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<meta name="DC.Title" content="7T Brain MRS in HIV Infection: Correlation with Cognitive Impairment and Performance on Neuropsychological Tests" />
<meta name="DC.Identifier" content="10.3174/ajnr.A5547" />
<meta name="DC.Date" content="2018-04-01" />
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<meta name="DC.Description" content="BACKGROUND AND PURPOSE: Validated neuroimaging markers of HIV-associated neurocognitive disorder in patients on antiretroviral therapy are urgently needed for clinical trials. The purpose of this study was to explore the relationship between cognitive impairment and brain metabolism in older subjects with HIV infection. It was hypothesized that MR spectroscopy measurements related to neuronal health and function (particularly N -acetylaspartate and glutamate) would be lower in HIV-positive subjects with worse cognitive performance.

MATERIALS AND METHODS: Forty-five HIV-positive patients (mean age, 58.9 ± 5.3 years; 33 men) underwent detailed neuropsychological testing and brain MR spectroscopy at 7T. Twenty-four subjects were classified as having asymptomatic cognitive impairment, and 21 were classified as having symptomatic cognitive impairment. Single-voxel proton MR spectra were acquired from 5 brain regions and quantified using LCModel software. Brain metabolites and neuropsychological test results were compared using nonparametric statistics and Pearson correlation coefficients.

RESULTS: Differences in brain metabolites were found between symptomatic and asymptomatic subjects, with the main findings being lower measures of N -acetylaspartate in the frontal white matter, posterior cingulate cortex, and precuneus. In the precuneus, glutamate was also lower in the symptomatic group. In the frontal white matter, precuneus, and posterior cingulate cortex, NAA and glutamate measurements showed significant positive correlation with better performance on neuropsychological tests.

CONCLUSIONS: Compared with asymptomatic subjects, symptomatic HIV-positive subjects had lower levels of NAA and glutamate, most notably in the frontal white matter, which also correlated with performance on neuropsychological tests. High-field MR spectroscopy offers insight into the pathophysiology associated with cognitive impairment in HIV and may be useful as a quantitative outcome measure in future treatment trials.

cART
:   combined antiretroviral therapy
FWM
:   frontal white matter
Glu
:   glutamate
HAND
:   HIV-associated neurocognitive disorder
PC
:   precuneus
PCC
:   posterior cingulate cortex
tNAA
:   NAA+ N- acetyl aspartylglutamate" />
<meta name="DC.Contributor" content="M. Mohamed" />
<meta name="DC.Contributor" content="P.B. Barker" />
<meta name="DC.Contributor" content="R.L. Skolasky" />
<meta name="DC.Contributor" content="N. Sacktor" />
<meta name="article:published_time" content="2018-04-01" />
<meta name="article:section" content="ADULT BRAIN" />
<meta name="citation_title" content="7T Brain MRS in HIV Infection: Correlation with Cognitive Impairment and Performance on Neuropsychological Tests" />
<meta name="citation_abstract" lang="en" content="&lt;h3&gt;BACKGROUND AND PURPOSE:&lt;/h3&gt;
&lt;p&gt;Validated neuroimaging markers of HIV-associated neurocognitive disorder in patients on antiretroviral therapy are urgently needed for clinical trials. The purpose of this study was to explore the relationship between cognitive impairment and brain metabolism in older subjects with HIV infection. It was hypothesized that MR spectroscopy measurements related to neuronal health and function (particularly &lt;i&gt;N&lt;/i&gt;-acetylaspartate and glutamate) would be lower in HIV-positive subjects with worse cognitive performance.&lt;/p&gt;&lt;h3&gt;MATERIALS AND METHODS:&lt;/h3&gt;
&lt;p&gt;Forty-five HIV-positive patients (mean age, 58.9 ± 5.3 years; 33 men) underwent detailed neuropsychological testing and brain MR spectroscopy at 7T. Twenty-four subjects were classified as having asymptomatic cognitive impairment, and 21 were classified as having symptomatic cognitive impairment. Single-voxel proton MR spectra were acquired from 5 brain regions and quantified using LCModel software. Brain metabolites and neuropsychological test results were compared using nonparametric statistics and Pearson correlation coefficients.&lt;/p&gt;&lt;h3&gt;RESULTS:&lt;/h3&gt;
&lt;p&gt;Differences in brain metabolites were found between symptomatic and asymptomatic subjects, with the main findings being lower measures of &lt;i&gt;N&lt;/i&gt;-acetylaspartate in the frontal white matter, posterior cingulate cortex, and precuneus. In the precuneus, glutamate was also lower in the symptomatic group. In the frontal white matter, precuneus, and posterior cingulate cortex, NAA and glutamate measurements showed significant positive correlation with better performance on neuropsychological tests.&lt;/p&gt;&lt;h3&gt;CONCLUSIONS:&lt;/h3&gt;
&lt;p&gt;Compared with asymptomatic subjects, symptomatic HIV-positive subjects had lower levels of NAA and glutamate, most notably in the frontal white matter, which also correlated with performance on neuropsychological tests. High-field MR spectroscopy offers insight into the pathophysiology associated with cognitive impairment in HIV and may be useful as a quantitative outcome measure in future treatment trials.&lt;/p&gt;" />
<meta name="citation_journal_title" content="American Journal of Neuroradiology" />
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<meta name="citation_publication_date" content="2018/04/01" />
<meta name="citation_mjid" content="ajnr;39/4/704" />
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<meta name="citation_issn" content="0195-6108" />
<meta name="citation_issn" content="1936-959X" />
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<meta name="citation_author" content="M. Mohamed" />
<meta name="citation_author_institution" content="aFrom the Russell H. Morgan Department of Radiology and Radiological Science (M.M., P.B.B.)" />
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<meta name="citation_author" content="P.B. Barker" />
<meta name="citation_author_institution" content="aFrom the Russell H. Morgan Department of Radiology and Radiological Science (M.M., P.B.B.)" />
<meta name="citation_author_institution" content="dPsychiatry and Behavioral Sciences (P.B.B.), Johns Hopkins University School of Medicine, Baltimore, Maryland" />
<meta name="citation_author_institution" content="eF.M. Kirby Center for Functional Brain Imaging (P.B.B.), Kennedy Krieger Institute, Baltimore, Maryland." />
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<meta name="citation_author" content="R.L. Skolasky" />
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<meta name="twitter:title" content="7T Brain MRS in HIV Infection: Correlation with Cognitive Impairment and Performance on Neuropsychological Tests" />
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<meta name="twitter:description" content="BACKGROUND AND PURPOSE: Validated neuroimaging markers of HIV-associated neurocognitive disorder in patients on antiretroviral therapy are urgently needed for clinical trials. The purpose of this study was to explore the relationship between cognitive impairment and brain metabolism in older subjects with HIV infection. It was hypothesized that MR spectroscopy measurements related to neuronal health and function (particularly N -acetylaspartate and glutamate) would be lower in HIV-positive subjects with worse cognitive performance.

