Preliminary Neuropsychological Normative Data in a Healthy Sample of Puerto Rican Women

Objective

Accurate diagnosis of neuropsychological (NP) impairment in Spanish-speaking Latinx women is limited by a lack of appropriate norms. While multiple normative datasets have emerged for Mexican/Mexican-American populations, there is a particular dearth of normative options for Puerto Rican women. This study collected normative data in a sample of Spanish-speaking healthy women in Puerto Rico (PR).

Participants and Method

The sample consisted of 63 healthy, HIV-seronegative women recruited as comparison participants in a longitudinal HIV-seropositive Latinx Women Cohort study at the University of Puerto Rico during 2002-2017. The NP battery included measures from seven cognitive domains: verbal fluency, executive functioning, processing speed, learning, memory, sensory, perceptual, and motor skills.

Results

The sample’s age ranged from 20-77 years (M = 42.14; SD = 12.71) and education ranged from 9-18 years (M = 13.74; SD = 2.09). The NP test M and SD raw score results were: Trail Making A (M = 41.29; SD = 14.87), Trail Making B (M = 105.14; SD = 49.77), Grooved Pegs Dominant Hand (M = 78.49; SD = 31.91), Stroop Word/Color (M = 47.86; SD = 23.66), Rey Verbal Learning Test Total (M = 42.0; SD = 9.36), Verbal Fluency FAS-F (M = 11.27; SD = 4.20), FAS-A (M = 12.05; SD=4.34), FAS-S (M = 10.67; SD = 4.19), Digit Span (M = 12.16; SD = 3.28), Spatial Span (M = 10.95; SD = 3.62), Benton Judgment of Line Orientation Test (M = 18.10; SD = 5.54), Finger Tapping Left (M = 50.58; SD = 7.78), Finger Tapping Right (M = 53.87; SD = 8.83), Seashore Rhythm Test (M = 23.38; SD = 3.99), and Rey Complex Figure Test Immediate (M = 13.17; SD = 6.99) and Delay (M = 13.58; SD = 7.21). The NP norms were stratified by age (10-year increments and 60+) and education (< 12 years and 12+ years).

Conclusions

This preliminary study provides initial normative data from a sample of healthy women living in PR, which can improve NP diagnostic accuracy for this population. This is particularly important given that this population experiences worse health outcomes compared to other Latinx subpopulations.

Neuro-QOL: brief measures of health-related quality of life for clinical research in neurology

OBJECTIVE

To address the need for brief, reliable, valid, and standardized quality of life (QOL) assessment applicable across neurologic conditions.

METHODS

Drawing from larger calibrated item banks, we developed short measures (8-9 items each) of 13 different QOL domains across physical, mental, and social health and evaluated their validity and reliability. Three samples were utilized during short form development: general population (Internet-based, n = 2,113); clinical panel (Internet-based, n = 553); and clinical outpatient (clinic-based, n = 581). All short forms are expressed as T scores with a mean of 50 and SD of 10.

RESULTS

Internal consistency (Cronbach α) of the 13 short forms ranged from 0.85 to 0.97. Correlations between short form and full-length item bank scores ranged from 0.88 to 0.99 (0.82-0.96 after removing common items from banks). Online respondents were asked whether they had any of 19 different chronic health conditions, and whether or not those reported conditions interfered with ability to function normally. All short forms, across physical, mental, and social health, were able to separate people who reported no health condition from those who reported 1-2 or 3 or more. In addition, scores on all 13 domains were worse for people who acknowledged being limited by the health conditions they reported, compared to those who reported conditions but were not limited by them.

CONCLUSION

These 13 brief measures of self-reported QOL are reliable and show preliminary evidence of concurrent validity inasmuch as they differentiate people based upon number of reported health conditions and whether those reported conditions impede normal function.

Proteomic analyses of monocyte-derived macrophages infected with human immunodeficiency virus type 1 primary isolates from Hispanic women with and without cognitive impairment

The signature for human immunodeficiency virus type 1 (HIV-1) neurovirulence remains a subject of intense debate. Macrophage viral tropism is one prerequisite but others, including virus-induced alterations in innate and adaptive immunity, remain under investigation. HIV-1-infected mononuclear phagocytes (MPs; perivascular macrophages and microglia) secrete toxins that affect neurons. The authors hypothesize that neurovirulent HIV-1 variants affect the MP proteome by inducing a signature of neurotoxic proteins and thus affect cognitive function. To test this hypothesis, HIV-1 isolates obtained from peripheral blood of women with normal cognition (NC) were compared to isolates obtained from women with cognitive impairment (CI) and to the laboratory adapted SF162, a spinal fluid R5 isolate from a patient with HIV-1-associated dementia. HIV-1 isolates were used to infect monocyte-derived macrophages (MDMs) and infection monitored by secreted HIV-1 p24 by enzyme-linked immunosorbent assay (ELISA). Cell lysates of uninfected and HIV-1-infected MDMs at 14 days post infection were fractionated by cationic exchange chromatography and analyzed by surface enhanced laser desorption ionization time of flight (SELDI-TOF) using generalized estimating equations statistics. Proteins were separated by one-dimensional sodium dodecyl sulfate-polyacrylamide gel electrophoresis (1D SDS-PAGE) and identified by tandem mass spectrometry. Levels of viral replication were similar amongst the HIV-1 isolates, although higher levels were obtained from one viral strain obtained from a patient with CI. Significant differences were found in protein profiles between virus-infected MDMs with NC, CI, and SF162 isolates (adjusted P value after multiple testing corrections, or q value <.10). The authors identified 6 unique proteins in NC, 7 in SF162, and 20 in CI. Three proteins were common to SF162 and CI strains. The MDM proteins linked to infection with CI strains were related to apoptosis, chemotaxis, inflammation, and redox metabolism. These findings support the hypothesis that the macrophage proteome differ when infected with viral isolates of women with and without CI.

