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Wagstaff RA, Mullens AB, Daken K, Cysique LA, Le Clercq D, Howard C, Gilling S, Piovesana A, Thompson CL. HIV associated neurocognitive disorder screening and diagnosis pathways in Australia: a scoping review and international implications. AIDS Care 2024:1-12. [PMID: 38685763 DOI: 10.1080/09540121.2024.2343768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 04/10/2024] [Indexed: 05/02/2024]
Abstract
Symptomatic HIV-associated neurocognitive disorder (HAND) is a complication of HIV (cognitive impairment, difficulties with everyday functioning). If detected early, interventions assist with optimizing care, avoiding rapid decline and enhancing coping. There remains inconsistency surrounding screening/diagnosis information within Australian healthcare professionals and community settings. A scoping review of academic literature, government policies and non-government organisations (NGOs) was conducted to map existing screening/diagnosis information using the guidelines of Joanna Briggs Institute. A literature search of EBSCOhost and Medline (dates: 2015-2021), the Australian government NGO web domains, Google and unpublished academic works was conducted (July 2021) and updated (December 2022) to identify Australian items (past 5 years). Seventeen items met the inclusion criteria. No government guidelines were identified. Various HIV-related organisations proposed different diagnostic guidelines. Most HAND research originated in Sydney. The most accessible information was from Dementia Australia, with some inaccuracies noted. There is scant Australian research/information on HAND screening/diagnosis. HAND translational research and screening/diagnosis standards are urgently needed to inform best practices. The Australian context is used to discuss international implications regarding higher-income countries with similar patterns/healthcare.
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Affiliation(s)
- Ruth A Wagstaff
- School of Psychology and Wellbeing, Centre for Health Research, Institute of Resilient Regions, University of Southern Queensland, Queensland, Australia
- College of Health & Human Sciences, Charles Darwin University, Darwin, Australia
| | - Amy B Mullens
- School of Psychology and Wellbeing, Centre for Health Research, Institute of Resilient Regions, University of Southern Queensland, Queensland, Australia
| | - Kirstie Daken
- School of Psychology and Wellbeing, Centre for Health Research, Institute of Resilient Regions, University of Southern Queensland, Queensland, Australia
| | - Lucette A Cysique
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada
- Faculty of Science, School of Psychology, The University of New South Wales, Sydney, Australia
- St. Vincent's Hospital Centre for Applied Medical Research, Sydney, Australia
| | - Diana Le Clercq
- School of Psychology and Wellbeing, Centre for Health Research, Institute of Resilient Regions, University of Southern Queensland, Queensland, Australia
| | | | - Sue Gilling
- Queensland Positive People, Brisbane, Australia
| | - Adina Piovesana
- School of Psychology and Wellbeing, Centre for Health Research, Institute of Resilient Regions, University of Southern Queensland, Queensland, Australia
| | - Claire L Thompson
- School of Health, Medical and Applied Sciences, Central Queensland University, Rockhampton, Australia
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Nguyen AL, Hussain MA, Pasipanodya E, Rubtsova AA, Moore RC, Jeste DV, Moore DJ. The impact of life stress, psychological resources, and proactive behaviors on quality of life among people living with HIV. Aging Ment Health 2023; 27:948-956. [PMID: 35486380 PMCID: PMC9943531 DOI: 10.1080/13607863.2022.2068126] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 04/08/2022] [Indexed: 02/01/2023]
Abstract
OBJECTIVES Quality of life (QoL) is an important consideration for people living with HIV (PWH). We investigated the relationship between stress, psychological resources, and proactive behaviors, on QoL (conceptualized as life satisfaction, successful aging, and depressive symptoms) by testing the hypotheses: (1) greater life stress (stress and functional impairment) is associated with poorer QoL; (2) resources (mastery, resilience, and social support) are associated with better QoL, beyond the influence of stress; and (3) proactive behaviors (medication management and leisure activities) mediate the relationship between resources and QoL. METHODS Secondary analyses were performed (N = 128 PWH). Participants' mean age was 52.3, 83.6% were male, and 53.9 identified as white. Multivariate regressions were performed within the context of path analyses. RESULTS In series 1, greater stress was associated with poorer life satisfaction (p < 0.001), lower self-rated successful aging (p < 0.001), and greater depression (p < 0.001). Functional impairment was associated with lower successful aging (p = 0.017) and greater depression (p = 0.001). In series 2, which accounted for mastery, resilience, social support, as well as demographic covariates, mastery was associated with greater life satisfaction (p = 0.038). In series 3, stress, functional impairment, leisure activities, and ART management were added to the model and social support was associated with engagement in leisure activities (p < 0.001), which was associated with better successful aging (p = 0.006). Fit indices suggested adequate relative fit. In bootstrapped analyses of indirect effects, social support was indirectly associated with successful aging through leisure activities (p = 0.020). CONCLUSIONS QoL, as captured by self-rated successful aging, is threatened by stress but positively influenced by social support and engaging in leisure activities. Findings support a model of proactive successful aging for PWH.
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Affiliation(s)
- Annie L. Nguyen
- Department of Family Medicine, University of Southern California, Los Angeles, CA, USA
| | - Mariam A. Hussain
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
- Joint Doctoral Program in Clinical Psychology, San Diego State University and University of California San Diego, San Diego, CA, USA
| | | | - Anna A. Rubtsova
- Department of Behavioral, Social, and Health Education Sciences, Emory University, Atlanta, GA, USA
| | - Raeanne C. Moore
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
| | - Dilip V. Jeste
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
| | - David J. Moore
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
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Jacob AE, Fazeli PL, Crowe MG, Vance DE. Correlates of subjective and objective everyday functioning in middle-aged and older adults with human immunodeficiency virus. APPLIED NEUROPSYCHOLOGY. ADULT 2022:1-13. [PMID: 36002029 DOI: 10.1080/23279095.2022.2109418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
People with human immunodeficiency virus (HIV) (PWH) are at an increased risk for impaired everyday functioning and they may also experience poor awareness of their functional status. This study identified factors associated with (1) subjective and objective instrumental activities of daily living (IADLs) and (2) awareness of functional capacity in PWH. In this cross-sectional study, 236 PWH completed a neurobehavioral assessment, including self-report and performance-based measures of IADLs. Multiple regressions were performed to identify demographic, personality, and cognitive factors contributing to subjective and objective evaluation of everyday functioning, as well as discrepancy between self-report and performance-based measures of IADLs. Results indicated that increased depression was associated with worsened self-report of everyday functioning but not performance of IADLs. Cognitive function and age were associated with IADL performance. Most participants (58.1%) demonstrated a discrepancy between self-report and actual performance of IADLs. Worse processing speed was correlated with greater discrepancy. Inaccurate self-reporters had worse overall cognitive functioning and lower levels of personality traits, including openness, conscientiousness, and agreeableness. In conclusion, self-report and actual performance of IADLs in PWH is influenced by different factors. Self-report may be more affected by psychological variables, such as mood and personality, while actual performance is more sensitive to age and cognitive function.
