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Fitzpatrick-Schmidt T, Oral E, Welsh DA, Molina PE, Ferguson TF, Edwards S. Moderate-to-severe cognitive impairment is associated with both recent and chronic alcohol misuse in people with HIV: The New Orleans alcohol use in HIV (NOAH) study. ALCOHOL, CLINICAL & EXPERIMENTAL RESEARCH 2024; 48:1405-1416. [PMID: 38825691 DOI: 10.1111/acer.15378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 04/21/2024] [Accepted: 05/06/2024] [Indexed: 06/04/2024]
Abstract
BACKGROUND Human immunodeficiency virus (HIV) profoundly impacts the nervous system, leading to neurological deficits including HIV-associated neurocognitive disorder (HAND). HAND represents the most common neurological comorbidity among people with HIV (PWH), and alcohol use may exacerbate cognitive deficits, especially in vulnerable populations. This study investigated relationships between alcohol use and cognition in an underserved cohort of PWH, on the hypothesis that alcohol misuse exacerbates cognitive deficits. METHODS Data collected from participants (n = 259; 66.7% male; mean age 52 ± 10 years) enrolled in the New Orleans Alcohol Use in HIV (NOAH) study were utilized for cross-sectional analysis. Cognitive function was assessed using the Montreal Cognitive Assessment (MoCA), and alcohol use was comprehensively measured using four metrics: the Alcohol Use Disorders Identification Test (AUDIT), 30-day timeline follow back (TLFB), lifetime drinking history, and phosphatidylethanol (PEth) levels. RESULTS The average MoCA score among participants was 20.7 ± 4.5, with 86.5% demonstrating cognitive impairment (MoCA < 26). Individuals with MoCA scores below 18 (moderately or severely cognitively impaired) had a higher frequency of recent severe alcohol misuse and greater lifetime alcohol consumption. Participants at increased risk for AUD (AUDIT ≥ 16) also had worse global cognition and memory task performance than those with lower AUDIT scores; this was particularly true among those aged 50 and older. Analysis of the MoCA sub-score data indicated that participants with increased AUD risk had impairments in the cognitive domains of language and memory. CONCLUSIONS Our findings demonstrate a high prevalence of cognitive impairment in the NOAH cohort and suggest that alcohol misuse contributes to global cognitive deficits in PWH, especially among individuals aged 50 and older. Further exploration of the impact of alcohol use on specific cognitive domains, including memory and language, should incorporate additional cognitive tasks. These findings highlight the importance of considering alcohol use and AUD risk as significant factors that may exacerbate cognitive deficits in vulnerable populations, including older PWH.
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Affiliation(s)
- Taylor Fitzpatrick-Schmidt
- Comprehensive Alcohol-HIV/AIDS Research Center, LSU Health Sciences Center, New Orleans, Louisiana, USA
- Department of Physiology, School of Medicine, LSU Health Sciences Center, New Orleans, Louisiana, USA
- Alcohol & Drug Abuse Center of Excellence, LSU Health Sciences Center, New Orleans, Louisiana, USA
| | - Evrim Oral
- Comprehensive Alcohol-HIV/AIDS Research Center, LSU Health Sciences Center, New Orleans, Louisiana, USA
- Biostatistics, School of Public Health, LSU Health Sciences Center, New Orleans, Louisiana, USA
| | - David A Welsh
- Comprehensive Alcohol-HIV/AIDS Research Center, LSU Health Sciences Center, New Orleans, Louisiana, USA
- Alcohol & Drug Abuse Center of Excellence, LSU Health Sciences Center, New Orleans, Louisiana, USA
| | - Patricia E Molina
- Comprehensive Alcohol-HIV/AIDS Research Center, LSU Health Sciences Center, New Orleans, Louisiana, USA
- Department of Physiology, School of Medicine, LSU Health Sciences Center, New Orleans, Louisiana, USA
- Alcohol & Drug Abuse Center of Excellence, LSU Health Sciences Center, New Orleans, Louisiana, USA
| | - Tekeda F Ferguson
- Comprehensive Alcohol-HIV/AIDS Research Center, LSU Health Sciences Center, New Orleans, Louisiana, USA
- Department of Physiology, School of Medicine, LSU Health Sciences Center, New Orleans, Louisiana, USA
- Alcohol & Drug Abuse Center of Excellence, LSU Health Sciences Center, New Orleans, Louisiana, USA
- Epidemiology, School of Public Health, LSU Health Sciences Center, New Orleans, Louisiana, USA
| | - Scott Edwards
- Comprehensive Alcohol-HIV/AIDS Research Center, LSU Health Sciences Center, New Orleans, Louisiana, USA
- Department of Physiology, School of Medicine, LSU Health Sciences Center, New Orleans, Louisiana, USA
- Alcohol & Drug Abuse Center of Excellence, LSU Health Sciences Center, New Orleans, Louisiana, USA
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Beltran-Najera I, Thompson JL, Matchanova A, Woods SP. Racial differences in scores on the HIV Dementia Scale: mediating effects of literacy and screening utility among Black and White persons with HIV disease. AIDS Care 2023; 35:1724-1731. [PMID: 36314429 PMCID: PMC10148926 DOI: 10.1080/09540121.2022.2132373] [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] [Received: 12/20/2021] [Accepted: 09/28/2022] [Indexed: 05/01/2023]
Abstract
There are many obstacles to screening for HIV-associated neurocognitive disorders (HAND), including the influence of various sociodemographic effects on screening measures. This study examined possible racial bias on the HIV Dementia Scale (HDS) in screening for HAND among 39 Black and 84 White persons living with HIV (PLWH). Black PLWH had significantly lower raw HDS scores than White PLWH, which was mediated by lower oral word reading scores. Nevertheless, HDS scores were comparably predictive of clinical HAND diagnoses for Black and White PLWH as determined by a comprehensive battery; overall, individuals who failed the HDS were three times as likely to have HAND as compared to those who performed within normal limits (sensitivity = .26, specificity = .94). Consistent with prior literature exploring race-group differences, findings suggest that lower scores among Black PLWH compared to White PLWH on a commonly-used screening measure for HAND are partly explained by reading scores, perhaps reflecting differences in educational quality and opportunities. However, race-group differences did not affect the classification accuracy of the HDS in detecting HAND, although overall diagnostic accuracy was modest in both groups. Future work should determine the optimal neurocognitive screening methods for Black PLWH and other under-represented ethnoracial groups.
