HIV-Associated Neurocognitive Disorders

2017 ◽  
Author(s):  
Joshua Alexander ◽  
David J Croteau ◽  
Ronald J Ellis
Keyword(s):  
Cognitive Impairment ◽  
Antiretroviral Therapy ◽  
Neurocognitive Disorders ◽  
Virologic Suppression ◽  
Neurocognitive Disorder ◽  
Asymptomatic Neurocognitive Impairment ◽  
Antiretroviral Adherence ◽  
Combined Antiretroviral Therapy ◽  
Neurocognitive Decline ◽  
Hiv Associated Neurocognitive Disorders

Three subclassifications of HIV Associated Neurocognitive Disorders (HAND) can be delineated: asymptomatic neurocognitive impairment (ANI), mild neurocognitive disorder (MND), and HIV-associated dementia (HAD). HAND occurs in about half of patients infected with HIV. All forms, including ANI and MND, are associated with unemployment and reduced antiretroviral adherence, which can lead to loss of virologic suppression, further neurocognitive decline, and systemic illness. Fortunately, combined antiretroviral therapy can stabilize and even reverse cognitive impairment.

scholarly journals Operationalization of the updated diagnostic algorithm for classifying HIV-related cognitive impairment and dementia

2010 ◽  
Vol 23 (5) ◽  
pp. 835-843 ◽  
Author(s):  
J. M. Foley ◽  
M. J. Wright ◽  
A. L. Gooding ◽  
M. Ettenhofer ◽  
M. Kim ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Executive Functioning ◽  
Functional Decline ◽  
Diagnostic Algorithm ◽  
Neurocognitive Disorders ◽  
Cognitively Impaired ◽  
Neurocognitive Disorder ◽  
Asymptomatic Neurocognitive Impairment ◽  
Global Cognition ◽  
Hiv Associated Neurocognitive Disorders

ABSTRACTBackground: This study applies the updated HIV-Associated Neurocognitive Disorders (HAND) diagnostic algorithm.Methods: Participants were 210 HIV-infected-adults, classified using proposed HAND criteria: HIV-Associated Dementia (HAD), Mild Neurocognitive Disorder (MND), Asymptomatic Neurocognitive Impairment (ANI).Results: The algorithm yielded: normal = 32.8%, ANI = 21.4%, MND = 34.3%, and HAD = 11.4%. Normal participants performed superior to HAND-defined participants on cognition, and HAD participants performed more poorly on global cognition and executive functioning. Two distinct subgroups of interest emerged: (1) functional decline without cognitive impairment; (2) severe cognitive impairment and minimal functional compromise.Conclusions: The algorithm discriminates between HIV-infected cognitively impaired individuals. Diagnosis yields two unique profiles requiring further investigation. Findings largely support the algorithm's utility for diagnosing HIV-cognitive-impairment, but suggest distinct subsets of individuals with discrepant cognitive/functional performances that may not be readily apparent by conventional application of HAND diagnosis.

scholarly journals Neuroimaging of HIV-associated neurocognitive disorders

2015 ◽  
Vol 9 (4) ◽  
pp. 380-384 ◽  
Author(s):  
Michel Elyas Jung Haziot ◽  
Silas Pereira Barbosa Junior ◽  
José E. Vidal ◽  
Francisco Tomaz Meneses de Oliveira ◽  
Augusto César Penalva de Oliveira
Keyword(s):  
Cognitive Impairment ◽  
Neurocognitive Disorders ◽  
Classification Criteria ◽  
Neurocognitive Disorder ◽  
Aids Patients ◽  
Asymptomatic Neurocognitive Impairment ◽  
Associated Diseases ◽  
Broad Term ◽  
Cns Penetration ◽  
Hiv Associated Neurocognitive Disorders

ABSTRACT A significant increase in the incidence of cognitive impairment in HIV/AIDS patients has been continuously observed. Consequently, three classification categories of cognitive impairment have been proposed: asymptomatic neurocognitive impairment (ANI) and mild neurocognitive disorder (MND), that correspond to the mild and intermediate forms, and HIV-associated dementia (HAD) for the most severe cases. HIV-associated neurocognitive disorders (HAND) is a broad term that encompasses these three categories. Moreover, the application of neuroimaging methods has led to a major breakthrough in understanding of the neurological changes in HIV, providing greater reliability in the exclusion of associated diseases and allowing earlier diagnosis. Therefore, abnormalities and/or specific neuroimaging elements may soon be incorporated into the HAND classification criteria, which will be of great value in the management of these diseases, including in the optimization of high CNS penetration antiretroviral regimens.