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Affiliation(s)
- Alexandra E Jacob
- Department of Psychology, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Pariya L Fazeli
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Michael G Crowe
- Department of Psychology, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - David E Vance
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
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Campbell LM, Sun-Suslow N, Heaton A, Heaton RK, Ellis RJ, Moore DJ, Moore RC. Fatigue is associated with worse cognitive and everyday functioning in older persons with HIV. AIDS 2022; 36:763-772. [PMID: 34999606 PMCID: PMC9081180 DOI: 10.1097/qad.0000000000003162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to determine whether there are relationships between fatigue, cognition, and everyday functioning in older persons with and without HIV and to examine if associations remain after accounting for depression, anxiety, and sleep quality. METHODS Sixty-nine persons with HIV (PWH) and 36 persons without HIV, aged 50-74 years, were recruited from ongoing studies at UC San Diego's HIV Neurobehavioral Research Program and from the community. Participants completed neuropsychological testing, a performance-based measure of everyday functioning, and self-report questionnaires of fatigue, depression, anxiety, sleep quality, and everyday functioning. Multivariable linear regressions and logistic regressions stratified by HIV serostatus were used to examine relationships between fatigue, cognition, and everyday functioning. Psychiatric symptoms and sleep quality were examined as covariates. RESULTS In this cross-sectional study, PWH had significantly greater fatigue than the HIV-negative group (g = 0.83; P < 0.01). When stratifying by HIV serostatus, greater fatigue was significantly associated with worse global cognition (β = -0.56;P < 0.01) in PWH even when controlling for covariates;however, fatigue was not significantly associated with global cognition in persons without HIV. In PWH and when accounting for covariates, fatigue was also associated with greater risk of self-reported everyday functioning impairment [odds ratio (OR) = 1.66 for 10-point increase in fatigue, P = 0.04] but not performance-based everyday functioning (P = 0.95). CONCLUSION Fatigue is associated with cognition, particularly measures with a speeded component, and self-reported everyday functioning in older PWH. Findings suggest that fatigue is important to assess and consider in the context of aging with HIV.
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Affiliation(s)
- Laura M Campbell
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology
- Department of Psychiatry, University of California, San Diego, La Jolla, California, USA
| | - Ni Sun-Suslow
- Department of Psychiatry, University of California, San Diego, La Jolla, California, USA
| | - Anne Heaton
- Department of Psychiatry, University of California, San Diego, La Jolla, California, USA
| | - Robert K Heaton
- Department of Psychiatry, University of California, San Diego, La Jolla, California, USA
| | - Ronald J Ellis
- Department of Psychiatry, University of California, San Diego, La Jolla, California, USA
| | - David J Moore
- Department of Psychiatry, University of California, San Diego, La Jolla, California, USA
| | - Raeanne C Moore
- Department of Psychiatry, University of California, San Diego, La Jolla, California, USA
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Vastag Z, Fira-Mladinescu O, Rosca EC. HIV-Associated Neurocognitive Disorder (HAND): Obstacles to Early Neuropsychological Diagnosis. Int J Gen Med 2022; 15:4079-4090. [PMID: 35450033 PMCID: PMC9017704 DOI: 10.2147/ijgm.s295859] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 04/11/2022] [Indexed: 12/19/2022] Open
Affiliation(s)
- Zsolt Vastag
- Doctoral School, Victor Babes University of Medicine and Pharmacy of Timisoara, Timisoara, 300041, Romania
- Clinical Hospital of Infectious Diseases and Pneumology Victor Babes Timisoara, Timisoara, 300173, Romania
| | - Ovidiu Fira-Mladinescu
- Clinical Hospital of Infectious Diseases and Pneumology Victor Babes Timisoara, Timisoara, 300173, Romania
- The XIIIth Department - Pulmonology, Center for Research and Innovation in Personalized Medicine of Respiratory Diseases, Victor Babes University of Medicine and Pharmacy Timisoara, Timișoara, 300041, Romania
- Ovidiu Fira-Mladinescu, The XIIIth Department - Pulmonology, Center for Research and Innovation in Personalized Medicine of Respiratory Diseases, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Sq. No. 2, Timisoara, 300041, Romania, Tel +40 745 608856, Email
| | - Elena Cecilia Rosca
- Department of Neurology, Victor Babes University of Medicine and Pharmacy of Timisoara, Timisoara, 300041, Romania
- Department of Neurology, Clinical Emergency County Hospital Timisoara, Timisoara, 300736, Romania
- Correspondence: Elena Cecilia Rosca, Department of Neurology, Clinical Emergency County Hospital Timisoara, Bd. Iosif Bulbuca No. 10, Timisoara, 300736, Romania, Tel + 40 746 173794, Email
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Thompson JL, Beltran-Najera I, Johnson B, Morales Y, Woods SP. Evidence for neuropsychological health disparities in Black Americans with HIV disease. Clin Neuropsychol 2022; 36:388-413. [PMID: 35166174 PMCID: PMC8868032 DOI: 10.1080/13854046.2021.1947387] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Black Americans are at high risk for HIV disease and associated morbidity. The impact and clinical correlates of HIV-associated neurocognitive impairment among Black Americans is not fully understood. The current study uses a full factorial design to examine the independent and combined effects of race and HIV disease on neurocognitive functioning, including its associations with everyday functioning and clinical disease markers in Black and White persons with HIV (PWH). METHOD Participants included 40 Black PWH, 83 White PWH, 28 Black HIV- and 64 White HIV- individuals. Neurocognition was measured by raw sample-based z-scores from a clinical battery. Everyday functioning was assessed using self- and clinician-rated measures of cognitive symptoms and activities of daily living. HIV-associated neurocognitive disorders were also classified using demographically adjusted normative standards and the Frascati criteria. RESULTS We observed a significant three-way interaction between HIV, race, and domain on raw neurocognitive z-scores. This omnibus effect was driven by medium and large effect size decrements in processing speed and semantic memory, respectively, in Black PWH compared to other study groups. Black PWH also demonstrated higher frequencies of HIV-associated neurocognitive disorders as compared to White PWH. Unexpectedly, global neurocognitive performance was negatively related to everyday functioning impairments for White PWH, but not for Black PWH. CONCLUSIONS Systemic disadvantages for Black Americans may combine with HIV disease to compound some neurocognitive impairments in this under-served population. Prospective studies are needed to identify better ways to prevent, measure, diagnose, and manage HIV-associated neurocognitive disorders among Black Americans.
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Affiliation(s)
| | | | | | | | - Steven Paul Woods
- Corresponding author: Steven Paul Woods, Psy.D. . Address: 126 Heyne Building, Suite 239D, Houston, TX 77004-5022. Phone: 713-743-6415
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Rosca EC, Tadger P, Cornea A, Tudor R, Oancea C, Simu M. International HIV Dementia Scale for HIV-Associated Neurocognitive Disorders: A Systematic Review and Meta-Analysis. Diagnostics (Basel) 2021; 11:1124. [PMID: 34202994 PMCID: PMC8235728 DOI: 10.3390/diagnostics11061124] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 06/16/2021] [Accepted: 06/16/2021] [Indexed: 12/02/2022] Open
Abstract
The present study aims to systematically review the evidence on the accuracy of the International HIV Dementia Scale (IHDS) test for diagnosing human immunodeficiency virus (HIV)-associated neurocognitive disorders (HAND) and outline the quality and quantity of research evidence available on the accuracy of IHDS in people living with HIV. We conducted a systematic literature review, searching five databases from inception until July 2020. We extracted dichotomized positive and negative test results at various thresholds and calculated the sensitivity and specificity of IHDS. Quality assessment was performed according to the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) criteria. Fifteen cross-sectional studies, published between 2011 and 2018, met the inclusion criteria for meta-analysis. Overall, 3760 patients were included, but most studies recruited small samples. We assessed most studies as being applicable to the review question, though we had concerns about the selection of participants in three studies. The accuracy of IHDS was investigated at thirteen cut-off points (scores 6-12). The threshold of 10 is the most useful for optimal HAND screening (including asymptomatic neurocognitive disorder, symptomatic HAND, and HIV-associated dementia) with fair diagnostic accuracy.
