Search PubMed⌕ Search

Biomedical subjects

Ola A Selnes

Publications and source records attributed to Ola A Selnes.

28 records · Page 2Linked to original sources
PubMed2004

Attenuated central nervous system infection in advanced HIV/AIDS with combination antiretroviral therapy.

BACKGROUND: Before the introduction of combination antiretroviral therapy (CART), neurological disease correlated with cerebrospinal fluid (CSF) levels of human immunodeficiency virus (HIV) RNA. OBJECTIVE: To investigate the relationships among HIV RNA levels, immune activation markers, and neurological status in patients receiving CART. DESIGN: Multicenter cohort study. SETTING: Academic neurology departments. PATIENTS: A total of 371 patients unselected for neurological complaints and with CD4 cell counts less than 200/microL or with cognitive symptoms and CD4 cell counts less than 300/microL were enrolled into the Northeastern AIDS Dementia cohort in 1998-2002. Diagnoses of HIV-associated dementia (HIV-D) and minor cognitive-motor disorder (MCMD) were obtained with a computerized algorithm. Plasma and CSF levels of HIV RNA, monocyte chemotactic protein 1, macrophage colony-stimulating factor, and tumor necrosis factor alpha were quantified. RESULTS: The mean +/- SD age was 41.5 +/- 7.2 years, and the mean +/- SD educational level was 12.3 +/- 2.2 years. Seventy percent of the cohort was black, and 30% were women. The mean +/- SD CD4 cell count was 136.8 +/- 87.9/microL, and CART was used in 71%. Twenty-nine percent of the patients were unimpaired (n = 106), 36% had MCMD (n = 133), and 35% had HIV-D (n = 128). Mean log(10) CSF HIV RNA copies per milliliter was 2.6 +/- 0.8, with no differences among the neurological groups, even after adjustments for baseline CD4 cell counts and antiretroviral therapy. Cerebrospinal fluid HIV RNA was undetectable in 47% of unimpaired, 46% of MCMD, and 43% of HIV-D patients (P = .91). Plasma levels of monocyte chemotactic protein type 1 and tumor necrosis factor alpha correlated weakly with HIV RNA levels but did not distinguish those with neurological deficits. CONCLUSIONS: In contrast to observations in individuals not treated with CART, we found no relationship between CSF markers and neurological status in this CART-using cohort with advanced HIV/AIDS. This was not explicable by demographic differences or plasma virological control. CART may substantially attenuate the degree of central nervous system HIV infection and immune activation, and in CART users, CSF HIV RNA and immune activation markers may fail to discriminate milder degrees of HIV-D and MCMD.

Acquired Immunodeficiency Syndrome↗
PubMed2004

Normative data for determining significance of test-retest differences on eight common neuropsychological instruments.

Clinicians and researchers who use neuropsychological tests to track functioning over time are in need of a method to correct for the effects of practice. Drawing from a large database of healthy, male subjects, we present data that can be used to calculate predicted retest scores for eight widely used neuropsychological instruments either via simple regression or reliable change index (RCI) methods. These methods are useful for individuals assessed across a wide time interval, 4-24 months. Limitations are discussed regarding the applicability of the data. Those with a need to factor out the effects of practice, test-retest reliability and other statistical confounds will find the information within this article useful.

Adult↗
PubMed2004

Self-reported memory symptoms with coronary artery disease: a prospective study of CABG patients and nonsurgical controls.

OBJECTIVE: Subjective memory complaints are common after coronary artery bypass grafting (CABG), but previous studies have concluded that such symptoms are more closely associated with depressed mood than objective cognitive dysfunction. We compared the incidence of self-reported memory symptoms at 3 and 12 months after CABG with that of a control group of patients with comparable risk factors for coronary artery disease but without surgery. METHODS: Patients undergoing CABG (n = 140) and a demographically similar nonsurgical control group with coronary artery disease (n = 92) were followed prospectively at 3 and 12 months. At each follow-up time, participants were asked about changes since the previous evaluation in areas of memory, calculations, reading, and personality. A Functional Status Questionnaire (FSQ) and self-report measure of symptoms of depression (CES-D) were also completed. RESULTS: The frequency of self-reported changes in memory, personality, and reading at 3 months was significantly higher among CABG patients than among nonsurgical controls. By contrast, there were no differences in the frequency of self-reported symptoms relating to calculations or overall rating of functional status. After adjustment for a measure of depression (CES-D rating score), the risk for self-reported memory changes remained nearly 5 times higher among the CABG patients than among control subjects. The relative risk of developing new self-reported memory symptoms between 3 and 12 months was 2.5 times higher among CABG patients than among nonsurgical controls (CI 1.24-5.02), and the overall prevalence of memory symptoms at 12 months was also higher among CABG patients (39%) than controls (14%). CONCLUSIONS: The frequency of self-reported memory symptoms 3 and 12 months after baseline is significantly higher among CABG patients than control patients with comparable risk factors for coronary and cerebrovascular disease. These differences could not be accounted for by symptoms of depression. The self-reported cognitive symptoms appear to be relatively specific for memory and may reflect aspects of memory functioning that are not captured by traditional measures of new verbal learning and memory. The etiology of these self-reported memory symptoms remains unclear, but our findings, as well as those of others, may implicate factors other than cardiopulmonary bypass itself.