scholarly journals HIV-associated neurocognitive disorders

2011 ◽  
Vol 17 (4) ◽  
pp. 4 ◽  
Author(s):  
Zahir Vally
Keyword(s):  
South African ◽  
Test Performance ◽  
Relevant Literature ◽  
Neurocognitive Disorders ◽  
Information Processing Speed ◽  
Psychomotor Slowing ◽  
Asymptomatic Neurocognitive Impairment ◽  
Assessment Techniques ◽  
Advanced Stages ◽  
Hiv Associated Neurocognitive Disorders

HIV infection is associated with disturbances in brain function referred to as HIV-associated neurocognitive disorders (HAND). This literature review outlines the recently revised diagnostic criteria for the range of HAND from the earliest to the more advanced stages: (i) asymptomatic neurocognitive impairment; (ii) mild neurocognitive disorder; and (iii) HIV-associated dementia. Relevant literature is also reviewed regarding the differential impact upon component cognitive domains known to be affected in HAND, which in turn should ideally be targeted during clinical and neuropsychological assessments: psychomotor and information processing speed, learning and memory, attention and working memory, speech and language, executive functioning and visuospatial functioning. A discussion outlining the neuropsychological tools used in the diagnostic screening of HAND is also included. The central mechanisms of HAND appear to revolve primarily around psychomotor slowing and cognitive control over mental operations, possibly reflecting the influence of disrupted fronto-striatal circuits on distributed neural networks critical to cognitive functions. The accurate assessment and diagnosis of HAND depends on meeting the need for statistically sound neuropsychological assessment techniques that may be used confidently in assessing South African populations, as well as the development of relevant norms for comparison of test performance data.

HIV-Associated Neurocognitive Disorders

2017 ◽  
Author(s):  
Rodrigo Hasbun ◽  
Richard Dunham ◽  
Joseph S. Kass ◽  
Rituparna Das ◽  
Karen Nunez-Wallace ◽  
...  
Keyword(s):  
Antiretroviral Therapy ◽  
Immunological Response ◽  
Trophic Factors ◽  
Neurocognitive Disorder ◽  
Hiv Dementia ◽  
Subcortical Dementia ◽  
Deep White Matter ◽  
The Brain ◽  
Hiv Associated Neurocognitive Disorders ◽  
Monocytes And Lymphocytes

HIV causes a chronic form of encephalitis (HIVE) that is clinically characterized by either dementia or mild neurocognitive impairment. Since the introduction of antiretroviral therapy in 1996, the incidence of HIV dementia has decreased by 50%, but the prevalence of mild neurocognitive disorder has increased up to 39%. HIVE is the result of direct microglial infection, interruption of trophic factors, or caused by inflammatory cytokines. HIV enters the brain primarily by the “Trojan horse mechanism”; it is carried by monocytes and lymphocytes that cross the blood–brain barrier. HIV has a predilection for the basal ganglia, deep white matter, and hippocampus, resulting in a subcortical dementia. HIV dementia is a diagnosis of exclusion and other co-infections, cerebrovascular disease, malnutrition, and drug abuse should be ruled out before making the diagnosis. In patients receiving antiretroviral therapy with immunological response, a novel condition termed CD8+ T cell encephalitis was recently described.

scholarly journals Antineuroinflammatory drugs in HIV-associated neurocognitive disorders as potential therapy

2019 ◽  
Vol 6 (3) ◽  
pp. e551
Author(s):  
Björn Ambrosius ◽  
Ralf Gold ◽  
Andrew Chan ◽  
Simon Faissner
Keyword(s):  
Viral Load ◽  
Dimethyl Fumarate ◽  
Neurocognitive Disorders ◽  
Reactive Oxygen Metabolites ◽  
Combined Antiretroviral Therapy ◽  
Target Hand ◽  
Pathologic Processes ◽  
Oxygen Metabolites ◽  
Hiv Associated Neurocognitive Disorders