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Affiliation(s)
- Elena Cecilia Rosca
- Department of Neurology, Victor Babes University of Medicine and Pharmacy of Timisoara, 300041 Timisoara, Romania; (A.C.); (R.T.); (M.S.)
- Department of Neurology, Clinical Emergency County Hospital Timisoara, 300736 Timisoara, Romania
- Neuroscience Research Center Timisoara, Clinical Emergency County Hospital Timisoara, 300736 Timisoara, Romania
| | | | - Amalia Cornea
- Department of Neurology, Victor Babes University of Medicine and Pharmacy of Timisoara, 300041 Timisoara, Romania; (A.C.); (R.T.); (M.S.)
- Department of Neurology, Clinical Emergency County Hospital Timisoara, 300736 Timisoara, Romania
- Neuroscience Research Center Timisoara, Clinical Emergency County Hospital Timisoara, 300736 Timisoara, Romania
| | - Raluca Tudor
- Department of Neurology, Victor Babes University of Medicine and Pharmacy of Timisoara, 300041 Timisoara, Romania; (A.C.); (R.T.); (M.S.)
- Department of Neurology, Clinical Emergency County Hospital Timisoara, 300736 Timisoara, Romania
- Neuroscience Research Center Timisoara, Clinical Emergency County Hospital Timisoara, 300736 Timisoara, Romania
| | - Cristian Oancea
- Center for Research and Innovation in Precision Medicine of Respiratory Diseases, University of Medicine and Pharmacy “Victor Babes” Timisoara, 300173 Timisoara, Romania;
| | - Mihaela Simu
- Department of Neurology, Victor Babes University of Medicine and Pharmacy of Timisoara, 300041 Timisoara, Romania; (A.C.); (R.T.); (M.S.)
- Department of Neurology, Clinical Emergency County Hospital Timisoara, 300736 Timisoara, Romania
- Neuroscience Research Center Timisoara, Clinical Emergency County Hospital Timisoara, 300736 Timisoara, Romania
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Delle Donne V, Ciccarelli N, Massaroni V, Borghetti A, Dusina A, Farinacci D, Visconti E, Tamburrini E, Fabbiani M, Di Giambenedetto S. The University of California San Diego performance-based skills assessment: a useful tool to detect mild everyday functioning difficulties in HIV-infected patients with very good immunological condition. J Neurovirol 2020; 26:899-907. [PMID: 32839950 PMCID: PMC7716816 DOI: 10.1007/s13365-020-00891-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 07/29/2020] [Accepted: 08/04/2020] [Indexed: 11/19/2022]
Abstract
Everyday functioning (EF) impairment is frequent in people living with HIV (PLWH). Our aim was to better explore EF and its association with PLWH cognition, by administering both the IADL scale, the most common functional scale, and a new and ecologic multi-domain (communication and financial skills) tool to measure EF as the University of California San Diego (UCSD) Performance-Based Skills Assessment-Brief Version (UPSA-B). Eighty-five PLWH on cART with very good immunological condition and 23 age- and education-matched healthy controls (HC) were enrolled. PLWH underwent a standardized neuropsychological battery plus IADL, and cognitive impairment was defined according to Frascati criteria. Both groups underwent the UPSA-B. Only 6 subjects (7%) were affected by cognitive impairment (asymptomatic profile). While IADL score was at ceiling for all patients, the UPSA-B total score was significantly worse in PLWH when compared with HC [mean 82.1 (SD 9.3) vs 89.2 (SD 6.2); p < 0.001]. At communication subtest, PLWH group and HC were significantly different (p = 0.002), while no difference emerged at financial skills (p = 0.096). Higher score at UPSA-B was independently associated with better global cognitive performance (composite Z-score) (β 7.79; p < 0.001). Also considering each single cognitive domain, UPSA-B performance (both total and at subtests) confirmed the association with neurocognitive performance. In conclusion, UPSA-B seems to better discriminate EF impairment than IADL in PLWH, and it was associated with cognitive functions, also in the absence of symptomatic cognitive impairment. Thus, it appears a promising tool in the context of HIV infection to avoid misdiagnosis and to better detect also mild EF.
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Affiliation(s)
- Valentina Delle Donne
- Infectious Diseases Institute, Department of Safety and Bioethics, Catholic University of Sacred Heart, Rome, Italy
| | - Nicoletta Ciccarelli
- Department of Psychology, Catholic University of the Sacred Heart, Largo Agostino Gemelli 1, 20123, Milan, Italy.
| | - Valentina Massaroni
- Infectious Diseases Institute, Department of Safety and Bioethics, Catholic University of Sacred Heart, Rome, Italy
| | - Alberto Borghetti
- UOC Infectious Diseases, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Alex Dusina
- Infectious Diseases Institute, Department of Safety and Bioethics, Catholic University of Sacred Heart, Rome, Italy
| | - Damiano Farinacci
- Infectious Diseases Institute, Department of Safety and Bioethics, Catholic University of Sacred Heart, Rome, Italy
| | - Elena Visconti
- UOC Infectious Diseases, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Enrica Tamburrini
- Infectious Diseases Institute, Department of Safety and Bioethics, Catholic University of Sacred Heart, Rome, Italy.,UOC Infectious Diseases, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Massimiliano Fabbiani
- Tropical and Infectious Diseases Unit, Department of Specialized and Internal Medicine, University Hospital of Siena, Siena, Italy
| | - Simona Di Giambenedetto
- Infectious Diseases Institute, Department of Safety and Bioethics, Catholic University of Sacred Heart, Rome, Italy.,UOC Infectious Diseases, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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Metral M, Nadin I, Locatelli I, Tarr PE, Calmy A, Kovari H, Brugger P, Cusini A, Gutbrod K, Schmid P, Schwind M, Kunze U, Di Benedetto C, Pignatti R, Du Pasquier R, Darling K, Cavassini M. How helpful are the European AIDS Clinical Society cognitive screening questions in predicting cognitive impairment in an aging, well-treated HIV-positive population? HIV Med 2019; 21:342-348. [PMID: 31883203 PMCID: PMC7216878 DOI: 10.1111/hiv.12828] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2019] [Indexed: 12/30/2022]
Abstract
Objectives Diagnosing neurocognitive impairment (NCI) in HIV infection requires time‐consuming neuropsychological assessment. Screening tools are needed to identify when neuropsychological referral is indicated. We examined the positive and negative predictive values (PPVs and NPVs, respectively) of the three European AIDS Clinical Society (EACS) screening questions in identifying NCI. Methods The Neurocognitive Assessment in the Metabolic and Aging Cohort (NAMACO) study recruited patients aged ≥45 years enrolled in the Swiss HIV Cohort Study between 1 May 2013 and 30 November 2016. NAMACO participants (1) answered EACS screening questions, (2) underwent standardized neuropsychological assessment and (3) completed self‐report forms [Center for Epidemiologic Studies Depression Scale (CES‐D)] rating mood. NCI categories were defined using Frascati criteria. PPVs and NPVs of the EACS screening questions in identifying NCI categories were calculated. Results Of 974 NAMACO participants with complete EACS screening question data, 244 (25.1%) expressed cognitive complaints in answer to at least one EACS screening question, of whom 51.3% had NCI (26.1% HIV‐associated and 25.2% related to confounding factors). The PPV and NPV of the EACS screening questions in identifying HIV‐associated NCI were 0.35 and 0.7, respectively. Restricting analysis to NCI with functional impairment or related to confounding factors, notably depression, the NPV was 0.90. Expressing cognitive complaints for all three EACS screening questions was significantly associated with depression (P < 0.001). Conclusions The EACS screening questions had an NPV of 0.7 for excluding patients with HIV‐associated NCI as defined by Frascati criteria. The PPV and NPV may improve if NCI diagnoses are based on new criteria.