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Chen PP, Wei XY, Tao L, Xin X, Xiao ST, He N. Cerebral abnormalities in HIV-infected individuals with neurocognitive impairment revealed by fMRI. Sci Rep 2023; 13:10331. [PMID: 37365237 DOI: 10.1038/s41598-023-37493-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 06/22/2023] [Indexed: 06/28/2023] Open
Abstract
Although the combination antiretroviral treatment (cART) has considerably lowered the risk of HIV associated dementia (HAD), the incidence of neurocognitive impairments (NCI) has not decreased likely due to the insidious and slow progressive nature of HIV infection. Recent studies showed that the resting-state functional magnetic resonance imaging (rs-fMRI) is a prominent technique in helping the non-invasive analysis of neucognitive impairment. Our study is to explore the neuroimaging characteristics among people living with HIV (PLWH) with or without NCI in terms of cerebral regional and neural network by rs-fMRI, based on the hypothesis that HIV patients with and without NCI have independent brain imaging characteristics. 33 PLWH with NCI and 33 PLWH without NCI, recruited from the Cohort of HIV-infected associated Chronic Diseases and Health Outcomes, Shanghai, China (CHCDO) which was established in 2018, were categorized into the HIV-NCI and HIV-control groups, respectively, based on Mini-Mental State Examination (MMSE) results. The two groups were matched in terms of sex, education and age. Resting-state fMRI data were collected from all participants to analyze the fraction amplitude of low-frequency fluctuation (fALFF) and functional connectivity (FC) to assess regional and neural network alterations in the brain. Correlations between fALFF/FC values in specific brain regions and clinical characteristics were also examined. The results showed increased fALFF values in the bilateral calcarine gyrus, bilateral superior occipital gyrus, left middle occipital gyrus, and left cuneus in the HIV-NCI group compared to the HIV-control group. Additionally, increased FC values were observed between the right superior occipital gyrus and right olfactory cortex, bilateral gyrus rectus, and right orbital part of the middle frontal gyrus in the HIV-NCI group. Conversely, decreased FC values were found between the left hippocampus and bilateral medial prefrontal gyrus, as well as bilateral superior frontal gyrus. The study concluded that abnormal spontaneous activity in PLWH with NCI primarily occurred in the occipital cortex, while defects in brain networks were mostly associated with the prefrontal cortex. The observed changes in fALFF and FC in specific brain regions provide visual evidence to enhance our understanding of the central mechanisms underlying the development of cognitive impairment in HIV patients.
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Affiliation(s)
- Pan-Pan Chen
- Department of Epidemiology, School of Public Health, Fudan University, Shanghai, 2000323, China
- Pudong New Area Center for Disease Control and Prevention, Shanghai, 201203, China
- Pudong Institute of Preventive Medicine, Fudan University, Shanghai, China
| | - Xiang-Yu Wei
- Institute of Acupuncture & Anesthesia, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, China
- Department of Acupuncture & Moxibustion, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, China
| | - Larissa Tao
- Department of Acupuncture & Moxibustion, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, China
- International Education College, Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, China
| | - Xin Xin
- Department of Epidemiology, School of Public Health, Fudan University, Shanghai, 2000323, China
- Pudong New Area Center for Disease Control and Prevention, Shanghai, 201203, China
- Pudong Institute of Preventive Medicine, Fudan University, Shanghai, China
| | - Shao-Tan Xiao
- Pudong New Area Center for Disease Control and Prevention, Shanghai, 201203, China
- Pudong Institute of Preventive Medicine, Fudan University, Shanghai, China
| | - Na He
- Department of Epidemiology, School of Public Health, Fudan University, Shanghai, 2000323, China.
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Eaton AD, Chan Carusone S, Murzin K, Hui J, McCullagh JW, Walmsley SL. Cognitive screening considerations for psychosocial clinical trials in HIV, aging, and cognition. Clin Trials 2023; 20:176-180. [PMID: 36924070 DOI: 10.1177/17407745221136970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Cognitive impairment is a common comorbidity among individuals aging with HIV, which can be an extreme source of stress and anxiety for many. Psychosocial interventions have the potential to alleviate symptoms associated with cognitive impairment and help improve the quality of life of people with HIV as they continue to age; these interventions are in the infancy of development and require further testing via clinical trials. The slow development of interventions may be partially attributed to a common trend of requiring a formal HIV-associated neurocognitive disorder diagnosis to qualify for psychosocial clinical trials. HIV-associated neurocognitive disorder is diagnosed through intensive, time-consuming tests, and still many cases of HIV-associated neurocognitive disorder remain undiagnosed, misdiagnosed, or misclassified due to the limitations of the assessment process. This commentary suggests an alternate method of screening for cognitive impairments through the use of a brief, low-barrier assessment, alongside validity considerations. Such alternate screening may improve enrollment and completion rates in psychosocial clinical trials for people aging with HIV and cognitive impairment, by removing the burden of extensive testing that is commonly associated with an HIV-associated neurocognitive disorder diagnosis from clinical trial eligibility, while still providing valuable insight into individuals' cognitive functioning.