Spanish validation of the HIV dementia scale in women

HIV infection is increasing in minority groups, particularly in African American and Hispanic women. Although the incidence of HIV dementia has decreased since the advent of highly active antiretroviral treatment, prevalence of neurocognitive complications has increased as patients are now living longer. This study's purpose was to determine the psychometric properties of the Spanish-language HIV Dementia Scale (HDS) in a group of HIV-infected women. We recruited 96 women: 60 HIV-seropositive and 36 HIV-seronegative. Modification of the HDS into a Spanish-language version consisted of translating the instructions, substituting four words in Spanish (gato, media, azul, piña), increasing 1 second in the psychomotor speed because the Spanish alphabet has more letters than the English alphabet, and not offering clues for memory recall. Cognitive impairment (CI) was defined according to the modified American Academy of Neurology HIV-dementia criteria including an asymptomatic CI group. Statistical analysis consisted of analysis of variance to determine group differences and receiver operator characteristics (ROC) to determine the optimal cutoff point for the screening of CI. HDS-Spanish total score and subscores for psychomotor speed and memory recall showed significant differences between HIV-seronegative and women with HIV-dementia (p < 0.001) and between HIV-seropositive women with normal cognition and those with HIV-dementia (p < 0.001). The optimal cutoff point of 13 or less had performance characteristics of 87% sensitivity and 46% specificity for HIV-associated CI (50.0% positive predictive value, 85.0% negative predictive value). The HDS-Spanish translation offers a useful screening tool with value for the identification of Hispanic women at risk of developing HIV-associated symptomatic neurocognitive disturbances.

Macrophage proteomic fingerprinting predicts HIV-1-associated cognitive impairment

BACKGROUND

Specific proteins produced from monocytes may be linked to the pathogenesis and aid in the diagnosis of HIV-1-associated dementia (HAD).

OBJECTIVE

The authors assessed whether a diagnostic phenomic protein profile could be obtained from monocyte-derived macrophages (MDM) from HIV-1-infected patients with cognitive impairment.

METHODS

Twenty-one HIV-1-infected Hispanic women and 10 seronegative controls matched by age and sex were followed at the University of Puerto Rico Medical Sciences Campus, where neuropsychological, immune, and viral parameters were tested. Monocytes were recovered by Percoll gradient centrifugation from peripheral blood mononuclear cells. MDM lysates were prepared after 7 days of cultivation and protein profiles analyzed by surface enhanced laser desorption/ionization (SELDI)-time of flight (TOF) ProteinChip tests. Classification trees were prepared for statistical analyses.

RESULTS

A total of 177 protein peaks from 2 to 80 kDa were evaluated in 31 patient MDM lysates by SELDI-TOF ProteinChip assays. Select protein peaks, at 5028 and 4320 Da, separated HIV-1-infected from HIV-1-seronegative subjects with a sensitivity of 100% and a specificity of 80%. Thirty-eight peaks were used to differentiate HIV-1-infected subjects with and without cognitive impairment. A 4348 Da protein separated the two groups with a sensitivity of 100% and a specificity of 75%.

CONCLUSIONS

The identification of unique phenomic MDM profiles from cognitively impaired HIV-1-infected patients supports the hypothesis that changes in monocyte function parallel the development of HAD.

Effect of flumazenil on electroencephalographic patterns induced by midazolam

BACKGROUND

Flumazenil is a competitive benzodiazepine receptor antagonist, reverts the sedation effects of benzodiazepines and its effect on electroencephalographic (EEG) patterns is controversial. The purpose of this study was to describe flumazenil's effect on EEG patterns of patients undergoing conscious sedation.

METHODS

Ten voluntary patients, aged 16-23, at elective oral surgery had conscious sedation with midazolam and local anesthesia. After the procedure, sedation was reversed with flumazenil. Each patient had 4 EEGs of 4 minutes each: baseline, 5 minutes after midazolam, prior to flumazenil, and 8 minutes after flumazenil. A clinical neurophysiologist interpreted EEGs blinded to time.

RESULTS

Eight patients had an awake and 2 had an awake and drowsy normal EEG. After midazolam all developed a diffuse beta wave and alpha wave attenuation or dropout. Prior to flumazenil 7 presented diffuse beta and scattered theta waves, and 3 an awake pattern (procedure required > 30 minutes). After flumazenil, reversal of beta and theta waves and appearance of alpha waves was noted; no changes occurred when procedure lasted more than 30 minutes. One patient presented with diffuse theta waves, 6 Hz.

CONCLUSIONS

Flumazenil reverts midazolam EEG changes if administered < 30 minutes after midazolam administration, midazolam-induced EEG changes revert spontaneously after 30 minutes, and flumazenil may precipitate theta activity.