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Affiliation(s)
- M Metral
- Service of Neurology, Department of Clinical Neurosciences, Lausanne, Switzerland
| | - I Nadin
- Service of Neurology, Department of Clinical Neurosciences, Lausanne, Switzerland.,Service of Neurology, University Hospital of Geneva, Geneva, Switzerland
| | - I Locatelli
- Department of Ambulatory Care and Community Medicine, University of Lausanne, Lausanne, Switzerland
| | - P E Tarr
- University Department of Medicine, Kantonsspital Bruderholz, University of Basel, Bruderholz, Switzerland
| | - A Calmy
- HIV Unit, Infectious Diseases Division, Department of Medicine, University Hospital of Geneva, Geneva, Switzerland
| | - H Kovari
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland
| | - P Brugger
- Neuropsychology Unit, Department of Neurology, University Hospital Zurich, Zurich, Switzerland
| | - A Cusini
- Department of Infectious Diseases and Hospital Epidemiology, Bern University Hospital and University of Bern, Bern, Switzerland
| | - K Gutbrod
- Division of Neurology, Bern University Hospital and University of Bern, Bern, Switzerland
| | - P Schmid
- Infectious Diseases and Hospital Epidemiology Division, Kantonsspital St Gallen, St Gallen, Switzerland
| | - M Schwind
- Neurology Clinic, St. Gallen, Switzerland
| | - U Kunze
- Memory Clinic, Felix Platter Hospital, University Center for Medicine of Aging, Basel, Switzerland
| | - C Di Benedetto
- Infectious Diseases Unit, Lugano Regional Hospital, Lugano, Switzerland
| | - R Pignatti
- Department of Neurology, Neurocentre of Southern Switzerland, Lugano Regional Hospital, Lugano, Switzerland
| | - R Du Pasquier
- Service of Neurology, Department of Clinical Neurosciences, Lausanne, Switzerland
| | - Kea Darling
- Service of Infectious Diseases, Lausanne University Hospital, Lausanne, Switzerland
| | - M Cavassini
- Service of Infectious Diseases, Lausanne University Hospital, Lausanne, Switzerland
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Rosca EC, Albarqouni L, Simu M. Montreal Cognitive Assessment (MoCA) for HIV-Associated Neurocognitive Disorders. Neuropsychol Rev 2019; 29:313-327. [PMID: 31440882 DOI: 10.1007/s11065-019-09412-9] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Accepted: 07/15/2019] [Indexed: 01/01/2023]
Abstract
This study aims to systematically review the evidence on the accuracy of the Montreal Cognitive Assessment (MoCA) test for diagnosing HIV-associated neurocognitive disorders (HAND) and to outline the quality and quantity of research evidence available about the accuracy of MoCA in populations infected with HIV. We conducted a systematic literature review, searching five databases from inception until January 2019. We extracted dichotomized positive and negative test results at various thresholds and calculated the sensitivity and specificity of MoCA. Quality assessment was performed according to the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) criteria. Eight cross-sectional studies met the inclusion criteria for meta-analysis. Overall, 1014 patients were included but most studies recruited small samples. Recruitment period ranged from 2009 to 2015. We assessed most studies as being applicable to the review question though we had concerns about the selection of participants in three studies. The accuracy of MoCA for diagnosing HAND was reported at six cut-off points (scores 22-27). The MoCA test provides information about general cognitive functioning disturbances that contribute to a diagnosis of HAND. A lower threshold than the original cut-off of 26 is probably more useful for optimal screening of HAND, as it lowers false positive rates and improves diagnostic accuracy. Nonetheless, the choice of cut-off always comes with a sensitivity-specificity trade-off, the preferred cut point depending on whether sensitivity or specificity is more valuable in a given context.
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Affiliation(s)
- Elena Cecilia Rosca
- Department of Neurology, University of Medicine and Pharmacy "Victor Babes", Timisoara, Romania. .,Department of Neurology, Clinical Emergency County Hospital, Bd. Iosif Bulbuca nr. 10, 300736, Timisoara, Romania.
| | - Loai Albarqouni
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia
| | - Mihaela Simu
- Department of Neurology, University of Medicine and Pharmacy "Victor Babes", Timisoara, Romania.,Department of Neurology, Clinical Emergency County Hospital, Bd. Iosif Bulbuca nr. 10, 300736, Timisoara, Romania
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Paolillo EW, Saloner R, Montoya JL, Campbell LM, Pasipanodya EC, Iudicello JE, Moore RC, Letendre SL, Jeste DV, Moore DJ. Frailty in Comorbid HIV and Lifetime Methamphetamine Use Disorder: Associations with Neurocognitive and Everyday Functioning. AIDS Res Hum Retroviruses 2019; 35:1044-1053. [PMID: 31303012 DOI: 10.1089/aid.2019.0062] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
HIV and methamphetamine (MA) use disorder are commonly comorbid and individually associated with adverse health consequences, including frailty; however, less is known about the combined effects of both conditions. The current cross-sectional study examined how HIV and lifetime MA use disorder relate to frailty and explored associations between frailty and relevant clinical outcomes (i.e., neurocognitive and everyday functioning). Participants were categorized into three groups based on HIV status and lifetime MA diagnosis: HIV+/MA+ (n = 43), HIV+/MA- (n = 75), and HIV-/MA- (n = 92). A frailty index score (representing proportion of accumulated multisystem deficits) was calculated from 27 medical and psychiatric deficits. Multiple regression was used to examine frailty index score by HIV/MA group. Additional multiple regression models examined the interaction between frailty and HIV/MA group on cognitive and everyday functioning. Comorbid HIV+/MA+ participants had higher frailty index scores than both HIV-/MA- (b = -0.13, p < .001) and HIV+/MA- participants (b = -0.06, p = .007). Additional models linked higher frailty index score to worse global neurocognition (b = -17.6, p = .018) and greater likelihood of everyday functioning dependence (odds ratio = 1.56, p = .021). Although these relationships did not significantly differ by HIV/MA status, group-stratified analyses showed that associations of frailty with neurocognitive and everyday functioning were strongest among the HIV+/MA+ group. Multimodal public health interventions aimed at reducing frailty may help to decrease the likelihood of neurocognitive and everyday functioning problems. Current findings additionally lay groundwork for future longitudinal research examining whether frailty predicts onset of neurocognitive and functional decline in individuals with comorbid HIV and MA use disorder.