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Affiliation(s)
- Andrew D Eaton
- Faculty of Social Work-Saskatoon Campus, University of Regina, Saskatoon, SK, Canada.,Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
| | - Soo Chan Carusone
- Casey House, Toronto, ON, Canada.,Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | | | - Jenny Hui
- Faculty of Social Work-Saskatoon Campus, University of Regina, Saskatoon, SK, Canada.,Ontario Institute for Studies in Education, University of Toronto, Toronto, ON, Canada
| | | | - Sharon L Walmsley
- Toronto General Research Institute, University Health Network, Toronto, ON, Canada
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Mhungu A, Sixsmith J, Burnett E. Adolescent Girls and Young Women's Experiences of Living with HIV in the Context of Patriarchal Culture in Sub-Saharan Africa: A Scoping Review. AIDS Behav 2022; 27:1365-1379. [PMID: 36318422 PMCID: PMC10129999 DOI: 10.1007/s10461-022-03872-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/17/2022] [Indexed: 04/28/2023]
Abstract
Adolescent girls and young women (AGYW) in sub-Saharan Africa are disproportionately affected by the human immunodeficiency virus (HIV) due to socio-cultural gender, power, and economic disparities. This scoping review examined the literature to explore what is known about AGYW's everyday personal, relational, and social experiences of HIV to help shape future protective HIV policy and practice. Six databases were searched: Medline, CINAHL, Scopus, ASSIA, Google Scholar, and ProQuest, resulting in a total of 12,581 articles. Of these, 40 articles were included in the review. Key themes generated from the thematic analysis were relational and psychosocial challenges, inhibiting sexual expression, poverty, stigma, and discrimination; managing health in everyday life; agency and resilience; and personal space and social support. In conclusion, the review found a lack of understanding of AGYW's everyday experiences of living with HIV from their own perspectives. There was also little consideration of the role of patriarchal culture and how this constrains AGYW's ability to negotiate their relationships. Further research is needed to reveal AGYW's perspectives on living with HIV in sub-Saharan Africa.
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Affiliation(s)
- Alington Mhungu
- School of Health Sciences, University of Dundee, 11 Arlie Place, DD1 4HN, Dundee, Scotland.
| | - Judith Sixsmith
- School of Health Sciences, University of Dundee, 11 Arlie Place, DD1 4HN, Dundee, Scotland
| | - Emma Burnett
- School of Health Sciences, University of Dundee, 11 Arlie Place, DD1 4HN, Dundee, Scotland
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Zenebe Y, Necho M, Yimam W, Akele B. Worldwide Occurrence of HIV-Associated Neurocognitive Disorders and Its Associated Factors: A Systematic Review and Meta-Analysis. Front Psychiatry 2022; 13:814362. [PMID: 35711575 PMCID: PMC9193596 DOI: 10.3389/fpsyt.2022.814362] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 04/05/2022] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND HIV-associated neurocognitive disorders are common in people living with HIV/AIDS and affect the adherence of patients to prescriptions, activities of daily living, and quality of life of patients. However, there is a lack of summative evidence in the area. The present meta-analysis was therefore addressing this gap. METHODS We did our electronic search in Psych-Info, EMBASE, Scopus, and PubMed. The retrieved articles were stored with the endnote reference manager and data was extracted using Meta-XL version 5.3. The quality of studies was evaluated with the modified Newcastle-Ottawa Scale (NOS). A random-effect model and STATA-16 were used to compute the average estimate of HAND. Heterogeneity was weighed with I2 statistics. A sensitivity analysis and subgroup analysis were employed. The existence/nonexistence of a publication bias was checked with the Eggers test of publication bias. RESULTS The average prevalence of HAND was 50.41% (95% CI: 45.56, 55.26). The average estimate of HAND in Europe was found to be 50.015% whereas in Africa, Asia, and the United States of America (USA) it was 49.566, 52.032, and 50.407% respectively. The prevalence of HAND in studies that used the HIV Dementia Scale (IHDS) was 36.883% and 59.956% at cutoff points of IHDS <9.5 and IHDS <10 respectively. Besides, the estimated average of HAND with the global dementia scale (GDS) was 40.766%. The prevalence of HAND in cross-sectional, cohort, and case-control studies was 49.52, 54.087, and 44.45% in that order. Socio-demographic variables; low level of education and older age, clinical and HIV related variables; the advanced stage of the illness and CD4 count of 500 cells/dl or less and psychological variables such as comorbidity of depression increases the risk of HAND. CONCLUSION The prevalence of HIV-associated neurocognitive disorders was about 50.41%. Low level of education and older age, clinical and HIV related variables such as the advanced stage of the illness and CD4 count of 500 cells/dl or less, and comorbidity of depression were associated with HIV associated neurocognitive disorders. Public health interventions for HIV patients should target these essential problems.
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Affiliation(s)
- Yosef Zenebe
- Department of Psychiatry, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Mogesie Necho
- Department of Psychiatry, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Wondwosen Yimam
- Department of Nursing, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Baye Akele
- Department of Pharmacy, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
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Robbins RN, Scott TM, Gouse H, Marcotte TD, Rourke SB. Screening for HIV-Associated Neurocognitive Disorders: Sensitivity and Specificity. Curr Top Behav Neurosci 2021; 50:429-478. [PMID: 32677005 DOI: 10.1007/7854_2019_117] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
HIV-associated neurocognitive disorder (HAND) remains prevalent among people living with HIV (PLWH), especially the mild forms, even those with well-controlled HIV. Recommendations from the literature suggest routine and regular screening for HAND to detect it early and manage it effectively and adjust treatments, if warranted, when present. However, screening for HAND is not routinely done, as there are no current guidelines on when to screen and which test or tests to use. Furthermore, many of the available screening tools for HAND often cannot accurately detect the mild forms of HAND and require highly trained healthcare professionals to administer and score the tests, a requirement that is not feasible for those low- and middle-income countries with the highest HIV incidence and prevalence rates. The purpose of this chapter was to review recent research on screening tests to detect HAND and report on the strengths, limitations, and psychometric properties of those tests to detect HAND.
