Robert K. Heaton

To test whether the cognitive deficits seen in eosinophilia-myalgiasyndrome are associated with non-neurologic factors fatigue, pain, depression or whether these deficits occur in the absence of suchfactors and are associated with a primary neurocognitive disorder.Although clinical studies suggest that aging may affect subgroups ofpsychotics in various ways, there are no large scale neuropsychologicalstudies specifically directed at psychosis in later life. In general, previous studies of cognitive functioning in psychosis have been limited byheterogeneity within and across groups being investigated. The proposedstudy will evaluate the cognitive profiles of 450 subjects in various areasof neuropsychological functions, including attention, achievement, intellect, learning and episodic memory, procedural memory, motor speed, constructional praxis, perception, language, and executive functions. Briefly, 150 middle-aged and elderly patients with early-onsetschizophrenia, 25 patients with late-onset schizophrenia, 25 patients withlate-onset delusional disorder, 50 younger schizophrenics, 50 Alzheimerdisease patients with and another 50 without psychosis, and 100 normalcontrols over age 45, recruited by the Clinical Core, will be evaluatedlongitudinally. Comprehensive test batteries will be administered to eachparticipant by experienced psychometrists in a standardized fashion. Thegeneral aims of the Neuropsychology core are threefold. First theNeuropsychology core will provide service to other Cores in the CRC, byproviding quantitative indices of cognitive functioning on each CRCparticipant. Secondly the Core will provide data necessary to addressspecific hypotheses on the nature of cognitive processes in psychosis bylongitudinally comparing neuropsychological profilesof patients withdifferent clinical characteristics. For instance, data derived from theNeuropsychology Core will be used to address specific hypotheses regardingcognitive functions associated with neuroleptic use, longitudinalevaluations of cognitive functions in clinical subtypes of older patientswith psychosis, specific patterns and levels of neuropsychologicalabilities in older patients with tardive dyskinesia, and relationshipsbetween changes in cognitive abilities and changes in clinical status overtime. Finally, the Core will initiate new hypotheses and generate pilotdata for further research in this area.For the renewal period, the previous Neuropsychology NP Core and memoryProject will be combined within one unit, which will address common aims ina more efficient and integrated fashion. Based upon our findings so far, we have been able to devise a briefer test battery that includes theessential components of the standard clinical test battery as well s moreexperimental NP tests selected for their relevance to subcortical rainpathology. In the next 5 years we propose to focus on the longer termtemporal and spatial anatomic progression of the NP deficits associatedwith HIV infection. Particularly, using our large cohort of datedseroconverters, we will chart the incidence and prevalence of both generaland specific NP impairments at each year after infection. NP status andits changes will be related to potentially important host and viralfactors, in addition to functional and structural brain imaging in life, and postmortem measures of regionally specific CNS viral burden and damage. Finally, we will further explore the everyday life significance of mild NPimpairments in HIVpersons who are medically asymptomatic or minimallysymptomatic; this will be done by comparing matched NP impaired andunimpaired subjects with respect to changes in employment status andperformance on standardized work samples. In addition to testing specific hypotheses regarding the NP impairmentassociated with HIV infection, the new NP Core will continue to providecomprehensive neurobehavioral data for comparison with data from all othercore study components and individual projects within the Center.