease. This is consistent with other data suggesting that the subtle effects of some conditions may become more manifest in the setting of immunocompromise.

Adult↗

PubMed2003

Effects of past noninjection drug abuse upon executive function and working memory in HIV infection.

Interactive effects of past noninjection drug abuse/dependence and HIV disease status upon measures of executive function were assessed in a group of 294 homosexual men. Participants were stratified according to HIV status and substance use diagnoses, thereby yielding a 4 (seronegative, asymptomatic seropositive, symptomatic seropositive, and AIDS defining illness) x 2 (never abused drugs, previous substance use disorder) design. Significant main effects of HIV status were found on the Wisconsin Card Sorting Test, Ruff Figural Fluency Test, Trail Making Test B, and total number of impaired performances. Analyses revealed that men with AIDS defining illness performed worse than the other three groups. Drug use history had no significant effect upon neurobehavioral function, and effect sizes for drug abuse history were small. The data suggest that prior drug use yields little if any residual cognitive impairment in HIV infection.

Acquired Immunodeficiency Syndrome↗

PubMed2003

The relationship between stressful life events and cognitive function in HIV-infected men.

Previous studies have demonstrated an impact of stress on immune function, and recent studies have suggested an adverse effect of stress on the brain. However, no previous study has examined the impact of stress on cognitive function. This article examines the relationship between stress and cognitive function in 82 HIV-negative subjects and 251 HIV-positive subjects. Subjects completed a comprehensive neuropsychological examination, measures of anxiety and depression, and a measure of stressful life events. After controlling for the impact of anxiety, depression, age, and education, stressful life events were related to cognitive impairment only among the HIV-positive subjects. The data were interpreted in the context of previous studies that have demonstrated an adverse effect of stress on the brain and suggest that this adverse impact may be expressed in the setting of a compromised immune system. Furthermore, this analysis suggests several implications for patient management.

Adult↗

PubMed2002

Central beta-adrenergic modulation of cognitive flexibility.

Situational stressors and anxiety impede performance on creativity tests requiring cognitive flexibility. Preliminary research revealed better performance on a task requiring cognitive flexibility, the anagram task, after propranolol (beta-adrenergic antagonist) than after ephedrine (beta-adrenergic agonist). However, propranolol and ephedrine have both peripheral and central beta-adrenergic effects. In order to determine whether noradrenergic modulation of cognitive flexibility is a centrally or peripherally mediated phenomenon, we compared the effects of propranolol (peripheral and central beta-blocker), nadolol (peripheral beta-blocker), and placebo on anagram task performance. Solution latency scores for each subject were compared across the drug conditions. Anagram solution latency scores after propranolol were significantly lower than after nadolol. This suggests a centrally mediated modulatory influence of the noradrenergic system on cognitive flexibility.

Adrenergic beta-Agonists↗

PubMed2002

Neuropsychological impairment among manic, depressed, and mixed-episode inpatients with bipolar disorder.

Previous research has demonstrated broad neurobehavioral abnormalities in bipolar affective disorder (cf. G. Cassens, L. Wolfe, & M. Zola, 1990). However, there have been no comparisons of neuropsychological function across patients with manic, depressed, or mixed subtypes. In the present study, 37 manic, 24 mixed-episode, and 25 depressed bipolar I inpatients and 34 control subjects were administered a brief battery of neuropsychological tests. The multivariate and univariate effects of participant group on the neuropsychological measures were uniformly significant (p < .05). Planned contrasts revealed that the bipolar participants performed worse than the controls, and few differences existed between the 3 patient groups. Additionally, the bipolar groups were impaired on 50% of the test battery. These abnormalities were unlikely attributable to differences in psychiatric symptomatology, medical illness, comorbid psychiatric diagnoses, or medication status. Findings imply that acute mood disturbance during bipolar disorder yields significant neurobehavioral dysfunction.

Adult↗