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Affiliation(s)
- Reuben N Robbins
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University Medical Center, New York, NY, USA.
| | - Travis M Scott
- Department of Psychology, Fordham University, The Bronx, NY, USA.,VA Palo Alto Health Care System, Sierra Pacific MIRECC, Palo Alto, CA, USA
| | - Hetta Gouse
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Thomas D Marcotte
- HIV Neurobehavioral Research Program, Center for Medicinal Cannabis Research, University of California, San Diego, San Diego, CA, USA
| | - Sean B Rourke
- Centre for Urban Health Solutions, St Michael's Hospital, Toronto University, Toronto, ON, Canada
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Naveed Z, Fox HS, Wichman CS, May P, Arcari CM, Meza J, Totusek S, Baccaglini L. Development of a Nomogram-Based Tool to Predict Neurocognitive Impairment Among HIV-positive Charter Participants. Open AIDS J 2021. [DOI: 10.2174/1874613602115010052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background:
Despite the widespread use of combination antiretroviral therapy (cART), HIV-associated neurocognitive impairment (NCI) persists in people living with HIV (PLWH). Studies have generated inconsistent results regarding etiological factors for NCI in PLWH. Furthermore, a user-friendly and readily available predictive tool is desirable in clinical practice to screen PLWH for NCI.
Objective:
This study aimed to identify factors associated with NCI using a large and diverse sample of PLWH and build a nomogram based on demographic, clinical, and behavioral variables.
Methods:
We performed Bayesian network analysis using a supervised learning technique with the Markov Blanket (MB) algorithm. Logistic regression was also conducted to obtain the adjusted regression coefficients to construct the nomogram.
Results:
Among 1,307 participants, 21.6% were neurocognitively impaired. During the MB analysis, age provided the highest amount of mutual information (0.0333). Logistic regression also showed that old age (>50 vs. ≤50 years) had the strongest association (OR=2.77, 95% CI=1.99-3.85) with NCI. The highest possible points on the nomogram were 626, translated to a nomogram-predicted probability of NCI to be approximately 0.95. The receiver operating characteristic (ROC) curve's concordance index was 0.75, and the nomogram's calibration plot exhibited an excellent agreement between observed and predicted probabilities.
Conclusion:
The nomogram used variables that can be easily measured in clinical settings and, thus, easy to implement within a clinic or web-interface platform. The nomogram may help clinicians screen for patients with a high probability of having NCI and thus needing a comprehensive neurocognitive assessment for early diagnosis and appropriate management.
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Prats A, López-Masramon E, Pérez-Álvarez N, Garolera M, Fumaz CR, Ferrer MJ, Clotet B, Muñoz-Moreno JA. NEU Screen Shows High Accuracy in Detecting Cognitive Impairment in Older Persons Living With HIV. J Assoc Nurses AIDS Care 2019; 30:35-41. [PMID: 30586082 DOI: 10.1097/jnc.0000000000000003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
The NEUrocognitive (NEU) Screen is a practical tool proposed to screen for HIV-associated cognitive impairment in the clinical setting. This is a pencil-and-paper method that can be applied rapidly (≤10 minutes for administration) and has no copyright limitations. In this study, we aimed at investigating its diagnostic accuracy in an older population of persons living with HIV (PLWH), with cutoffs set at 30, 40, 50, and 60 years. Data were collected from a sample of 368 PLWH who underwent a comprehensive neuropsychological tests battery (gold standard). Results of statistical tests showed that accuracy of the NEU Screen increased with age of the participants. The highest degree of precision, with a sensitivity of 91% and specificity of 92%, was obtained for people ages 60 years or older (correct classification: 91%). These optimal results point to the great potential of the NEU Screen as a tool for detecting cognitive disorders in older PLWH.
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Affiliation(s)
- Anna Prats
- Anna Prats, MS, is Neuropsychologist, Fundació Lluita contra la SIDA, Hospital Universitari Germans Trias i Pujol, Badalona, Catalonia, Spain; and Doctoral Candidate, Departament de Psiquiatria i Medicina Legal, Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Catalonia, Spain. Estela López-Masramon, MS, is Neuropsychologist, Fundació Lluita contra la SIDA, Hospital Universitari Germans Trias i Pujol, Badalona, Catalonia, Spain. Núria Pérez-Álvarez, PhD, is Statistician, Fundació Lluita contra la SIDA, Hospital Universitari Germans Trias i Pujol, Badalona, Catalonia, Spain; and Assistant Professor, Universitat Politècnica de Catalunya, Barcelona, Catalonia, Spain. Maite Garolera, PhD, is Neuropsychologist, Clinical Research Group for Brain, Cognition and Behavior, Consorci Sanitari Hospital de Terrassa, Terrassa, Catalonia, Spain; and Senior Researcher, Grup de Recerca Consolidat en Neuropsicologia, Universitat de Barcelona, Barcelona, Catalonia, Spain. Carmina R. Fumaz, PhD, is Psychologist, Fundació Lluita contra la SIDA, Hospital Universitari Germans Trias i Pujol, Badalona, Catalonia, Spain. Maria J. Ferrer, MS, is Psychologist, Fundació Lluita contra la SIDA, Hospital Universitari Germans Trias i Pujol, Badalona, Catalonia, Spain. Bonaventura Clotet, PhD, is Physician, Fundació Lluita contra la SIDA, Hospital Universitari Germans Trias i Pujol, Badalona, Catalonia, Spain; Senior Researcher, Institut per la Recerca de la SIDA, IrsiCaixa Badalona, Catalonia, Spain; and Professor, Universitat de Vic, Vic, Catalonia, Spain. Jose A. Muñoz-Moreno, PhD, is Psychologist, Fundació Lluita contra la SIDA, Hospital Universitari Germans Trias i Pujol, Badalona, Catalonia, Spain; and Assistant Professor, Facultat de Psicologia i Ciències de l'Educació, Universitat Oberta de Catalunya, Barcelona, Catalonia, Spain
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Visual evoked and event-related brain potentials in HIV-infected adults: a longitudinal study over 2.5 years. Doc Ophthalmol 2019; 139:83-97. [PMID: 30993574 DOI: 10.1007/s10633-019-09697-4] [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: 10/18/2018] [Accepted: 04/09/2019] [Indexed: 10/27/2022]
Abstract