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Affiliation(s)
- Emily W. Paolillo
- Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California San Diego, San Diego, California
- Department of Psychiatry, University of California San Diego, San Diego, California
| | - Rowan Saloner
- Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California San Diego, San Diego, California
- Department of Psychiatry, University of California San Diego, San Diego, California
| | - Jessica L. Montoya
- Department of Psychiatry, University of California San Diego, San Diego, California
| | - Laura M. Campbell
- Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California San Diego, San Diego, California
- Department of Psychiatry, University of California San Diego, San Diego, California
| | | | - Jennifer E. Iudicello
- Department of Psychiatry, University of California San Diego, San Diego, California
- HIV Neurobehavioral Research Program, University of California San Diego, San Diego, California
| | - Raeanne C. Moore
- Department of Psychiatry, University of California San Diego, San Diego, California
- HIV Neurobehavioral Research Program, University of California San Diego, San Diego, California
- VA San Diego Healthcare System, San Diego, California
| | - Scott L. Letendre
- HIV Neurobehavioral Research Program, University of California San Diego, San Diego, California
- Department of Medicine, University of California San Diego, San Diego, California
| | - Dilip V. Jeste
- Department of Psychiatry, University of California San Diego, San Diego, California
- Sam and Rose Stein Institute for Research on Aging, University of California San Diego, San Diego, California
| | - David J. Moore
- Department of Psychiatry, University of California San Diego, San Diego, California
- HIV Neurobehavioral Research Program, University of California San Diego, San Diego, California
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Kordovski VM, Tierney SM, Woods SP. Conceptualizing and Assessing Everyday Functioning in the Context of HIV-Associated Neurocognitive Disorders. Curr Top Behav Neurosci 2019; 50:329-346. [PMID: 30610667 DOI: 10.1007/7854_2018_78] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Combination antiretroviral therapy has reduced the rates of severe HIV-associated neurocognitive disorders (HAND), but the prevalence of milder forms of HAND that can affect everyday functioning remains high. As HIV-infected adults approach near-normal life expectancies, they may become increasingly susceptible to declines in everyday functioning secondary to a variety of physical and mental factors, including HAND. Although impairments in everyday functioning are a hallmark of HAND diagnoses and can adversely influence quality of life, there are no gold standard measures of this fundamentally important and complex construct. This chapter provides a brief review of the various self-report, clinician-rated, and performance-based methods by which everyday functioning is measured in the setting of HIV disease, including global activities of daily living and specific domains of medication adherence, financial management, automobile driving, and vocational functioning.
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Moore RC, Hussain MA, Watson CWM, Fazeli PL, Marquine MJ, Yarns BC, Jeste DV, Moore DJ. Grit and Ambition are Associated with Better Neurocognitive and Everyday Functioning Among Adults Living with HIV. AIDS Behav 2018; 22:3214-3225. [PMID: 29455265 DOI: 10.1007/s10461-018-2061-1] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Grit and ambition are psychological factors that may protect neurocognitive function among persons living with HIV (PLWH). We examined associations between grit, ambition, premorbid verbal intellectual function, and current neurocognitive and everyday functioning among PLWH and persons without HIV (HIV-). 120 PLWH and 94 HIV- adults completed the Grit Scale (includes total score and consistency of interests and perseverance of effort subscales), ambition scale, and a comprehensive neurobehavioral battery. PLWH had lower grit scores than HIV- adults. The two groups did not differ on ambition. No relationship was observed between grit and cognition among HIV- adults. Among PLWH, however, higher perseverance of effort and more ambition was related to better global neurocognitive functioning, and higher grit, but not ambition, was related to independence in daily functioning. Longitudinal studies are needed to elucidate these relationships over time and examine whether grit or ambition have protective effects on cognitive outcomes among PLWH.
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Affiliation(s)
- Raeanne C Moore
- Department of Psychiatry, University of California, San Diego, 220 Dickinson Drive, St B (8231), San Diego, CA, 92103-8231, USA.
- VA San Diego Healthcare System, San Diego, CA, USA.
| | - Mariam A Hussain
- San Diego Joint Doctoral Program in Clinical Psychology, San Diego State University, University of California, San Diego, CA, USA
| | - Caitlin W-M Watson
- San Diego Joint Doctoral Program in Clinical Psychology, San Diego State University, University of California, San Diego, CA, USA
| | - Pariya L Fazeli
- Department of Family, Community, and Health Systems, School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
| | - María J Marquine
- Department of Psychiatry, University of California, San Diego, 220 Dickinson Drive, St B (8231), San Diego, CA, 92103-8231, USA
| | - Brandon C Yarns
- Department of Medicine, Division of General Internal Medicine, UCLA David Geffen School of Medicine, Los Angeles, CA, USA
- Department of Psychiatry (BCY), VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Dilip V Jeste
- Department of Psychiatry, University of California, San Diego, 220 Dickinson Drive, St B (8231), San Diego, CA, 92103-8231, USA
- Department of Neurosciences, University of California, San Diego, CA, USA
- Sam and Rose Stein Institute for Research on Aging, University of California, San Diego, CA, USA
| | - David J Moore
- Department of Psychiatry, University of California, San Diego, 220 Dickinson Drive, St B (8231), San Diego, CA, 92103-8231, USA
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Trunfio M, Vai D, Montrucchio C, Alcantarini C, Livelli A, Tettoni MC, Orofino G, Audagnotto S, Imperiale D, Bonora S, Di Perri G, Calcagno A. Diagnostic accuracy of new and old cognitive screening tools for HIV-associated neurocognitive disorders. HIV Med 2018; 19:455-464. [PMID: 29761877 DOI: 10.1111/hiv.12622] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/23/2018] [Indexed: 01/01/2023]
Abstract
OBJECTIVES Considering the similarities between HIV-associated neurocognitive disorders (HAND) and neurodegenerative dementias and the frequency of executive dysfunctions among HIV-positive patients, we evaluated the accuracy of the Frontal Assessment Battery and Clock-Drawing Test together with the Three Questions Test and International HIV Dementia Scale to screen for HAND. METHODS A cross-sectional monocentric study was conducted from 2010 to 2017. The index tests were represented by the four screening tools; the reference standard was represented by a comprehensive neurocognitive battery used to investigate 10 cognitive domains. Patients were screened by a trained infectious diseases physician and those showing International HIV Dementia Scale scores ≤ 10 and/or complaining of neurocognitive symptoms were then evaluated by a trained neuropsychologist. RESULTS A total of 650 patients were screened and 281 received the full neurocognitive evaluation. HAND was diagnosed in 140 individuals. The sensitivity, specificity, correct classification rate and area under the receiver operating characteristic curve (AUROC) were, respectively, as follows: Frontal Assessment Battery, 40.7%, 95.1%, 68.3% and 0.81; International HIV Dementia Scale, 74.4%, 56.8%, 65.4% and 0.73; Clock-Drawing Test, 30.9%, 73.4%, 53.8% and 0.56; and Three Questions Test, 37.3%, 54.1% and 45.7%. Raising the Frontal Assessment Battery's cut-off to ≤ 16 improved its sensitivity, specificity and correct classification rate to 78.0%, 63.9% and 70.8%, respectively. CONCLUSIONS We observed poor screening performances of the Three Questions and Clock-Drawing Tests. While the International HIV Dementia Scale showed a poor specificity, the Frontal Assessment Battery showed the highest correct classification rate and a promising performance at different exploratory cut-offs.