MATERIALS AND METHODS: Forty-five HIV-positive patients (mean age, 58.9 ± 5.3 years; 33 men) underwent detailed neuropsychological testing and brain MR spectroscopy at 7T. Twenty-four subjects were classified as having asymptomatic cognitive impairment, and 21 were classified as having symptomatic cognitive impairment. Single-voxel proton MR spectra were acquired from 5 brain regions and quantified using LCModel software. Brain metabolites and neuropsychological test results were compared using nonparametric statistics and Pearson correlation coefficients.

RESULTS: Differences in brain metabolites were found between symptomatic and asymptomatic subjects, with the main findings being lower measures of N -acetylaspartate in the frontal white matter, posterior cingulate cortex, and precuneus. In the precuneus, glutamate was also lower in the symptomatic group. In the frontal white matter, precuneus, and posterior cingulate cortex, NAA and glutamate measurements showed significant positive correlation with better performance on neuropsychological tests.

CONCLUSIONS: Compared with asymptomatic subjects, symptomatic HIV-positive subjects had lower levels of NAA and glutamate, most notably in the frontal white matter, which also correlated with performance on neuropsychological tests. High-field MR spectroscopy offers insight into the pathophysiology associated with cognitive impairment in HIV and may be useful as a quantitative outcome measure in future treatment trials.

cART
:   combined antiretroviral therapy
FWM
:   frontal white matter
Glu
:   glutamate
HAND
:   HIV-associated neurocognitive disorder
PC
:   precuneus
PCC
:   posterior cingulate cortex
tNAA
:   NAA+ N- acetyl aspartylglutamate" />
<meta name="og-title" property="og:title" content="7T Brain MRS in HIV Infection: Correlation with Cognitive Impairment and Performance on Neuropsychological Tests" />
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<meta name="og-site-name" property="og:site_name" content="American Journal of Neuroradiology" />
<meta name="og-description" property="og:description" content="BACKGROUND AND PURPOSE: Validated neuroimaging markers of HIV-associated neurocognitive disorder in patients on antiretroviral therapy are urgently needed for clinical trials. The purpose of this study was to explore the relationship between cognitive impairment and brain metabolism in older subjects with HIV infection. It was hypothesized that MR spectroscopy measurements related to neuronal health and function (particularly N -acetylaspartate and glutamate) would be lower in HIV-positive subjects with worse cognitive performance.

MATERIALS AND METHODS: Forty-five HIV-positive patients (mean age, 58.9 ± 5.3 years; 33 men) underwent detailed neuropsychological testing and brain MR spectroscopy at 7T. Twenty-four subjects were classified as having asymptomatic cognitive impairment, and 21 were classified as having symptomatic cognitive impairment. Single-voxel proton MR spectra were acquired from 5 brain regions and quantified using LCModel software. Brain metabolites and neuropsychological test results were compared using nonparametric statistics and Pearson correlation coefficients.