PURPOSE The aim of this neurophysiological study was to monitor changes in the visual and cognitive function of HIV-infected patients treated with combination antiretroviral therapy. METHODS Eleven adult Czech HIV+ patients, with a mean age of 35 years and CD4 cell count ≥ 230 × 106 cells/L of blood at the time of enrollment, underwent four to six examinations over the course of 2.5 years to evaluate pattern-reversal and motion-onset visual evoked potentials (P-VEPs and M-VEPs), visually driven oddball event-related potentials (ERPs) and Montreal Cognitive Assessments. In addition to evaluating the intraindividual change in the observed parameters, we also compared patient data to data from eleven age- and gender-matched controls. RESULTS We did not find any significant differences in P-VEPs between the patients and controls or in the paired comparison of the first and last visit. The only significant finding for P-VEPs was a linear trend in prolongation of the 20' P-VEP P100 peak time. In M-VEPs, we found a significant intergroup difference in the N160 peak time recorded during the first visit for peripheral M-VEPs only. During the last visit, all N160 peak times for patients differed significantly from those of the control group. The only intervisit difference close to the level of significance was for peripheral M-VEPs, which confirmed the trend analysis. No significant differences between patients and controls were found in the ERPs, but the P300 peak time showed a significant difference between the first and last visits, as confirmed by the trend. Patient reaction time was not significantly delayed at the first visit; however, it was prolonged with time, as confirmed by the trend. CONCLUSION Our aim was to evaluate whether antiretroviral treatment in HIV+ patients is sufficient to preserve brain visual function. The optic nerve and primary visual cortex function tested by the P-VEPs seem to be preserved. The prolongation of the M-VEPs suggests an individually detectable decline in CNS function, but these changes did not show a progression during the follow-up. From a longitudinal perspective, the trends in peak time prolongation of the 20' P-VEP, peripheral M-VEP, ERP and reaction time suggest a faster decline than that caused by aging in healthy populations, as previously described in a cross-sectional study.
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Chan LG, Ho MJ, Lin YC, Ong Y, Wong CS. Development of a neurocognitive test battery for HIV-associated neurocognitive disorder (HAND) screening: suggested solutions for resource-limited clinical settings. AIDS Res Ther 2019; 16:9. [PMID: 30987670 PMCID: PMC6463654 DOI: 10.1186/s12981-019-0224-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 04/05/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Practical screening strategies are necessary to detect neurocognitive impairment of all severities in HIV populations, which remains prevalent despite highly active antiretroviral therapy and requires full neuropsychological testing for diagnosis. We aimed to develop a brief and clinically feasible battery to screen for HIV-associated neurocognitive disorders (HAND) in resource-limited settings even where English is not the native language. METHODS A total of 53 outpatients were recruited from a multi-ethnic Southeast Asian HIV-positive cohort. Performance on a neuropsychological protocol was used to define cognitive impairment, of which 28 patients (52.8%) were identified with HAND. Receiver operating characteristic analysis was used to determine the best combinations of cognitive tests for the screening battery. RESULTS 3 different combinations of cognitive tests that required minimal literacy, time to administer, and administrator training were found to classify HAND with fair accuracy. Montreal Cognitive Assessment (MoCA), in combination with tests of psychomotor coordination, verbal learning and speed processing, yielded area under curve scores of above 0.75, the primary outcome of receiver operating characteristic analysis. CONCLUSION The 3-test combinations presented in this study appear to be promising screening options for HAND in HIV-infected patients. The addition of 2 tests to MoCA improves the overall accuracy while retaining its convenience, giving more potential for the inclusion of cognitive screening in routine clinical care. Further validation of the batteries in specific settings is warranted to determine specific screening cut-offs to a global cognitive score.
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Affiliation(s)
- Lai Gwen Chan
- Department of Psychological Medicine, Tan Tock Seng Hospital, Annex 1 Building Level 3, 11 Jalan Tan Tock Seng, Singapore, 308433 Singapore
| | - Mei Jing Ho
- Department of Psychological Medicine, Tan Tock Seng Hospital, Annex 1 Building Level 3, 11 Jalan Tan Tock Seng, Singapore, 308433 Singapore
| | - Yijun Carol Lin
- Department of Psychological Medicine, Tan Tock Seng Hospital, Annex 1 Building Level 3, 11 Jalan Tan Tock Seng, Singapore, 308433 Singapore
| | - Yining Ong
- Department of Psychological Medicine, Tan Tock Seng Hospital, Annex 1 Building Level 3, 11 Jalan Tan Tock Seng, Singapore, 308433 Singapore
| | - Chen Seong Wong
- National Centre for Infectious Diseases, Tan Tock Seng Hospital, 16 Jalan Tan Tock Seng, Singapore, 308442 Singapore
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Chan FCC, Chan P, Chan I, Chan A, Tang THC, Lam W, Fong WC, Lee MP, Li P, Chan GHF. Cognitive screening in treatment-naïve HIV-infected individuals in Hong Kong - a single center study. BMC Infect Dis 2019; 19:156. [PMID: 30760220 PMCID: PMC6375138 DOI: 10.1186/s12879-019-3784-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 02/06/2019] [Indexed: 11/11/2022] Open
Abstract
Background HIV-associated neurocognitive disorder (HAND) remains prevalent in the era of combination antiretroviral therapy (cART). The prevalence of HAND in Hong Kong is not known. Methods Between 2013 and 2015, 98 treatment-naïve HIV-1-infected individuals were referred to and screened by the AIDS Clinical Service, Queen Elizabeth Hospital with (1) the International HIV Dementia Scale (IHDS), a screening tool that targets moderate to severe HAND, (2) the Montreal Cognitive Assessment (MoCA), a frequently used cognitive screening test and (3) the Patient Health Questionnare-9 (PHQ-9), a 9-item questionnaire that evaluates depression symptoms. Within the study period, 57 of them completed the second set of IHDS and MoCA at 6 months after baseline assessment. Results Most participants were male (94%), with a median age of 31 years. At baseline, 38 (39%) and 25 (26%) of them scored below the IHDS (≤10) and MoCA (25/26) cut-offs respectively. Poor IHDS performers also scored lower on MoCA (p = 0.039) but the correlation between IHDS and MoCA performance was weak (r = 0.29, p = 0.004). Up to a third of poor IHDS performers (13/38) showed moderate depression (PHQ-9 > 9). In the multivariable analysis, a lower education level (p = 0.088), a history of prior psychiatric illness (p = 0.091) and the presence of moderate depression (p = 0.079) tended to be significantly associated with poor IHDS performance. At follow-up, 54 out of 57 were on cART, of which 46 (85%) had achieved viral suppression. Their blood CD4+ T-lymphocytes and IHDS scores were higher at follow-up compared to baseline values (both p < 0.001) but their MoCA performance was similar at both assessments. Of note, 17 participants in this subgroup scored below the IHDS cut-off at both assessments. Conclusions Poor IHDS performance, and likely cognitive impairment, was frequently observed in treatment-naïve HIV-infected individuals in our locality. A considerable proportion continued to score below the IHDS cut-off at 6 months after cART. Depression was frequently observed in this vulnerable population and was associated with poor IHDS performance. Electronic supplementary material The online version of this article (10.1186/s12879-019-3784-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Fiona C C Chan
- Department of Medicine, Queen Elizabeth Hospital, Hong Kong, SAR, People's Republic of China
| | - Phillip Chan
- SEARCH, Thai Red Cross AIDS Research Centre, 104 Ratchadamri Rd, Khwaeng Pathum Wan, Khet Pathum Wan, Krung Thep Maha Nakhon, Bangkok, 10330, Thailand.