Today, HIV-infected (HIV+) patients can be treated efficiently with combined antiretroviral therapy (cART), leading to long-term suppression of viral load, in turn increasing life expectancy. While cART reduced the occurrence of HIV-associated dementia, the prevalence of subtle forms of HIV-associated neurocognitive disorders (HAND) is unchanged. This is related to persistent immune activation within the CNS, which is not addressed by cART. Pathologic processes leading to HAND consist of the release of proinflammatory cytokines, chemokines, reactive oxygen metabolites and glutamate, and the release of HIV proteins. Some of those processes can be targeted using medications with immunomodulatory and neuroprotective properties such as dimethyl fumarate, teriflunomide, or minocycline. In this review, we will summarize the knowledge about key pathogenic processes involved in HAND and potential therapeutic avenues to target HAND.

scholarly journals Prevalence and Correlates of HIV-Associated Neurocognitive Disorders (HAND) in Northwestern Nigeria

2015 ◽  
Vol 2015 ◽  
pp. 1-9 ◽  
Author(s):  
Ahmad M. Yakasai ◽  
Mustafa I. Gudaji ◽  
Hamza Muhammad ◽  
Aliyu Ibrahim ◽  
Lukman F. Owolabi ◽  
...  
Keyword(s):  
Antiretroviral Therapy ◽  
Highly Active Antiretroviral Therapy ◽  
Neuropsychological Test ◽  
Binary Logistic Regression ◽  
Neurocognitive Disorders ◽  
Hiv Positive ◽  
Binary Logistic Regression Model ◽  
Highly Active ◽  
Patients At Risk ◽  
Hiv Associated Neurocognitive Disorders

HIV-associated Neurocognitive Disorders (HAND) are common among HIV-positive individuals. This study explored the prevalence and correlates of HAND in Nigeria. 80 HIV-positive and 40 HIV-negative adults selected from Aminu Kano Teaching Hospital (AKTH) received comprehensive evaluations. A multidomain neuropsychological test (MDNPT) battery assessing 7 domains was administered to the participants and their performance was combined with measures of functional status to classify impairments into various grades of HAND. Univariate and multivariate analyses were performed to identify correlates of symptomatic HAND. Among the HIV-positive individuals, 50% were highly active antiretroviral therapy-experienced (HAART+) and 50% were highly active antiretroviral therapy naive (HAART−). Symptomatic HAND was found among 40% of the HAART− individuals and 30% of the HAART+ individuals. Respective prevalence of HIV-associated dementia (HAD) was 23% and 5%, respectively (p=0.0002). In a binary logistic regression model, only fewer years of education independently predicted symptomatic HAND [Odds Ratio (OR) = 1.2, 95% confidence interval (CI) = 1.04–1.44,p=0.016]. The prevalence of HAND in Nigeria is high with HAD being commoner among HAART− patients. Provision of HAART and strict monitoring of patients at risk of HAND are needed to scale down the burden of the disease.

scholarly journals Neuropsychiatric Symptoms in Mild Cognitive Impairment

2017 ◽  
Vol 62 (3) ◽  
pp. 161-169 ◽  
Author(s):  
Damien Gallagher ◽  
Corinne E. Fischer ◽  
Andrea Iaboni
Keyword(s):  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Cognitive Decline ◽  
Neuropsychiatric Symptoms ◽  
Later Life ◽  
Neurocognitive Disorders ◽  
Prognostic Indicators ◽  
Neurocognitive Disorder ◽  
Clinical Stages ◽  
Before And After

Objective: Neuropsychiatric symptoms (NPS) may be the first manifestation of an underlying neurocognitive disorder. We undertook a review to provide an update on the epidemiology and etiological mechanisms of NPS that occur in mild cognitive impairment (MCI) and just before the onset of MCI. We discuss common clinical presentations and the implications for diagnosis and care. Method: The authors conducted a selective review of the literature regarding the emergence of NPS in late life, before and after the onset of MCI. We discuss recent publications that explore the epidemiology and etiological mechanisms of NPS in the earliest clinical stages of these disorders. Results: NPS have been reported in 35% to 85% of adults with MCI and also occur in advance of cognitive decline. The occurrence of NPS for the first time in later life should increase suspicion for an underlying neurocognitive disorder. The presenting symptom may provide a clue regarding the etiology of the underlying disorder, and the co-occurrence of NPS may herald a more accelerated cognitive decline. Conclusions: NPS are prevalent in the early clinical stages of neurocognitive disorders and can serve as both useful diagnostic and prognostic indicators. Recognition of NPS as early manifestations of neurocognitive disorders will become increasingly important as we move towards preventative strategies and disease-modifying treatments that may be most effective when deployed in the earliest stages of disease.

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