EEG and dementia indicators in AIDS patients' Rorschach test

Prado, G. Fernandes do; Carvalho, L.B.C.; Silva, A. Baptista da; Lima, J.G.C.

doi:10.1590/S0004-282X1994000300005

Abstracts

We studied the EEG and Rorschach test (RT) of nineteen AIDS patients and eight normal people in the same age group. Eight patients presented slow alpha rhythms (8 to 9 Hz); three, not-slow alpha rhythms (>9 to 13Hz); and eight, beta rhythms in background activity. Paroxystic activity, characterized by diffuse theta or delta waves, was present in eleven patients. We observed Oberholzer syndrome (organic dementia diagnosed by RT) in ten patients and Piotrowski syndrome (organic dementia diagnosed by RT) in eleven patients; six presented both. When considering only the group of AIDS patients, we did not observe a significant relation among slow alpha rhythm, not-slow alpha rhythm and the presence of paroxystic activity with the above-mentioned syndromes. AIDS patients with slow alpha rhythms showed a significantly greater number of Piotrowski syndrome dementia indicators when compared to normal individuals or those with slow alpha rhythms. We did not observe the same with Oberholzer syndrome.

dementia; AIDS; HIV infection; EEG; Rorschach test

Realizou-se EEG e teste psicodiagnóstico de Rorschach (TR) em dezenove pacientes aidéticos e em oito pessoas normais na mesma faixa etária. Oito pacientes apresentaram alfa lento, três alfa não lento e oito ritmo beta na atividade de base. A atividade paroxística esteve presente em onze pacientes, tendo sido caracterizada por ondas teta ou delta difusas. A síndrome de Oberholzer (demência orgânica observada através do RT) foi observada em dez pacientes e a síndrome de Piotrowski (demência orgânica observada através do RT) em onze pacientes; seis pacientes apresentaram as duas síndromes. Não se observou relação entre ritmo alfa lento, alfa não lento e presença de atividade paroxística com as referidas síndromes, quando se considerou apenas o grupo de pacientes aidéticos. Os pacientes aidéticos com ritmo alfa lento apresentaram número significantemente maior de indicadores da síndrome de Piotrowski quando comparados às pessoas normais e com alfa lento, não se demonstrando o mesmo em relação à síndrome de Oberholzer.

demência; AIDS (SIDA); infecção por HIV; EEG; teste de Rorschach

EEG and dementia indicators in AIDS patients' Rorschach test

EEG e indicadores de demência no teste de Rorschach em pacientes com AIDS

G. Fernandes do Prado^I; L.B.C. Carvalho^II; A. Baptista da Silva^III; J.G.C. Lima^IV

^IDiscipline of Neurology, Escola Paulista de Medicina (EPM) and Institute of Psychology, Universidade de São Paulo (USP): Pós-graduando da Disciplina de Neurologia, EPM

^IIDiscipline of Neurology, Escola Paulista de Medicina (EPM) and Institute of Psychology, Universidade de São Paulo (USP): Pós-graduanda do Instituto de Psicologia, USP

^IIIDiscipline of Neurology, Escola Paulista de Medicina (EPM) and Institute of Psychology, Universidade de São Paulo (USP): Professor Adjunto da Disciplina de Neurologia, EPM

^IVDiscipline of Neurology, Escola Paulista de Medicina (EPM) and Institute of Psychology, Universidade de São Paulo (USP): Professor Titular e Chefe da Disciplina de Neurologia, EPM

SUMMARY

We studied the EEG and Rorschach test (RT) of nineteen AIDS patients and eight normal people in the same age group. Eight patients presented slow alpha rhythms (8 to 9 Hz); three, not-slow alpha rhythms (>9 to 13Hz); and eight, beta rhythms in background activity. Paroxystic activity, characterized by diffuse theta or delta waves, was present in eleven patients. We observed Oberholzer syndrome (organic dementia diagnosed by RT) in ten patients and Piotrowski syndrome (organic dementia diagnosed by RT) in eleven patients; six presented both. When considering only the group of AIDS patients, we did not observe a significant relation among slow alpha rhythm, not-slow alpha rhythm and the presence of paroxystic activity with the above-mentioned syndromes. AIDS patients with slow alpha rhythms showed a significantly greater number of Piotrowski syndrome dementia indicators when compared to normal individuals or those with slow alpha rhythms. We did not observe the same with Oberholzer syndrome.