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Affiliation(s)
- M Trunfio
- Department of Medical Sciences, Unit of Infectious Diseases, Amedeo di Savoia Hospital, University of Torino, Torino, Italy
| | - D Vai
- Unit of Neurology, Maria Vittoria Hospital, Torino, Italy
| | - C Montrucchio
- Department of Medical Sciences, Unit of Infectious Diseases, Amedeo di Savoia Hospital, University of Torino, Torino, Italy
| | - C Alcantarini
- Department of Medical Sciences, Unit of Infectious Diseases, Amedeo di Savoia Hospital, University of Torino, Torino, Italy
| | - A Livelli
- Unit of Infectious Diseases, Divisione A, Amedeo di Savoia Hospital, Torino, Italy
| | - M C Tettoni
- Department of Medical Sciences, Unit of Infectious Diseases, Amedeo di Savoia Hospital, University of Torino, Torino, Italy
| | - G Orofino
- Unit of Infectious Diseases, Divisione A, Amedeo di Savoia Hospital, Torino, Italy
| | - S Audagnotto
- Department of Medical Sciences, Unit of Infectious Diseases, Amedeo di Savoia Hospital, University of Torino, Torino, Italy
| | - D Imperiale
- Unit of Neurology, Maria Vittoria Hospital, Torino, Italy
| | - S Bonora
- Department of Medical Sciences, Unit of Infectious Diseases, Amedeo di Savoia Hospital, University of Torino, Torino, Italy
| | - G Di Perri
- Department of Medical Sciences, Unit of Infectious Diseases, Amedeo di Savoia Hospital, University of Torino, Torino, Italy
| | - A Calcagno
- Department of Medical Sciences, Unit of Infectious Diseases, Amedeo di Savoia Hospital, University of Torino, Torino, Italy
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Haddow LJ, Laverick R, Daskalopoulou M, McDonnell J, Lampe FC, Gilson R, Speakman A, Antinori A, Balestra P, Bruun T, Gerstoft J, Nielsen L, Vassilenko A, Collins S, Rodger AJ. Multicenter European Prevalence Study of Neurocognitive Impairment and Associated Factors in HIV Positive Patients. AIDS Behav 2018; 22:1573-1583. [PMID: 28144792 PMCID: PMC5902513 DOI: 10.1007/s10461-017-1683-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
We conducted a cross-sectional study in 448 HIV positive patients attending five European outpatient clinics to determine prevalence of and factors associated with neurocognitive impairment (NCI) using computerized and pen-and-paper neuropsychological tests. NCI was defined as a normalized Z score ≤-1 in at least 2 out of 5 cognitive domains. Participants' mean age was 45.8 years; 84% male; 87% white; 56% university educated; median CD4 count 550 cells/mm3; 89% on antiretroviral therapy. 156 (35%) participants had NCI, among whom 26 (17%; 5.8% overall) reported a decline in activities of daily living. Prevalence of NCI was lower in those always able to afford basic needs (adjusted prevalence ratio [aPR] 0.71, 95% confidence interval [CI] 0.54-0.94) or with a university education (aPR 0.72, 95% CI 0.54-0.97) and higher in those with severe depressive symptoms (aPR 1.53, 95% CI 1.09-2.14) or a significant comorbid condition (aPR 1.40, 95% CI 1.03-1.90).
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Affiliation(s)
- Lewis J Haddow
- Research Department of Infection and Population Health, Mortimer Market Centre, University College London, Capper Street, London, WC1E 6JB, UK.
| | - Rosanna Laverick
- Research Department of Infection and Population Health, Mortimer Market Centre, University College London, Capper Street, London, WC1E 6JB, UK
| | - Marina Daskalopoulou
- Research Department of Infection and Population Health, Mortimer Market Centre, University College London, Capper Street, London, WC1E 6JB, UK
| | | | - Fiona C Lampe
- Research Department of Infection and Population Health, Mortimer Market Centre, University College London, Capper Street, London, WC1E 6JB, UK
| | - Richard Gilson
- Research Department of Infection and Population Health, Mortimer Market Centre, University College London, Capper Street, London, WC1E 6JB, UK
| | - Andrew Speakman
- Research Department of Infection and Population Health, Mortimer Market Centre, University College London, Capper Street, London, WC1E 6JB, UK
| | - Andrea Antinori
- National Institute for Infectious Diseases, Lazzaro Spallanzani, Rome, Italy
| | - Pietro Balestra
- National Institute for Infectious Diseases, Lazzaro Spallanzani, Rome, Italy
| | - Tina Bruun
- Department of Infectious Diseases, Rigshospitalet, Centre for Health & Infectious Disease Research (CHIP), University of Copenhagen, Copenhagen, Denmark
| | - Jan Gerstoft
- Department of Infectious Diseases, Rigshospitalet, Centre for Health & Infectious Disease Research (CHIP), University of Copenhagen, Copenhagen, Denmark
| | - Lars Nielsen
- Infektionsmedicinsk Afdeling, Nordsjællands Hospital, Hillerød, Denmark
| | | | | | - Alison J Rodger
- Research Department of Infection and Population Health, Mortimer Market Centre, University College London, Capper Street, London, WC1E 6JB, UK
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17
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Moore DJ, Fazeli PL, Moore RC, Woods SP, Letendre SL, Jeste DV, Grant I. Positive Psychological Factors are Linked to Successful Cognitive Aging Among Older Persons Living with HIV/AIDS. AIDS Behav 2018; 22:1551-1561. [PMID: 29264737 DOI: 10.1007/s10461-017-2001-5] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
We aimed to characterize successful cognitive aging (SCA) among older HIV-infected (HIV+) and HIV-uninfected (HIV-) adults, and to determine associations with positive psychological factors and health-related quality of life (HRQoL). Ninety-nine HIV+ and 46 HIV- older adults (≥ 50 years) completed measures of neurocognition, positive psychological factors, and HRQoL. Using study-defined SCA criteria (i.e., no cognitive or everyday impairment or major depressive disorder), we compared positive psychological factors and HRQoL across four groups: HIV+/SCA+, HIV+/SCA-, HIV-/SCA+, HIV-/SCA-. SCA was identified in 29% of the HIV+ sample compared to 61% of the HIV- sample (p < 0.01). HIV+/SCA+ participants had higher scores on 8 of 10 measures of positive psychological factors as well as better HRQoL (ps < 0.05) as compared to the HIV+/SCA- group. Furthermore, the HIV+/SCA+ participants had comparable scores on these factors as HIV- adults. Fewer HIV+ than HIV- participants met SCA criteria; however, the level of positive psychological factors among the HIV+/SCA+ group was comparable to the HIV- sample. Our findings present opportunities for interventions to optimize positive psychological factors and potentially improve SCA among older HIV+ adults.
