Neuropsychological tests

Neuropsychological examination supports the clinical diagnosis of HIV-associated dementia, by providing evidence of cognitive and motor dysfunction. Moreover, it may be useful in the differential diagnosis with a depressive syndrome.

The most prominent impairment is observed on tests of fine motor control (finger tapping, grooved pegboard), rapid sequential problem solving (trail-making A and B, digit symbol), visuospatial problem solving (block design), spontaneity (verbal fluency), and visual memory (visual reproduction). In contrast, naming and vocabulary skills are largely preserved even in the most advanced cases. This pattern has been regarded as consistent with the clinical picture of a 'subcortical dementia'.

The signs that should alert to the possible presence of a depressive 'pseudodementia' are as follows: (8)

1. the intratest variability of performance (i.e. missing easy items and then correctly answering more difficult questions);

2. mood-congruent complaints, which are at odds with objective performance (i.e. the subject complains of having difficulties with a test, whereas his or her performance is near perfect);

3. responses of 'I don't know' or giving up, which are followed by the correct answer, when the subject is further urged to respond. It should be considered, however, that dementia and depression may coexist in HIV-seropositive subjects.

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