Key words: dementia, AIDS, HIV infection, EEG, Rorschach test.

RESUMO

Realizou-se EEG e teste psicodiagnóstico de Rorschach (TR) em dezenove pacientes aidéticos e em oito pessoas normais na mesma faixa etária. Oito pacientes apresentaram alfa lento, três alfa não lento e oito ritmo beta na atividade de base. A atividade paroxística esteve presente em onze pacientes, tendo sido caracterizada por ondas teta ou delta difusas. A síndrome de Oberholzer (demência orgânica observada através do RT) foi observada em dez pacientes e a síndrome de Piotrowski (demência orgânica observada através do RT) em onze pacientes; seis pacientes apresentaram as duas síndromes. Não se observou relação entre ritmo alfa lento, alfa não lento e presença de atividade paroxística com as referidas síndromes, quando se considerou apenas o grupo de pacientes aidéticos. Os pacientes aidéticos com ritmo alfa lento apresentaram número significantemente maior de indicadores da síndrome de Piotrowski quando comparados às pessoas normais e com alfa lento, não se demonstrando o mesmo em relação à síndrome de Oberholzer.

Palavras-chave: demência, AIDS (SIDA), infecção por HIV, EEG, teste de Rorschach.

Texto completo disponível apenas em PDF.

Full text available only in PDF format.

Acknowledgement - We gratefully acknowledge William Shelton for his help in revising this text.

Aceite: 23-janeiro-1994.

Dr. Gilmar Fernandes do Prado - Rua Santa Flora 244 - 01549-040 São Paulo SP - Brasil.