RESULTS: Differences in brain metabolites were found between symptomatic and asymptomatic subjects, with the main findings being lower measures of N -acetylaspartate in the frontal white matter, posterior cingulate cortex, and precuneus. In the precuneus, glutamate was also lower in the symptomatic group. In the frontal white matter, precuneus, and posterior cingulate cortex, NAA and glutamate measurements showed significant positive correlation with better performance on neuropsychological tests.

CONCLUSIONS: Compared with asymptomatic subjects, symptomatic HIV-positive subjects had lower levels of NAA and glutamate, most notably in the frontal white matter, which also correlated with performance on neuropsychological tests. High-field MR spectroscopy offers insight into the pathophysiology associated with cognitive impairment in HIV and may be useful as a quantitative outcome measure in future treatment trials.

cART
:   combined antiretroviral therapy
FWM
:   frontal white matter
Glu
:   glutamate
HAND
:   HIV-associated neurocognitive disorder
PC
:   precuneus
PCC
:   posterior cingulate cortex
tNAA
:   NAA+ N- acetyl aspartylglutamate" />
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    <div class="highwire-article-citation highwire-citation-type-highwire-article node60150--5" data-node-nid="60150" id="top-node-60150--6422901503" data-pisa="ajnr;39/4/704" data-pisa-master="ajnr;ajnr.A5547" data-apath="/ajnr/39/4/704.atom" data-hw-author-tooltip-instance="highwire_author_tooltip"><div class="highwire-cite highwire-cite-highwire-article highwire-citation-jcore-article-title-complete clearfix has-author-tooltip highwire-citation-highwire-article-top-a">
  
  
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    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0">M. Mohamed</span>, <span class="highwire-citation-author" data-delta="1">P.B. Barker</span>, <span class="highwire-citation-author" data-delta="2">R.L. Skolasky</span> and <span class="highwire-citation-author" data-delta="3">N. Sacktor</span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">April 2018,  </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">39 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(4) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">704-712; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata">DOI: https://doi.org/10.3174/ajnr.A5547 </span></div>
  
  
  
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<div id="hw-article-author-popups-top-node-60150--6422901503" style="display: none;"><div class="author-tooltip-0"><div class="author-tooltip-name">M. Mohamed </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Russell H. Morgan Department of Radiology and Radiological Science (M.M., P.B.B.)</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=M.%2BMohamed%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Mohamed%20M&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AM.%2BMohamed%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0002-5464-3293" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for M. Mohamed</a></li></ul></div><div class="author-tooltip-1"><div class="author-tooltip-name">P.B. Barker </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Russell H. Morgan Department of Radiology and Radiological Science (M.M., P.B.B.)</div><div class='author-affiliation'><span class='nlm-sup'>d</span>Psychiatry and Behavioral Sciences (P.B.B.), Johns Hopkins University School of Medicine, Baltimore, Maryland</div><div class='author-affiliation'><span class='nlm-sup'>e</span>F.M. Kirby Center for Functional Brain Imaging (P.B.B.), Kennedy Krieger Institute, Baltimore, Maryland.</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=P.B.%2BBarker%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Barker%20P&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AP.B.%2BBarker%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0002-6410-7793" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for P.B. Barker</a></li></ul></div><div class="author-tooltip-2"><div class="author-tooltip-name">R.L. Skolasky </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>b</span>Departments of Neurology (R.L.S., N.S.)</div><div class='author-affiliation'><span class='nlm-sup'>c</span>Orthopedic Surgery (R.L.S.)</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=R.L.%2BSkolasky%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Skolasky%20R&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AR.L.%2BSkolasky%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0002-2598-4427" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for R.L. Skolasky</a></li></ul></div><div class="author-tooltip-3"><div class="author-tooltip-name">N. Sacktor </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>b</span>Departments of Neurology (R.L.S., N.S.)</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=N.%2BSacktor%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Sacktor%20N&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AN.%2BSacktor%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0001-5349-8058" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for N. 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      <div class="highwire-cite-title">7T Brain MRS in HIV Infection: Correlation with Cognitive Impairment and Performance on Neuropsychological Tests</div>  
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      <div class="highwire-cite-title">7T Brain MRS in HIV Infection: Correlation with Cognitive Impairment and Performance on Neuropsychological Tests</div>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0"><span class="nlm-given-names">M.</span> <span class="nlm-surname">Mohamed</span></span>, <span class="highwire-citation-author" data-delta="1"><span class="nlm-given-names">P.B.</span> <span class="nlm-surname">Barker</span></span>, <span class="highwire-citation-author" data-delta="2"><span class="nlm-given-names">R.L.</span> <span class="nlm-surname">Skolasky</span></span>, <span class="highwire-citation-author" data-delta="3"><span class="nlm-given-names">N.</span> <span class="nlm-surname">Sacktor</span></span></span></div>
  
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