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Affiliation(s)
- David J Moore
- Department of Psychiatry, University of California, San Diego, San Diego, CA, USA.
| | - Pariya L Fazeli
- Department of Psychiatry, University of California, San Diego, San Diego, CA, USA
- Department of Family, Community, and Health Systems, School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Raeanne C Moore
- Department of Psychiatry, University of California, San Diego, San Diego, CA, USA
- Stein Institute for Research on Aging, University of California, San Diego, San Diego, CA, USA
- Veterans Administration San Diego Health Care System, San Diego, San Diego, CA, USA
| | - Steven P Woods
- Department of Psychiatry, University of California, San Diego, San Diego, CA, USA
- Department of Psychology, University of Houston, Houston, TX, USA
| | - Scott L Letendre
- Department of Medicine, University of California, San Diego, San Diego, CA, USA
| | - Dilip V Jeste
- Department of Psychiatry, University of California, San Diego, San Diego, CA, USA
- Stein Institute for Research on Aging, University of California, San Diego, San Diego, CA, USA
| | - Igor Grant
- Department of Psychiatry, University of California, San Diego, San Diego, CA, USA
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Abstract
PURPOSE OF REVIEW HIV-associated neurocognitive disease is the most active topic for neuroAIDS investigations at present. Although impairment is mild in patients successfully treated with modern antiviral regimens, it remains an ongoing problem for HIV patients. It is important to update the emerging research concerning HIV-associated neurocognitive disease. RECENT FINDINGS The virus enters the brain during acute infection, with evidence for abnormal functioning that may occur early and often persists. Direct relationships with ongoing viral infection continue to be monitored, but chronic inflammation often associated with monocytes and macrophages appears to be the most likely driver of cognitive dysfunction. Appreciation for cerebrovascular disease as a significant comorbidity that is associated with cognitive deficits is increasing. Neuroimaging is actively being developed to address detection and measurement of changes in the brain. Optimal combined antiretroviral treatment therapy has vastly improved neurologic outcomes, but so far has not been demonstrated to reverse the remaining mild impairment. Inflammatory and vascular mechanisms of cerebral dysfunction may need to be addressed to achieve better outcomes. SUMMARY Ongoing research is required to improve neurological outcomes for persons living with HIV. It is likely that interventions beyond antiviral approaches will be required to control or reverse HIV-associated neurocognitive disease.
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Self-Reported Decline in Everyday Function, Cognitive Symptoms, and Cognitive Function in People With HIV. J Acquir Immune Defic Syndr 2017; 76:e74-e83. [PMID: 29016449 DOI: 10.1097/qai.0000000000001468] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND We determined factors associated with self-reported decline in activities of daily living (ADLs) and symptoms of cognitive impairment in HIV positive adults in 5 European clinics. METHODS HIV+ adults underwent computerized and pen-and-paper neuropsychological tests and questionnaires of cognitive symptoms and ADLs. We considered cognitive function in 5 domains, psychosocial factors, and clinical parameters as potentially associated with symptoms. Separate regression analyses were used to determine factors associated with a decline in ADL (defined as self-reported decline affecting ≥2 ADLs and attributed to cognitive difficulties) and self-reported frequency of symptoms of cognitive impairment. We also estimated the diagnostic accuracy of both questionnaires as tests for cognitive impairment. RESULTS Four hundred forty-eight patients completed the assessments [mean age 45.8 years, 84% male, 87% white, median CD4 count 550 cells/mm, median time since HIV diagnosis 9.9 years, 81% virologically suppressed (HIV-1 plasma RNA <50 copies/mL)]. Ninety-six (21.4%) reported decline in ADLs and attributed this to cognitive difficulties. Self-reported decline in ADLs and increased symptoms of cognitive impairment were both associated with worse performance on some cognitive tests. There were also strong associations with financial difficulties, depressive and anxiety symptoms, unemployment, and longer time since HIV diagnosis. Both questionnaires performed poorly as diagnostic tests for cognitive impairment. CONCLUSIONS Patients' own assessments of everyday function and symptoms were associated with objectively measured cognitive function. However, there were strong associations with other psychosocial issues including mood and anxiety disorders and socioeconomic hardship. This should be considered when assessing HIV-associated cognitive impairment in clinical care or research studies.
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20
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Hakkers CS, Kraaijenhof JM, van Oers-Hazelzet EB, Visser-Meily AJ, Hoepelman AI, Arends JE, Barth RE. HIV and Cognitive Impairment in Clinical Practice: The Evaluation of a Stepwise Screening Protocol in Relation to Clinical Outcomes and Management. AIDS Patient Care STDS 2017; 31:363-369. [PMID: 28783374 DOI: 10.1089/apc.2017.0022] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Neurocognitive impairment (NCI) is an increasingly important comorbidity in an ageing HIV+ population. Despite the lack of available treatment modalities, screening for NCI is recommended. In the UMC Utrecht, yearly NCI screening is done using the Montreal Cognitive Assessment (MoCA) tool and the HIV Dementia Scale (HDS). The aim of this study was to evaluate this screening protocol in relation to clinical outcomes and management. A retrospective cohort study was performed in suppressed adult HIV+ patients. Apart from the MoCa and the HDS, the Utrecht Scale for Evaluation of Rehabilitation-Participation (USER-P) and the Hospital Anxiety and Depression Scale (HADS) were performed. Patients scoring below average on cognitive screening tests or with subjective cognitive complaints were further evaluated using a standardized protocol, including optimizing cART and checking for somatic disorders. In patients with cognitive complaints and participation restrictions, cognitive rehabilitation was proposed. Two hundred eighty-six patients were screened. The vast majority were MSM with an average age of 49 years. One hundred forty-four out of 286 patients (50%) had an abnormal test score and/or had subjective cognitive complaints. Restrictions in participation were present in 23% of patients. Six patients on Efavirenz switched their regimes, as this drug is known for its potential central nervous system (CNS) side effects. A depressive component was present in 58 patients (40%). Five patients had a clinical relevant laboratory abnormality. Moreover, six patients were referred for cognitive rehabilitation, which resulted in a 100% success rate in set goals in the five evaluable patients. Although the protocol was not fully adhered to in all patients, it did result in detectable underlying causes of NCI in 59% of patients, and 21% was referred for further treatment. Moreover, cognitive rehabilitation appears to be a very successful intervention for patients with NCI who experience subjective complaints and participation restrictions.