1. Anders KH, Guerra WF, Tomiyasu U, Verity MA, Vinters AV. The neuropathology of AIDS: UCLA experience and review. Am J Pathol 1986, 124: 537-558.
2. Bizari L, Souza MA. Rorschach em aidéticos. Encontro Brasileiro de Rorschach, São Paulo,1988: Resumos. São Paulo, 1989.
3. Bohm E. Psicosis orgânicas. In BOHM E. Manual del psicodioagnóstico de Rorschach, Ed 8, Madrid: Ediciones Morata 1984, p 356-368.
4. Brenneman DE, Westbrook GL, Fitzgerald SP, Ennist DL, Elkins KL, Ruff MR, Pert CB. Neuronal cell killing by the envelop protein of HIV and its prevention by vasoactive intestinal peptide. Nature 1988, 335: 639-642.
5. Dalgleish AG, Beverley PC, Clapham RP, Crawford DH, Greaves MF, Weiss RA. The CD4 (T4) antogen is an essential component of the receptor for the AIDS retrovirus. Nature 1984, 312: 763-767.
6. De La Monte SM, Ho DD, Schooley RT, Hirsch MS, Richardson EP. Subacute encephalomyelitis of AIDS and its relation to HTLV-III infection. Neurology 1987, 37: 562-569.
7. Dreyer EB, Kaiser PK, Offermann JT, Lipton SA. HIV-1 coat protein neurotoxicity prevented by calcium channel antagonists. Science 1990, 248: 364-367.
8. Everall IP, Luthert PJ, Lantos PL. Neuronal loss in the frontal cortex in HIV infection. Lancet 1991, 337: 1119-1121.
9. Enzensberger W, Fischer PA, Helm EB, Stille W. Value of electroencephalography in AIDS. Lancet 1985, 4: 1047-1048.
10. Enzensberger W, Helm EB, Fischer PA. EEG follow-up examination in AIDS patients. Electroenceph Clin Neurophysiol 1986, 63:28P.
11. Fischer PA, Enzensberger W. Neurological complications in AIDS. J Neurol 1987, 234: 269-279.
12. Gabuzda DH, Levy SR, Chiappa KH. Electroencephalography in AIDS and AIDS-related complex. Clin Electroenceph 1988, 19: 1-6.
13. Grant I, AtkinsonH, Hesselink JR, Kennedy CJ, Richman DD, Spector SA, McCutchan JA. Evidence for early central nervous system involvement in acquired immunodeficiency syndrome (AIDS) and other human immunodeficiency virus (HIV) infections. Ann Intern Med 1987, 107: 828-836.
14. Gray F, Gherardi R, Poirier J. Les lésions du systeme nerveux au cours du SIDA. Arch Anat Cytol Path 1986, 34: 268-278.
15. Hamburg MA, Koening S, Fauci AS. Immunology of AIDS and HIV infection. In Mandell GL. Principles and practises of infections diseases and their etiology agents. Part II, Vol I, Section P. Ed 3. New York: Churchill Livingstone, 1990, p 1046-1058.
¹⁶
Ifsecn. A glossary of terms most commonly used by clinical electroencephalographers. Electroenceph Clin Neurophysiol 1974, 37: 538-548.
17. Ketzler S, Weis S, Haug H, Budka H. Loss of neurons in the frontal cortex in AIDS brains. Acta Neuropathol 1990, 80: 92-94.
18. Klatzmann D, Champagne E, Chamaret S, Gruest J, Guetard D, Hercend T, Cluckman JC, Montagnier L. T-lymphocyte T4 molecule behaves as the receptor for human retrovirus LAV. Nature 1984, 312: 767.
19. Koralnik, Beaumandir A, Hausler R, Kholer A, Delacoux R, Hirschel B. Abnormalities of EEG and otoneurologic test in asymptomatic HIV infected homosexuals: a prospective controlled study. V^e Conférence Internationale sur le SIDA. Montreal, 1989. Abregés. Montreal, 1989, p 462.
20. Levy RM, Bredesen DE, Rosenblun ML. Neurological manifestations for the acquired immunodeficiency syndrome (AIDS): experience at UCSF and review of the literature. J Neurosurg 1985, 62: 475-495.
21. Link D. AIDS dementia complex. Treatment Issues 2, Vol. VI, 1992.
22. Minoli L, Nappi G. EEG findings and cognitive performance in 82 HIV-infected patients. V^E Conférence Iinternationale sur le SIDA. Montreal, 1989. Abregés. Montreal, 1989, p 462.
23. Navia BA, Jordan BD, Price RW. The AIDS dementia complex: I. Clinical features. Ann Neurol 1986, 19: 517-524.
24. Navia BA, Cho ES, Petito CK, Price RW. The AIDS dementia complex: II. Neuropathology Ann Neurol 1986, 19: 525-535.
25. Oberholzer E. Zur differentialdiagnose psychicher Folgezustande nach Schadeltraumen mittels des Rorschachschen Formdeutversuchs. Zges Neurol Psychiatr 1931, 136: 596-629.
26. Piotrowski Z. The Rorschach inkblot method in organic disturbances of the central nervous system. J Nerv Ment Dis 1937, 86: 525-537.
27. Prado GF. Estudo das alterações eletrencefalográficas em pacientes aidéticos com ou sem complicações secundárias. Tese de Mestrado, Escola Paulista de Medicina. São Paulo, 1991.
28. Prado GF, Silva AB, Lima JGC. Electroencephalogram (EEG) base rhythm in AIDS patients. Arq Neuropsiquiatr 1993, 51: 169-174.
29. Price RW, Brew B, Sidtis J, Rosenblum M, Scheckk AC, Cleary P, The brain in AIDS: central nervous system HIV-1 infection and AIDS dementia complex. Science 1988, 239: 586-591.
30. Pulliam L, Herndier BG, Tand NM, McGrath MS. Human immunodeficiency virus-infected macrophages produce soluble factors that cause histological and neurochemical alterations in cultured human brains. J Clin Invest 1991, 87: 503-512.
31. Riedel RR, Helmstaedter C, Bülau P, Durwen HF, Brackmann H, Fimmers R, Clarenbach P, Miller EN, Bottcher M. Early signs of cognitive deficits among human immunodeficiency virus-positive hemophiliacs. Acta Psychiatr Scand 1992, 85: 321-326.
32. Schnurbus R, Konneke J, Scheuler W, Kubicki ST, Henkes H, Girke W, Bienzle U. Comparison of EEG findings in HIV-infected and non-infected patients in out-patients and in-patients follow-ups. V^E Conférence Iinternationale sur le SIDA. Montreal, 1989. Abregés. Montreal, 1989, p 462.
33. Smith T, Jakobsen J, Gaub J, Helweg-Larsen S, Trojaborg W. Clinical and electrophysiological studies of human immunodeficiency virus-seropositive men without AIDS. Ann Neurol 1988, 23: 295-297.
34. Tinuper P, De Carolis P, Galeotti M, Baldrati A, Sacquegna T, Gritti FM. Electroencephalography and HIV infection. Lancet 1989, 1: 554

