title: The Edinburgh cohort of HIV-positive injecting drug users at 10 years after infection: a case-control study of the evolution of dementia.
abstract: OBJECTIVE
  To examine the evolution of dementia in HIV-positive injecting drug users (IDU) in Edinburgh.
  
  
  METHODS
  Case-control study.
  
  
  METHODS
  Twenty six (6%) out of 404 patients in the Edinburgh cohort of HIV-positive IDU who have developed HIV-1-associated dementia in the 10 years since infection and seroconversion.
  
  
  METHODS
  Patients were tested repeatedly, where possible, on a range of neuropsychological and neurophysiological measures. The results from patients with dementia were compared with those of age, sex and IQ-matched non-demented HIV-positive controls from the cohort. An auditory event-related potential (P3 or P300), a neurophysiological measure of cognitive function, detected the onset of a marked slowing of cognitive and psychomotor functions. Neuropsychological measures that involve the speed of information processing such as the Trail-Making task also identified the early stages of dementia.
  
  
  RESULTS
  Dementia was associated with a more advanced stage of systemic disease, increased rates of decline in CD4 cell counts and markedly reduced survival compared with the non-demented controls. No evidence for a protective effect of treatment with zidovudine was detected.
  
  
  CONCLUSIONS
  In the first 10 years after infection with HIV-1 dementia is an individual development, not the clinical extreme of general intellectual impairment, and had occurred in at least 6% of our IDU cohort. Future questions concern the long-term rate of dementia, the critical neuropathological change and the true potential for early treatment.
authors.affiliation: University Department of Psychiatry, Royal Edinburgh Hospital, UK.
authors.forename: G M
authors.initials: GM
authors.lastname: Goodwin
authors.forename: D O
authors.initials: DO
authors.lastname: Pretsell
authors.forename: A
authors.initials: A
authors.lastname: Chiswick
authors.forename: V
authors.initials: V
authors.lastname: Egan
authors.forename: R P
authors.initials: RP
authors.lastname: Brettle
mesh_terms: D015526:AIDS Dementia Complex / Q000188:drug therapy / Q000453:epidemiology / Q000276:immunology / Q000503:physiopathology* / Q000523:psychology; D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use; D018791:CD4 Lymphocyte Count; D016022:Case-Control Studies; D003071:Cognition; D018450:Disease Progression; D005072:Evoked Potentials, Auditory; D005260:Female; D006679:HIV Seropositivity; D006801:Humans; D008297:Male; D009483:Neuropsychological Tests; D011597:Psychomotor Performance; D015819:Substance Abuse, Intravenous; D006113:United Kingdom / Q000453:epidemiology; D015215:Zidovudine / Q000627:therapeutic use
chemical_list: D000998:Antiviral Agents; D015215:Zidovudine