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Ned Sacktor, MD; Ronald L. Van Heertum, MD; George Dooneief, MD, MPH; Jack Gorman, MD; Alexander Khandji, MD; Karen Marder, MD, MPH; Ramy Nour, MD; George Todak, MSW; Yaakov Stern, PhD; Richard Mayeux, MD, MSE

Arch Neurol. 1995;52(12):1170-1173.

Abstract
Objective
To determine whether technetium Tc 99m exametazime (HMPAO) single-photon emission computed tomography (SPECT) can distinguish between human immunodeficiency virus (HIV)-positive homosexual men with normal neuropsychologic test results and HIV-positive homosexual men with abnormal neuropsychologic test results.

Design
Neurologic, neuropsychologic, magnetic resonance imaging, and Tc 99m HMPAO SPECT examinations were performed on 10 HIV-positive homosexual men without cognitive impairment and five HIV-positive homosexual men with cognitive impairment.

Patients
Human immunodeficiency virus—positive homosexual men from New York City were recruited for the study.

Main Outcome Measures
Findings on SPECT scans were evaluated qualitatively for focal defects, heterogeneity of the cortical margin, white matter hypoperfusion, and decreased global cortical uptake. All SPECT focal defects were coregistered with magnetic resonance images; SPECT heterogeneity and global cortical uptake were also measured quantitatively.

Results
Coregistration with magnetic resonance imaging revealed that 63% of the focal SPECT defects corresponded to brain gyri and 37% corresponded to sulci. There was no significant difference in the frequency of qualitative or quantitative SPECT abnormalities between HIV-positive homosexual men with and without cognitive impairment. However, after examining individual neuropsychologic test factors, impaired motor speed performance was associated with decreased quantitative global cerebral uptake.

Conclusions
Qualitative SPECT abnormalities are not increased in frequency in HIV-positive homosexual men with global cognitive impairment compared with those in HIV-positive homosexual men without cognitive impairment. Impaired motor speed performance may be associated with decreased quantitative global cerebral uptake.

Author Affiliations
From the Gertrude H. Sergievsky Center (Drs Sacktor, Dooneief, Marder, Stern, and Mayeux); the HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute (Drs Sacktor, Dooneief, Gorman, Marder, Stern, and Mayeux and Mr Todak); and the Departments of Neurology (Drs Sacktor, Dooneief, Marder, Stern, and Mayeux), Radiology (Drs Van Heertum, Khandji, and Nour), and Psychiatry (Drs Gorman, Stern, and Mayeux and Mr Todak), Columbia University College of Physicians and Surgeons, New York, NY. Dr Sacktor is currently with the Johns Hopkins Bayview Medical Center, Baltimore, Md.

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