Publication Dates

Publication in this collection
19 Jan 2011
Date of issue
Sept 1994

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. Anders KH, Guerra WF, Tomiyasu U, Verity MA, Vinters AV. The neuropathology of AIDS: UCLA experience and review. Am J Pathol 1986, 124: 537-558.

[2] 2. Bizari L, Souza MA. Rorschach em aidéticos. Encontro Brasileiro de Rorschach, São Paulo,1988: Resumos. São Paulo, 1989.

[3] 3. Bohm E. Psicosis orgânicas. In BOHM E. Manual del psicodioagnóstico de Rorschach, Ed 8, Madrid: Ediciones Morata 1984, p 356-368.

[4] 4. Brenneman DE, Westbrook GL, Fitzgerald SP, Ennist DL, Elkins KL, Ruff MR, Pert CB. Neuronal cell killing by the envelop protein of HIV and its prevention by vasoactive intestinal peptide. Nature 1988, 335: 639-642.

[5] 5. Dalgleish AG, Beverley PC, Clapham RP, Crawford DH, Greaves MF, Weiss RA. The CD4 (T4) antogen is an essential component of the receptor for the AIDS retrovirus. Nature 1984, 312: 763-767.

[6] 6. De La Monte SM, Ho DD, Schooley RT, Hirsch MS, Richardson EP. Subacute encephalomyelitis of AIDS and its relation to HTLV-III infection. Neurology 1987, 37: 562-569.

[7] 7. Dreyer EB, Kaiser PK, Offermann JT, Lipton SA. HIV-1 coat protein neurotoxicity prevented by calcium channel antagonists. Science 1990, 248: 364-367.

[8] 8. Everall IP, Luthert PJ, Lantos PL. Neuronal loss in the frontal cortex in HIV infection. Lancet 1991, 337: 1119-1121.

[9] 9. Enzensberger W, Fischer PA, Helm EB, Stille W. Value of electroencephalography in AIDS. Lancet 1985, 4: 1047-1048.

[10] 10. Enzensberger W, Helm EB, Fischer PA. EEG follow-up examination in AIDS patients. Electroenceph Clin Neurophysiol 1986, 63:28P.

[11] 11. Fischer PA, Enzensberger W. Neurological complications in AIDS. J Neurol 1987, 234: 269-279.

[12] 12. Gabuzda DH, Levy SR, Chiappa KH. Electroencephalography in AIDS and AIDS-related complex. Clin Electroenceph 1988, 19: 1-6.

[13] 13. Grant I, AtkinsonH, Hesselink JR, Kennedy CJ, Richman DD, Spector SA, McCutchan JA. Evidence for early central nervous system involvement in acquired immunodeficiency syndrome (AIDS) and other human immunodeficiency virus (HIV) infections. Ann Intern Med 1987, 107: 828-836.

[14] 14. Gray F, Gherardi R, Poirier J. Les lésions du systeme nerveux au cours du SIDA. Arch Anat Cytol Path 1986, 34: 268-278.

[15] 15. Hamburg MA, Koening S, Fauci AS. Immunology of AIDS and HIV infection. In Mandell GL. Principles and practises of infections diseases and their etiology agents. Part II, Vol I, Section P. Ed 3. New York: Churchill Livingstone, 1990, p 1046-1058.

[16] ¹⁶
Ifsecn. A glossary of terms most commonly used by clinical electroencephalographers. Electroenceph Clin Neurophysiol 1974, 37: 538-548.