Aged↗
PubMed2003

Cognitive changes with coronary artery disease: a prospective study of coronary artery bypass graft patients and nonsurgical controls.

BACKGROUND: Cognitive impairment after coronary artery bypass grafting (CABG) is well recognized, but previous investigations have been limited by lack of an appropriate control group. We compared changes in cognitive performance at 3 and 12 months after CABG with those in a control group of patients with comparable risk factors for coronary artery disease (CAD) who had not undergone surgery. METHODS: Patients undergoing CABG (n = 140) and demographically similar nonsurgical control subjects with CAD (n = 92) completed baseline neuropsychological assessment and were followed prospectively at 3 and 12 months. Cognitive function was evaluated with a battery of neuropsychological tests assessing the cognitive domains of attention, language, verbal and visual memory, visuoconstruction, executive function, and psychomotor and motor speed. RESULTS: The CABG patients who were tested in their hospital rooms before surgery had lower scores for timed tests; however, after adjustment for demographic variables and testing location there were no statistically significant differences between the CABG and nonsurgical control subjects in baseline neuropsychological test performance. Both groups improved from baseline to 3 months; the only statistically significant group difference was a greater improvement in the CABG group with regard to verbal memory. At 12 months there were no statistically significant differences between the two groups. CONCLUSIONS: The prospective longitudinal neuropsychological performance of patients with CABG did not differ from that of comparable nonsurgical control subjects with CAD at 3 months or 1 year after base line examination. This suggests that the previously reported cognitive decline during the early postoperative period after CABG is transient and reversible. Continued follow-up will determine whether a specific "late decline" occurs in CABG patients but not in nonsurgical control subjects with similar risk factors for cardiovascular and cerebrovascular disease.

Aged↗
PubMed2003

Psychosocial risk factors of HIV morbidity and mortality: findings from the Multicenter AIDS Cohort Study (MACS).

Despite the use of laboratory markers in estimating HIV prognosis, significant variation in the natural history of HIV-1 infection remains unexplained. Recent studies suggest psychosocial risk factors have important prognostic significance in HIV disease. The objective of the present study was to examine the prognostic influence of age, general intellectual functioning, and emotional distress across the spectrum of HIV disease progression. The study sample was drawn from the Multicenter AIDS Cohort Study (MACS), a 13-year, prospective study of HIV-seropositive men recruited from four study centers across the country. The participants were 1,231 HIV-seropositive MACS participants, followed from baseline (median 8/15/87) to the end of the observation period (12/15/98). HIV disease progression was evaluated with respect to three outcome measures: (1) number of years from baseline testing to the first AIDS defining illness (progression to AIDS), (2) years from baseline to HIV-dementia (progression to dementia), and (3) years from baseline to death (survival). The influence of psychosocial risk factors on outcome measures was evaluated using survival analyses. General intellectual functioning, age, and somatic symptoms of depression, were found to be significant predictors of HIV disease progression and survival. Older age at baseline was associated with a more rapid progression to dementia and death. Lower Shipley IQ estimates were associated with a more rapid disease progression (AIDS and dementia) and shortened survival. Somatic symptoms of depression were associated with shortened survival. In addition, age, IQ, and somatic symptoms of depression, had an additive effect with an increase in the number of risk factors associated with accelerated disease progression and shortened time to death. These findings remained consistent, despite controlling for baseline CD4 and HIV medication use. Psychosocial cofactors are important in understanding HIV disease progression. Methods for estimating HIV prognosis may become more reliable if psychosocial factors are considered. Future research will clarify if psychosocial risk factors reflect central nervous system integrity, brain reserve capacity or mediate morbidity and mortality through social economic status, access to health care and other social correlates.

AIDS Dementia Complex↗
PubMed2002

Neurocognitive aspects of medication adherence in HIV infection.

Strict adherence to the current highly active antiretroviral therapies (HAART) is a prerequisite for treatment success. The complexities of the treatment regimens places high demands on motivational and cognitive factors, and studies of cognitive predictors of adherence are just beginning to emerge. Traditional measures of new learning and recall may not be among the best neuropsychologic predictors of adherence. Rather, certain aspects of frontal and executive functioning appear to be more strongly associated with good adherence.

