Dement Neurocogn Disord.  2020 Mar;19(1):19-27. 10.12779/dnd.2020.19.1.19.

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

Affiliations
  • 1Department of Medicine, Chandra Laxmi Hospital, Vaishali Ghaziabad, UP, India. aritika1994@gmail.com

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.

Keyword

HIV; Neurocognitive Disorder; Neurocognitive Assessment; Dementia: HAND

MeSH Terms

Activities of Daily Living
Delivery of Health Care
Female
Hand
HIV
HIV Infections
Humans
Male
Mass Screening
Memory
Methylenebis(chloroaniline)
Neurocognitive Disorders*
Neuropsychological Tests
Outpatients
Prevalence
Methylenebis(chloroaniline)
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