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. 2016 Dec;40(12):2656-2666.
doi: 10.1111/acer.13250. Epub 2016 Oct 19.

Impairments in Component Processes of Executive Function and Episodic Memory in Alcoholism, HIV Infection, and HIV Infection with Alcoholism Comorbidity

Rosemary Fama  1   2 , Edith V Sullivan  1 , Stephanie A Sassoon  2 , Adolf Pfefferbaum  2 , Natalie M Zahr  1   2
Affiliations

Impairments in Component Processes of Executive Function and Episodic Memory in Alcoholism, HIV Infection, and HIV Infection with Alcoholism Comorbidity

Rosemary Fama et al. Alcohol Clin Exp Res. 2016 Dec.

Abstract

Background: Executive functioning and episodic memory impairment occur in HIV infection (HIV) and chronic alcoholism (ALC). Comorbidity of these conditions (HIV + ALC) is prevalent and heightens risk of vulnerability to separate and compounded deficits. Age and disease-related variables can also serve as mediators of cognitive impairment and should be considered, given the extended longevity of HIV-infected individuals in this era of improved pharmacological therapy.

Methods: HIV, ALC, HIV + ALC, and normal controls (NC) were administered traditional and computerized tests of executive function and episodic memory. Test scores were expressed as age- and education-corrected Z-scores; selective tests were averaged to compute Executive Function and Episodic Memory Composite scores. Efficiency scores were calculated for tests with accuracy and response times.

Results: HIV, ALC, and HIV + ALC had lower scores than NC on Executive Function and Episodic Memory Composites, with HIV + ALC even lower than ALC and HIV on the Episodic Memory Composite. Impairments in planning and free recall of visuospatial material were observed in ALC, whereas impairments in psychomotor speed, sequencing, narrative free recall, and pattern recognition were observed in HIV. Lower decision-making efficiency scores than NC occurred in all 3 clinical groups. In ALC, age and lifetime alcohol consumption were each unique predictors of Executive Function and Episodic Memory Composite scores. In HIV + ALC, age was a unique predictor of Episodic Memory Composite score.

Conclusions: Disease-specific and disease-overlapping patterns of impairment in HIV, ALC, and HIV + ALC have implications regarding brain systems disrupted by each disease and clinical ramifications regarding the complexities and compounded damping of cognitive functioning associated with dual diagnosis that may be exacerbated with aging.

Keywords: Alcoholism; Comorbidity; Episodic Memory; Executive Functions; HIV Infection.

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Figures

Figure 1
Figure 1
Bar graphs depicting age- and education-corrected Z scores for the Executive Function and Episodic Memory Composites for all groups.
Figure 2
Figure 2
Bar graphs depicting age- and education-corrected Z scores for individual test scores that went into the Executive Function and Episodic Memory Composite scores for all groups. SWM=Spatial Working Memory; TRAILSB=Trail Making Part B; CGT=Cambridge Gambling Test; SOC=Stockings of Cambridge; IED=Intra-Extra Dimensional Set Shift; LMI=Logical Memory I; REYO=Rey-Osterrieth Complex Figure; SRM=Spatial Recognition Memory; PRM=Pattern Recognition Memory
Figure 3
Figure 3
Bar graphs depicting Efficiency Scores (Accuracy/Response Time ratios) for the Cambridge Gambling, Spatial Recognition, and Pattern Recognition subtests of the CANTAB.
Figure 4
Figure 4
Scatterplots depicting significant relationships between lifetime alcohol consumption and Executive Function Composite scores in the ALC group.
Figure 5
Figure 5
Scatterplots depicting significant relationships between age and Executive Function Composite scores in the ALC and HIV+ALC group and Memory Composite score in the ALC group.
See this image and copyright information in PMC

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