AIDS-Associated Nephropathy↗
PubMed2002

Encephalopathy and stroke after coronary artery bypass grafting: incidence, consequences, and prediction.

BACKGROUND: In contrast to perioperative stroke, much less attention has been paid to those with evidence of diffuse brain encephalopathy, presenting as delirium, confusion, coma, and seizures in the immediate postoperative period. OBJECTIVE: To determine the incidence, consequences, and predictive factors for encephalopathy and stroke following coronary artery bypass grafting. METHODS: In a prospective evaluation of 2711 patients operated on between January 1, 1997, and December 31, 2000, preoperative risk factors were obtained before surgery and postoperative outcomes, encephalopathy and stroke, were determined on a daily basis. All strokes were confirmed by neurologic consultation and, in most instances, by imaging. Logistic regression analyses were performed to determine risk factors for these outcomes. RESULTS: The incidence of encephalopathy was 6.9% and of stroke, 2.7%. For patients without either of these outcomes, the average length of stay in the hospital was 6.6 days and the mortality was 1.4%. In contrast, patients with encephalopathy had a length of stay of 15.2 days and a mortality of 7.5%, and those with stroke, a length of stay of 17.5 days and a mortality of 22.0%. Predictive models were developed for encephalopathy involving 5 preoperative factors (age, past stroke, carotid bruit, hypertension, and diabetes) and 1 perioperative factor (time on cardiopulmonary bypass). The model for stroke involved only 3 preoperative risk factors (past stroke, hypertension, and diabetes). CONCLUSIONS: Encephalopathy or stroke is associated with significant increases in length of stay and mortality after coronary artery bypass grafting. Patients at higher risk for these outcomes can be identified before surgery.

Aged↗
PubMed2002

HIV-associated cognitive impairment before and after the advent of combination therapy.

The objective of this study was to describe the occurrence of HIV dementia and neuropsychological testing abnormalities in a new cohort of HIV-seropositive individuals at high risk for HIV dementia and to compare these results to a cohort before the advent of highly active antiretroviral therapy (HAART). HAART has been associated with improvements in cognitive performance in some HIV-infected patients. However, it is uncertain whether HAART has changed the frequency of specific neurocognitive abnormalities. Baseline data from 272 HIV-seropositive subjects in the Dana cohort recruited from January, 1994, to December, 1995, and 251 HIV-seropositive subjects in the Northeastern AIDS Dementia Consortium (NEAD) cohort recruited from April, 1998, to August, 1999, were compared. Participants in both cohorts received nearly identical assessments. After adjusting for differences in age, education, gender, race, and CD4 count between the two cohorts, there were no differences in the occurrence of HIV dementia or abnormalities either 1 SD or 2 SDs below established norms for any of the neuropsychological tests. Even though HAART has reduced the incidence of HIV dementia, HIV-associated cognitive impairment continues to be a major clinical problem among individuals with advanced infection.

AIDS Dementia Complex↗
PubMed2002

Assessing HIV-associated dementia: modified HIV dementia scale versus the Grooved Pegboard.

The HIV dementia scale (HDS) previously has been shown to be sensitive in identifying persons with HIV-associated dementia (HAD). We aimed to develop a simpler version of the HDS--the Modified HDS (M-HDS)--which would be appropriate for use by nonneurologists. We sought to determine whether the M-HDS and the widely used Grooved Pegboard (GP) were comparable in identifying and staging the severity of dementia in HIV-seropositive persons. Data from 455 HIV-seropositive persons were analyzed, and patients were separated into 2 groups: demented (n = 144) and nondemented (n = 311), where the diagnosis was established by a single neurologist. Of the 144 with HAD, 13 had severe dementia, 55 had moderate dementia, 51 had mild dementia, and 25 had minor cognitive/motor disorder. We assessed the relationship between dementia severity and score on the M-HDS and GP (nondominant hand). Results showed both the M-HDS (z = -4.32; P < .05) and the GP nondominant (z = -4.08; P < .05) differentiated demented from nondemented persons. Furthermore, the M-HDS (z = -2.95; P < .05) and GP nondominant (z = -2.68; P < .05) discriminated equally well the stages of dementia severity. A cutoff score of 7.5 on the M-HDS maximized its sensitivity (70%) and specificity (71%). The M-HDS and the GP (nondominant) were found to be equally sensitive and specific in categorizing and staging HAD. However, the M-HDS requires no equipment and is simpler to administer; so it may be more useful for screening by nonneurologists.

AIDS Dementia Complex↗