| | - Iris Chan
- Department of Clinical Psychology, Queen Elizabeth Hospital, Hong Kong, SAR, People's Republic of China
| | - Andrew Chan
- Department of Medicine, Queen Elizabeth Hospital, Hong Kong, SAR, People's Republic of China
| | - Tommy H C Tang
- Department of Medicine, Queen Elizabeth Hospital, Hong Kong, SAR, People's Republic of China
| | - Wilson Lam
- Department of Medicine, Queen Elizabeth Hospital, Hong Kong, SAR, People's Republic of China
| | - W C Fong
- Department of Medicine, Queen Elizabeth Hospital, Hong Kong, SAR, People's Republic of China
| | - M P Lee
- Department of Medicine, Queen Elizabeth Hospital, Hong Kong, SAR, People's Republic of China
| | - Patrick Li
- Hong Kong Sanatorium and Hospital, Hong Kong, SAR, People's Republic of China
| | - Germaine H F Chan
- Department of Medicine, Queen Elizabeth Hospital, Hong Kong, SAR, People's Republic of China
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Milic J, Russwurm M, Cerezales Calvino A, Brañas F, Sánchez-Conde M, Guaraldi G. European cohorts of older HIV adults: POPPY, AGEhIV, GEPPO, COBRA and FUNCFRAIL. Eur Geriatr Med 2019; 10:247-257. [DOI: 10.1007/s41999-019-00170-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2019] [Accepted: 01/24/2019] [Indexed: 12/13/2022]
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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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Quigley A, O'Brien K, Parker R, MacKay-Lyons M. Exercise and cognitive function in people living with HIV: a scoping review. Disabil Rehabil 2018; 41:1384-1395. [PMID: 29376434 DOI: 10.1080/09638288.2018.1432079] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND Since the advent of antiretrovirals, people with HIV are living longer and have improved quality of life. However, 30-60% of these individuals experience cognitive impairment. Fortunately, physical activity has emerged as a management strategy for cognitive impairment. PURPOSE To map the evidence on physical activity and cognition in HIV. METHODS We searched five databases using terms related to physical activity and HIV. Two authors independently reviewed titles and abstracts for studies that addressed physical activity/exercise and cognition in people with HIV. Authors reviewed full texts to identify articles that met our inclusion criteria. One author extracted the data, then we collated the results and summarized the characteristics of included studies. RESULTS Sixteen studies from high-income countries were included; eight were interventional (five randomized controlled trials and three pre-post single group observational studies) and eight were non-interventional studies. The interventional studies included aerobic, resistive, and Tai Chi exercise for 8 weeks to 12 months in duration. Two of eight interventional studies found exercise to benefit self-reported cognition. All eight non-interventional studies showed a positive relationship between physical activity and cognitive function. CONCLUSIONS Results of this study suggest that physical activity may preserve or improve cognition in people living with HIV. Implications for Rehabilitation Physical activity may play a role in preserving or improving cognition in the human immunodeficiency virus population. Exercise should be prescribed for people with human immunodeficiency virus based on the stage of infection. Rehabilitation professionals should follow current exercise guidelines when prescribing exercise for people living with human immunodeficiency virus.