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Affiliation(s)
- Charlotte S. Hakkers
- Department of Internal Medicine and Infectious Diseases, University Medical Center Utrecht (UMCU), Utrecht, The Netherlands
| | - Jordan M. Kraaijenhof
- Department of Internal Medicine and Infectious Diseases, University Medical Center Utrecht (UMCU), Utrecht, The Netherlands
| | - Esther B. van Oers-Hazelzet
- Department of Internal Medicine and Infectious Diseases, University Medical Center Utrecht (UMCU), Utrecht, The Netherlands
| | - Anne J.M.A. Visser-Meily
- Department of Rehabilitation, Physical Therapy Science & Sports, Brain Center Rudolf Magnus, University Medical Center Utrecht (UMCU), Utrecht, The Netherlands
| | - Andy I.M. Hoepelman
- Department of Internal Medicine and Infectious Diseases, University Medical Center Utrecht (UMCU), Utrecht, The Netherlands
| | - Joop E. Arends
- Department of Internal Medicine and Infectious Diseases, University Medical Center Utrecht (UMCU), Utrecht, The Netherlands
| | - Roos E. Barth
- Department of Internal Medicine and Infectious Diseases, University Medical Center Utrecht (UMCU), Utrecht, The Netherlands
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21
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Gouse H, Casson-Crook M, Decloedt EH, Joska JA, Thomas KGF. Adding a brief self-report cognitive tool to the IHDS improves effectiveness of identifying patients with HIV-associated dementia in South Africa. J Neurovirol 2017; 23:686-695. [PMID: 28748448 DOI: 10.1007/s13365-017-0551-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 06/02/2017] [Accepted: 06/25/2017] [Indexed: 01/17/2023]
Abstract
We compared the diagnostic accuracy of two brief screening tools (the International HIV Dementia Scale (IHDS), and the IHDS combined with a novel self-report instrument, the HIV Cognitive Symptom Questionnaire (HCSQ)) with that of three brief neuropsychological screening batteries (a 2-, a 3-, and a 4-test battery, each consisting of standardized cognitive tests) in discriminating individuals with HIV-associated dementia (HAD) from those with milder forms of cognitive impairment. We analyzed data from 94 isiXhosa-speaking South African HIV-infected participants who were screened as part of a clinical trial evaluating adjunctive treatment in patients with moderate to severe HIV-associated cognitive impairment. A comprehensive neuropsychological battery diagnosed 53% (50/94) of the participants with HAD. We evaluated the sensitivity and specificity for the screening tools and screening batteries. The brief screening tool performed better compared to the brief neuropsychology battery. The IHDS-HCSQ combination delivered 94% sensitivity and 63% specificity for HAD compared to the IHDS (74 and 70% at a cutoff of ≤8) which offers a viable and quick way to screen for HAD in people living with HIV. It is easy to administer, is time- and cost-efficient, and it appears to be a better option, for these purposes, than brief neuropsychology batteries. It is viable for use in clinical, research, and workplace settings when identification of HIV-infected people with severe cognitive impairment is required.
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Affiliation(s)
- Hetta Gouse
- Department of Psychiatry and Mental Health, HIV Mental Health Research Unit, University of Cape Town, Cape Town, South Africa.
| | - Martine Casson-Crook
- Department of Psychiatry and Mental Health, HIV Mental Health Research Unit, University of Cape Town, Cape Town, South Africa
| | - Eric H Decloedt
- Division of Clinical Pharmacology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa.,Division of Clinical Pharmacology, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - John A Joska
- Department of Psychiatry and Mental Health, HIV Mental Health Research Unit, University of Cape Town, Cape Town, South Africa
| | - Kevin G F Thomas
- Department of Psychology, University of Cape Town, Cape Town, South Africa
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22
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Maubert ME, Wigdahl B, Nonnemacher MR. Opinion: Inhibition of Blood-Brain Barrier Repair as a Mechanism in HIV-1 Disease. Front Neurosci 2017; 11:228. [PMID: 28491017 PMCID: PMC5405129 DOI: 10.3389/fnins.2017.00228] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 04/05/2017] [Indexed: 12/22/2022] Open
Affiliation(s)
- Monique E Maubert
- Department of Microbiology and Immunology, and Center for Molecular Virology and Translational Neuroscience, Institute for Molecular Medicine and Infectious Disease, Drexel University College of MedicinePhiladelphia, PA, USA
| | - Brian Wigdahl
- Department of Microbiology and Immunology, and Center for Molecular Virology and Translational Neuroscience, Institute for Molecular Medicine and Infectious Disease, Drexel University College of MedicinePhiladelphia, PA, USA.,Sidney Kimmel Cancer Center, Thomas Jefferson UniversityPhiladelphia, PA, USA
| | - Michael R Nonnemacher
- Department of Microbiology and Immunology, and Center for Molecular Virology and Translational Neuroscience, Institute for Molecular Medicine and Infectious Disease, Drexel University College of MedicinePhiladelphia, PA, USA
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23
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Abstract
Combination antiretroviral treatment is associated with clear benefits in HIV-positive subjects, and is also effective in the central nervous system (CNS), meaning HIV-associated dementia is now an uncommon event. Nevertheless, a significant number of patients show symptoms of neurocognitive impairment which may negatively affect their quality of life. Although several risk factors for HIV-associated neurocognitive disorders have been identified, there is no clear recommendation for their prevention and management. In this review, the penetration of drugs into the cerebrospinal fluid/CNS is discussed as well as the viral and clinical consequences associated with higher/lower compartmental exposure. We also review the potential interventions according to the currently identified underlying mechanisms, including persistent CNS immune activation, legacy effects, low-level viral replication and escape, co-morbidities, and antiretroviral-associated direct and indirect 'neurotoxicity'. Adjunctive therapies and interventions (including neuro-rehabilitation) are then briefly discussed. The treatment of HIV infection in the CNS is a complex area of therapeutics requiring multidisciplinary interventions and further study.
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Affiliation(s)
- A Calcagno
- Unit of Infectious Diseases, Department of Medical Sciences, University of Torino, c/o Ospedale Amedeo di Savoia, C.so Svizzera 164, 10159, Torino, Italy.
| | - G Di Perri
- Unit of Infectious Diseases, Department of Medical Sciences, University of Torino, c/o Ospedale Amedeo di Savoia, C.so Svizzera 164, 10159, Torino, Italy
| | - S Bonora
- Unit of Infectious Diseases, Department of Medical Sciences, University of Torino, c/o Ospedale Amedeo di Savoia, C.so Svizzera 164, 10159, Torino, Italy
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A comparison of the sensitivity, stability, and reliability of three diagnostic schemes for HIV-associated neurocognitive disorders. J Neurovirol 2017; 23:404-421. [PMID: 28108972 DOI: 10.1007/s13365-016-0510-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Revised: 12/19/2016] [Accepted: 12/26/2016] [Indexed: 10/20/2022]
Abstract
HIV-associated neurocognitive disorders (HAND) occur in approximately 50% of HIV-infected individuals, yet available diagnostic criteria yield varying prevalence rates. This study examined the frequency, reliability, and sensitivity to everyday functioning problems of three HAND diagnostic criteria (DSM-5, Frascati, Gisslén). Participants included 361 adults with HIV disease and 199 seronegative adults. Neurocognitive status as defined by each of the three diagnostic systems was determined via a comprehensive neuropsychological battery. Everyday functioning was evaluated through self-report and clinician ratings. Results of logistic regressions revealed an association of HIV serostatus with Frascati-defined neurocognitive impairment (p = .027, OR = 1.7[1.1, 2.7]), but not DSM-5 or Gisslén-defined criteria (ps > .05). Frascati and DSM-5 criteria demonstrated agreement on 71% of observations, Frascati and Gisslén showed agreement on 80%, and DSM-5 and Gisslén criteria showed agreement on 46%, though reliability across the three criteria was poor. Only Frascati-defined neurocognitive impairment significantly predicted everyday functioning problems (p = .002, OR = 2.3[1.4, 3.8]). However, when both neurocognitive and complaint criteria were considered, the DSM-5 guidelines demonstrated significant relationships to everyday functioning, serostatus, and also increased reliability overtime compared to neurocognitive criteria alone (all ps < .05). A subset (n = 118) of the HIV+ group was assessed again after 14.0 (2.2) months. DSM-5 criteria evidenced significantly higher rates of incident neurocognitive disorder compared to both Frascati (p = .003) and Gisslén (p = .021) guidelines, while there were fewer remitting neurocognitive disorder diagnoses when Gisslén criteria were applied to the study sample compared to Frascati (p = .04). Future studies should aim to identify gold standard biological markers (e.g., neuropathology) and clinical outcomes associated with specific diagnostic criteria.
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