Determining the Neurocognitive Status and the Functional Ability of Patients to Screen for HIV-Associated Neurocognitive Disorder (HAND)

Abstract

Background and Purpose: To adequately evaluate the extent of neurocognitive impairment in patient living with human immunodeficiency virus (PLHIV), a battery of neuropsychological tests is typically administered which are neither cost effective nor time efficient in the outpatient clinical setting. The aim of the study was to assess neurocognitive status and functional ability of people living with HIV and find a brief screening tool to identify those who would benefit from a full diagnostic evaluation. Methods: The study enrolled 160 PLHIV (80 pre-antiretroviral therapy [ART] and 80 on ART) fulfilling the inclusion and exclusion criteria. Neurocognitive assessment and an assessment of Functional ability was done by using the Montreal Cognitive Assessment (MoCA) and Lawton and Brody Instrumental Activities of Daily Living Scale scale, respectively. Results: The study population consisted of 75.6% males and 24.4% females with mean age of 44±10 years. The overall prevalence of HIV associated neurocognitive disorder (HAND) in the study subjects was 52.5%. Of these, 47.5% had asymptomatic neurocognitive impairment and 5% had minor neurocognitive disorder. In MoCA, the most frequently affected domains were Language (97.6%), visuospatial ability (92.9%) and memory (71.4%). Conclusions: The prevalence of HAND in both groups were similar suggesting that neurocognitive impairment starts early in HIV infection. Memory and Visuospatial function impairment had the most predictive potential for detecting the presence of HAND. HAND screening is recommended in all PLHIV at enrolment into care. Simple tools like MoCA can be used in busy outpatient settings by healthcare workers to screen for HAND.

Cognitive and motor deficits in older adults with HIV infection: Comparison with normal ageing and Parkinson’s disease

“…Although visuospatial deficits have not received as much attention as executive function, information processing speed, and memory deficits, a number of studies have reported such deficits in the HIV populations. Indeed, a recent study noted that the relevance of visuospatial processes may be one of the most predictive deficits of HAND (Agarwal et al ., 2020). Historically, visuospatial processing deficits in HIV have been noted in older studies (e.g., Dolan et al ., 2003), although they have received less attention relative to other cognitive domains.…”

“…As people with HIV age, reflective of the frontostriatal dysfunction and dopaminergic changes characteristic of the disease, cognitive, and motor symptoms (Agarwal, Aujla, Gupta, & Kumar, 2020) similar to those observed in PD may emerge. Indeed, the interaction of age, chronic neuroinflammation, and living on ART long‐term (Ances et al ., 2012; Hakkers et al ., 2017) might exacerbate this phenotype (Rubin et al ., 2018).…”

Neuropsychological Characteristics of Adults with HIV: A Systematic Review

“…Due to their descriptive nature and the impossibility of establishing causal relations, the studies included in this systematic review correspond to a 4b JBI (2014) evidence level, this level is low. Nonetheless, four of the studies can be considered of high methodological quality (>75%) [16][17][18][19] according to the JBI checklist and three with moderate quality (50-75%) [20][21][22][23][24][25][26] (Table 1). Regarding the evaluation of possible biases, we identified differences in age and formal education between the HIV+/HIV-groups in some comparative studies that could have influenced the results.…”

“…Most studies were conducted in Africa, including Sub-Saharan Africa [26], Zimbabwe [17], and a multicenter study from Kenya, Tanzania, and Uganda [22]; as well as Europe, including Italy [24], France [19], and a multicenter study from Switzerland [21]. The remaining studies originated in the USA [18], India [23], and Japan [16].…”

The Cost Effectiveness of Mental Health Treatment in the Lifetime of Older Adults with HIV in New York City: A Markov Approach

“…ART has sharply expanded life expectancy for people with HIV [ 3 , 4 ] but their QoL has worsened due to ART toxicity, aging, comorbidities, polypharmacy, and mental health disorders [ 5 – 9 ]. At most, 50% of people with HIV under ART suffer from HIV-associated neurocognitive disorders (HAND), such as HIV-associated dementia, and mild neurocognitive disorders defined as lower performance in neurocognitive tests [ 10 – 12 ]. Depression is a chronic and recurrent disease, seldom identified as a factor affecting the outcome of treatment.…”