[17] 17. Ketzler S, Weis S, Haug H, Budka H. Loss of neurons in the frontal cortex in AIDS brains. Acta Neuropathol 1990, 80: 92-94.

[18] 18. Klatzmann D, Champagne E, Chamaret S, Gruest J, Guetard D, Hercend T, Cluckman JC, Montagnier L. T-lymphocyte T4 molecule behaves as the receptor for human retrovirus LAV. Nature 1984, 312: 767.

[19] 19. Koralnik, Beaumandir A, Hausler R, Kholer A, Delacoux R, Hirschel B. Abnormalities of EEG and otoneurologic test in asymptomatic HIV infected homosexuals: a prospective controlled study. V^e Conférence Internationale sur le SIDA. Montreal, 1989. Abregés. Montreal, 1989, p 462.

[20] 20. Levy RM, Bredesen DE, Rosenblun ML. Neurological manifestations for the acquired immunodeficiency syndrome (AIDS): experience at UCSF and review of the literature. J Neurosurg 1985, 62: 475-495.

[21] 21. Link D. AIDS dementia complex. Treatment Issues 2, Vol. VI, 1992.

[22] 22. Minoli L, Nappi G. EEG findings and cognitive performance in 82 HIV-infected patients. V^E Conférence Iinternationale sur le SIDA. Montreal, 1989. Abregés. Montreal, 1989, p 462.

[23] 23. Navia BA, Jordan BD, Price RW. The AIDS dementia complex: I. Clinical features. Ann Neurol 1986, 19: 517-524.

[24] 24. Navia BA, Cho ES, Petito CK, Price RW. The AIDS dementia complex: II. Neuropathology Ann Neurol 1986, 19: 525-535.

[25] 25. Oberholzer E. Zur differentialdiagnose psychicher Folgezustande nach Schadeltraumen mittels des Rorschachschen Formdeutversuchs. Zges Neurol Psychiatr 1931, 136: 596-629.

[26] 26. Piotrowski Z. The Rorschach inkblot method in organic disturbances of the central nervous system. J Nerv Ment Dis 1937, 86: 525-537.

[27] 27. Prado GF. Estudo das alterações eletrencefalográficas em pacientes aidéticos com ou sem complicações secundárias. Tese de Mestrado, Escola Paulista de Medicina. São Paulo, 1991.

[28] 28. Prado GF, Silva AB, Lima JGC. Electroencephalogram (EEG) base rhythm in AIDS patients. Arq Neuropsiquiatr 1993, 51: 169-174.

[29] 29. Price RW, Brew B, Sidtis J, Rosenblum M, Scheckk AC, Cleary P, The brain in AIDS: central nervous system HIV-1 infection and AIDS dementia complex. Science 1988, 239: 586-591.

[30] 30. Pulliam L, Herndier BG, Tand NM, McGrath MS. Human immunodeficiency virus-infected macrophages produce soluble factors that cause histological and neurochemical alterations in cultured human brains. J Clin Invest 1991, 87: 503-512.

[31] 31. Riedel RR, Helmstaedter C, Bülau P, Durwen HF, Brackmann H, Fimmers R, Clarenbach P, Miller EN, Bottcher M. Early signs of cognitive deficits among human immunodeficiency virus-positive hemophiliacs. Acta Psychiatr Scand 1992, 85: 321-326.

[32] 32. Schnurbus R, Konneke J, Scheuler W, Kubicki ST, Henkes H, Girke W, Bienzle U. Comparison of EEG findings in HIV-infected and non-infected patients in out-patients and in-patients follow-ups. V^E Conférence Iinternationale sur le SIDA. Montreal, 1989. Abregés. Montreal, 1989, p 462.

[33] 33. Smith T, Jakobsen J, Gaub J, Helweg-Larsen S, Trojaborg W. Clinical and electrophysiological studies of human immunodeficiency virus-seropositive men without AIDS. Ann Neurol 1988, 23: 295-297.

[34] 34. Tinuper P, De Carolis P, Galeotti M, Baldrati A, Sacquegna T, Gritti FM. Electroencephalography and HIV infection. Lancet 1989, 1: 554