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Affiliation(s)
- Adria Quigley
- a Department of Health , Dalhousie University , Halifax , NS, Canada
| | - Kelly O'Brien
- b Department of Physical Therapy , University of Toronto , Toronto , Canada.,c Rehabilitation Sciences Institute , University of Toronto , Toronto , Canada.,d Institute of Health Policy , University of Toronto , Toronto , Canada
| | - Robin Parker
- e Evidence Synthesis and Information Services , Dalhousie University , Halifax , Canada.,f Department of Community Health and Epidemiology , Dalhousie University , Halifax , Canada
| | - Marilyn MacKay-Lyons
- g Department of Physiotherapy , Dalhousie University , Halifax , Canada.,h Department of Medicine , Dalhousie University , Halifax , Canada.,i Nova Scotia Health Authority , Halifax , Canada
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Frain JA, Chen L. Examining the effectiveness of a cognitive intervention to improve cognitive function in a population of older adults living with HIV: a pilot study. Ther Adv Infect Dis 2018; 5:19-28. [PMID: 29344357 PMCID: PMC5761923 DOI: 10.1177/2049936117736456] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE The purpose of this randomized-controlled pilot study was to explore the effectiveness of a home-based computerized cognitive training intervention in improving cognitive function in a population of older adults with mild cognitive impairment who are living with HIV. METHODS In all, 24 participants were enrolled in this study. All study participants were impaired [defined as Montreal Cognitive Assessment (MoCA) score < 26]; 12 were randomly assigned to a computer-training intervention group and 12 to a control group. The intervention group used a home-based computerized cognitive training program for 8 weeks, while the control group received health-related newsletter via email and follow-up phone calls. Cognitive function was measured at study entry, immediately post intervention, and 8 and 16 weeks post intervention. RESULTS This study achieved a 92% retention rate, losing two persons from the intervention group. Participants in the intervention group scored significantly higher on cognitive testing immediately post intervention compared to the control group: F(1, 19) = 4.92, p = 0.04. The partial Eta squared of 0.32 indicates a small to moderate effect size. DISCUSSION Cognitive improvement was seen immediately after the intervention, and cognitive improvement was still evident 16 weeks post intervention. Cognitive training could be considered as an option for older adults with HIV experiencing mild cognitive impairment.
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Affiliation(s)
- Judy A. Frain
- Goldfarb School of Nursing at Barnes-Jewish College, St. Louis, MO, USA
| | - Ling Chen
- Washington University in St. Louis, St. Louis, MO, USA
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Abstract
In the current era of therapy for human immunodeficiency virus (HIV), life expectancy for persons living with HIV (PLWH) approaches that of the general population. This newly prolonged survival among PLWH is associated with an increased prevalence of comorbidities due to the inflammation, immune activation and immune senescence associated with HIV infection. Higher prevalence of tobacco and alcohol use, co-infection with viral hepatitis and traditional cardiovascular risk factors such as hypertension and hyperlipidemia contribute as well. In this review, we hope to describe the current comorbidities occurring among PLWH and bring increased awareness for conditions that may otherwise not be considered given the younger age at time of presentation.
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Affiliation(s)
- Emma Kaplan-Lewis
- Division of Infectious Diseases, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1090, New York, NY 10029, USA.
| | - Judith A Aberg
- Division of Infectious Diseases, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1090, New York, NY 10029, USA
| | - Mikyung Lee
- Division of Infectious Diseases, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1090, New York, NY 10029, USA
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McLaurin KA, Booze RM, Mactutus CF. Temporal processsing demands in the HIV-1 transgenic rat: Amodal gating and implications for diagnostics. Int J Dev Neurosci 2016; 57:12-20. [PMID: 28040491 DOI: 10.1016/j.ijdevneu.2016.11.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Revised: 11/07/2016] [Accepted: 11/08/2016] [Indexed: 11/25/2022] Open
Abstract
Despite the success of combination antiretroviral therapy (cART), approximately 50% of HIV-1 seropositive individuals develop HIV-1 associated neurocognitive disorders (HAND). Unfortunately, point-of-care screening tools for HAND lack sensitivity and specificity, especially in low-resource countries. Temporal processing deficits have emerged as a critical underlying dimension of neurocognitive impairments observed in HIV-1 and may provide a key target for the development of a novel point-of-care screening tool for HAND. Cross-modal prepulse inhibition (PPI; i.e., auditory, visual, or tactile prepulse stimuli) and gap-prepulse inhibition (gap-PPI; i.e., auditory, visual or tactile prepulse stimuli), two translational experimental paradigms, were used to assess the nature of temporal processing deficits in the HIV-1 transgenic (Tg) rat. Cross-modal PPI revealed a relative insensitivity to the manipulation of interstimulus interval (ISI) in HIV-1 Tg rats in comparison to controls, regardless of prestimulus modality. Gap-PPI revealed differential sensitivity to the manipulation of ISI, independent of modality, in HIV-1 Tg rats in comparison to control animals. Manipulation of context (i.e., concurrent visual or tactile stimulus) in auditory PPI revealed a differential sensitivity in HIV-1 Tg animals compared to controls. The potential utility of amodal temporal processing deficits as an innovative point-of-care screening tool was explored using a discriminant function analysis, which diagnosed the presence of the HIV-1 transgene with 97.4% accuracy. Thus, the presence of amodal temporal processing deficits in the HIV-1 Tg rat supports the hypothesis of a central temporal processing deficit in HIV-1 seropositive individuals, heralding an opportunity for the development of a point-of-care screening tool for HAND.
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Affiliation(s)
- Kristen A McLaurin
- Program in Behavioral Neuroscience, Department of Psychology, University of South Carolina, Columbia, SC, 29208, United States
| | - Rosemarie M Booze
- Program in Behavioral Neuroscience, Department of Psychology, University of South Carolina, Columbia, SC, 29208, United States
| | - Charles F Mactutus
- Program in Behavioral Neuroscience, Department of Psychology, University of South Carolina, Columbia, SC, 29208, United States.
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McDermott A, Zaporojan L, McNamara P, Doherty CP, Redmond J, Forde C, Gormley J, Egaña M, Bergin C. The effects of a 16-week aerobic exercise programme on cognitive function in people living with HIV. AIDS Care 2016; 29:667-674. [PMID: 27892704 DOI: 10.1080/09540121.2016.1263723] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
High levels of cardiovascular fitness and physical activity are associated with higher levels of cognitive function in people with HIV, thus, they may reduce the risk of developing HIV-associated neurocognitive disorder (HAND). This study aimed to investigate the effects of a 16-week aerobic exercise intervention on cognitive function in people with HIV. Eleven participants living with HIV were recruited into the study. Participants were randomised into either an exercise group (n = 5), that completed a 16-week aerobic exercise programme training, 3 times per week (2 supervised sessions and one unsupervised session) or a control group (n = 6) that received no intervention. Outcomes measured included cognitive function (Montreal cognitive assessment (MOCA) and the Trail making tests A and B), aerobic fitness (modified Bruce protocol), sleep quality (Pittsburgh sleep quality index; PSQI) and physical activity levels (seven-day accelerometry). At baseline, higher levels of moderate physical activity were positively correlated with higher MOCA scores and levels of aerobic fitness were negatively associated with Trail A scores (P = 0.04 and P = 0.001 respectively). However, exercise training did not induce any significant improvements in cognitive function or aerobic fitness. The overall mean adherence rate to the exercise programme was 60%. In conclusion, in the present study a 16-week aerobic exercise intervention did not affect the cognitive function of participants with HIV. It is likely that longer intervention periods and/or higher adherence rates to exercise might be needed for an aerobic exercise programme to be effective in improving cognitive function in a cohort with no baseline cognitive impairments.
