Evaluation of a Cognitive Rehabilitation Protocol in HIV Patients with Associated Neurocognitive Disorders: Efficacy and Stability Over Time

Abstract

The primary aim of the present study was to evaluate the efficacy and stability over time of a cognitive rehabilitation protocol (restorative and compensatory approach) in HIV/AIDS patients with HIV-associated Neurocognitive Disorder (HAND). At baseline, 32 HIV/AIDS patients (16 with and 16 without HAND) were assessed with a neuropsychological battery (i.e., pre-assessment) consisting of 22 tests covering eight cognitive domains. Then, the experimental group was administered over 4 months a cognitive rehabilitation protocol aimed at improving four cognitive domains by means of eight paper and pencil/computer-based exercises. The control group received guideline-adherent clinical care (i.e., standard of care). At the end of the cognitive treatment, both groups were re-administered the neuropsychological battery (i.e., post-assessment). Additionally, 6 months after post-assessment, the experimental group was given the same neuropsychological battery (i.e., follow up-assessment). In order to test the efficacy of the cognitive rehabilitation protocol, we compared between groups the results of the neuropsychological battery at the pre- and post-assessments. In order to evaluate the stability over time, the effects of the cognitive rehabilitation protocol was examined comparing within the experimental group the results of the neuropsychological battery at post- and follow up-assessments. Our results show that the two groups did not differ at the pre-assessment, but differed at post-assessment. Specifically, the experimental group showed a significant improvement in five domains (Learning and memory, Abstraction/executive functioning, Verbal fluency, Attention/working memory, and Functional), whereas the control group significantly worsened in the same domains. The improvement of the experimental group did not change in the follow up-assessment in two domains (Abstraction/executive functioning, Attention/working memory, and Functional). Overall, these findings support the efficacy and, to some extent, the stability over time of our cognitive rehabilitation protocol.

Prevalence of HIV-associated neurocognitive disorder (HAND) and its subgroups among HIV-positive persons on anti-retroviral therapy in Iran

“…Possible explanations for these fluctuations in the prevalence rates across different regions could be due to the differences in clinical variables such as nadir and current CD4 count, RNA viral loads and comorbidity factors or differences in general factors including age and educational level can influence the prevalence rate. Since normative standards applicable to specific linguistic, cultural and social groups can lead to variable diagnoses in HAND (Livelli et al, 2015;Zhang et al, 2012).…”

Cognitive Impairment and Persistent CNS Injury in Treated HIV

“…It continues to be reasonable to recommend physical exercise [73] and potentially cognitive rehabilitation [74] in an armamentarium that includes vigilance in management of comorbidities in this complex and multi-etiology cognitive impairment.…”

Cognitive Neuro-Rehabilitation of HIV-Associated Neurocognitive Disorders: Case Reports of A New Computer-Based Restorative Approach In 3 Hiv-Positive Cart-Treated Patients

“…Even if their outcome was not the resolution of HAND, but the improvement of specific neurocognitive functions, their initial results were encouraging. Given a recent report by Livelli et al [7] showing the efficacy and stability over time of a cognitive rehabilitation protocol in treated HIV-positive patients with HAND, we hereby describe our experience on the efficacy of a new computer-based program in 3 HIV-positive patients on cART.…”