Differentiating HIV-Associated Neurocognitive Disorders From Alzheimer’s Disease: an Emerging Issue in Geriatric NeuroHIV

Abstract

Purpose of Review To examine characteristics that may distinguish HIV-associated Neurocognitive Disorder (HAND) from early Alzheimer's disease (AD) Recent Findings CSF AD biomarkers are perturbed in HIV, yet these alterations may be limited to settings of advanced dementia or unsuppressed plasma HIV RNA. Neuropsychological testing will require extensive batteries to maximize utility. Structural imaging is limited for early AD detection in the setting of HIV, but proper studies are absent. While positron emission tomography (PET) amyloid imaging has altered the landscape of differential diagnosis for age-associated neurodegenerative disorders, costs are prohibitive. Summary Risk for delayed AD diagnosis in the aging HIV-infected population is now among the most pressing issues in geriatric neuro HIV. While clinical, imaging, and biomarker characterization of AD is extensively defined, fewer data define characteristics of HAND in the setting of suppressed plasma HIV RNA. Data needed to inform the phenotype of AD in the setting of HIV are equally few.

Diagnostic accuracy of new and old cognitive screening tools for HIV‐associated neurocognitive disorders

“… may be explained by the different CDT interpretation model and gold standard battery we used. The observed poor performance may also be attributable to cortical imprinting , which makes CDT less effective in revealing subcortical deficits, which are still more common in HAND patients .…”

“…The discordance between our results and those reported by Levy et al [22] may be explained by the different CDT interpretation model and gold standard battery we used. The observed poor performance may also be attributable to cortical imprinting [34], which makes CDT less effective in revealing subcortical deficits, which are still more common in HAND patients [35,36]. 3QT, which is based on symptom reporting, has been proposed as an easy-to-use screening tool for HAND by Simioni et al [11].…”

“…3QT, which is based on symptom reporting, has been proposed as an easy-to-use screening tool for HAND by Simioni et al [11]. However, self-reported symptoms have substantial limitations in the setting of HIV infection as a consequence of the prevailing asymptomatic nature of HAND and the evidence of poor metacognition and insight into objective measures of functional skills [36,37], making reliance on symptom reporting risky for such a diagnosis. Moreover, self-reported attributions may be more closely related to affective distress than objective decline [37,38].…”

Exploring the Etiological Links behind Neurodegenerative Diseases: Inflammatory Cytokines and Bioactive Kynurenines

“…Increased hyperphosphorylated tau in the hippocampus was reported in HIV-infected patients on cART (Figure 4c). Thus, differential diagnosis of AD in patients with HAND is a challenging issue [153].…”

Cognitive remediation group therapy versus mutual aid group therapy: A pilot randomized, controlled trial to determine the feasibility and acceptability of group therapy for people aging with HIV facing cognitive challenges

“…In the absence of and even alongside an eventual pharmacological remedy, psychosocial approaches are needed to improve coping with HAND's symptoms 17 . Although existing research has illuminated unique cognitive challenges amongst people aging with HIV 18 , such as a higher prevalence of cognitive impairment at an earlier age 19 than the general population and dual stigma associated with HIV and cognitive challenges 20 , psychosocial interventions have not yet been well tested for people aging with HIV and the optimal approach is unknown 21 .…”