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Affiliation(s)
- Adam McDermott
- a Department of Physiology, School of Medicine , Trinity College Dublin , Dublin , Ireland
| | - Lilia Zaporojan
- b Department of Neurology , St. James' Hospital , Dublin , Ireland
| | - Patricia McNamara
- c Academic Unit of Neurology , Trinity College Dublin , Dublin , Ireland
| | - Colin P Doherty
- c Academic Unit of Neurology , Trinity College Dublin , Dublin , Ireland
| | - Janice Redmond
- b Department of Neurology , St. James' Hospital , Dublin , Ireland
| | - Cuisle Forde
- d Discipline of Physiotherapy, School of Medicine , Trinity College Dublin , Dublin , Ireland
| | - John Gormley
- d Discipline of Physiotherapy, School of Medicine , Trinity College Dublin , Dublin , Ireland
| | - Mikel Egaña
- a Department of Physiology, School of Medicine , Trinity College Dublin , Dublin , Ireland
| | - Colm Bergin
- e Department of Infectious Diseases , St. James' Hospital , Dublin , Ireland.,f School of Medicine , Trinity College Dublin , Dublin , Ireland
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Evaluating the Montreal Cognitive Assessment (MoCA) and its subtests for DSM-5 mild neurocognitive disorders (NCD): Does age have an effect on the screening accuracy? J Psychosom Res 2016; 85:26-7. [PMID: 27212666 DOI: 10.1016/j.jpsychores.2016.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 04/11/2016] [Accepted: 04/14/2016] [Indexed: 11/21/2022]
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Milanini B, Ciccarelli N, Fabbiani M, Baldonero E, Limiti S, Gagliardini R, Borghetti A, D'Avino A, Mondi A, Colafigli M, Cauda R, Di Giambenedetto S. Neuropsychological screening tools in Italian HIV+ patients: a comparison of Montreal Cognitive Assessment (MoCA) and Mini Mental State Examination (MMSE). Clin Neuropsychol 2016; 30:1457-1468. [PMID: 27180611 DOI: 10.1080/13854046.2016.1183048] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Despite the progress in HIV treatments, mild forms of cognitive impairment still persist. Brief and sensitive screening tools are needed. We evaluated the accuracy of the Montreal Cognitive Assessment (MoCA) compared to the Mini Mental State Examination (MMSE) to detect cognitive impairment in HIV-infected participants. METHOD HIV-infected patients were consecutively enrolled during routine outpatient visits at a single institution. The MoCA, the MMSE, and a comprehensive neuropsychological battery were administered. Patients were considered as affected by cognitive impairment if they showed decreased cognitive function in at least two ability domains based on age and education adjusted Italian normative cut-offs. RESULTS Ninety-three HIV-infected participants (75% males, median age 47, all on antiretroviral therapy; 90% HIV-RNA <50copies/mL, median CD4 644 cells/μL) were enrolled. Thirteen participants (14%) were diagnosed as cognitively compromised via a comprehensive neuropsychological examination. The area under the curve of the adjusted MMSE and MoCA scores to detect cognitive impairment were .51 (95% CI = .31-.72, p = .877) and .70 (95% CI = .53-.86, p = .025), respectively. A MoCA score <22 was able to predict the cognitive impairment with 62% of sensitivity and 76% of specificity. CONCLUSIONS Our findings suggested that the prognostic performance of the MoCA to detect cognitive impairment among mildly impaired HIV-infected participants was only moderate. Further investigations are needed to identify optimal cognitive tests to screen HIV-infected individuals or to explore whether a combination of cognitive tests might represent a viable alternative to a single screening tool.
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Affiliation(s)
- Benedetta Milanini
- a Institute of Clinical Infectious Diseases , Catholic University of Sacred Heart , Rome , Italy
| | - Nicoletta Ciccarelli
- a Institute of Clinical Infectious Diseases , Catholic University of Sacred Heart , Rome , Italy
| | - Massimiliano Fabbiani
- a Institute of Clinical Infectious Diseases , Catholic University of Sacred Heart , Rome , Italy
| | - Eleonora Baldonero
- a Institute of Clinical Infectious Diseases , Catholic University of Sacred Heart , Rome , Italy
| | - Silio Limiti
- a Institute of Clinical Infectious Diseases , Catholic University of Sacred Heart , Rome , Italy
| | - Roberta Gagliardini
- a Institute of Clinical Infectious Diseases , Catholic University of Sacred Heart , Rome , Italy
| | - Alberto Borghetti
- a Institute of Clinical Infectious Diseases , Catholic University of Sacred Heart , Rome , Italy
| | - Alessandro D'Avino
- a Institute of Clinical Infectious Diseases , Catholic University of Sacred Heart , Rome , Italy
| | - Annalisa Mondi
- a Institute of Clinical Infectious Diseases , Catholic University of Sacred Heart , Rome , Italy
| | - Manuela Colafigli
- a Institute of Clinical Infectious Diseases , Catholic University of Sacred Heart , Rome , Italy
| | - Roberto Cauda
- a Institute of Clinical Infectious Diseases , Catholic University of Sacred Heart , Rome , Italy
| | - Simona Di Giambenedetto
- a Institute of Clinical Infectious Diseases , Catholic University of Sacred Heart , Rome , Italy
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