Utility of the HIV dementia scale in assessing risk for significant HIV-related cognitive-motor deficits in a high-risk urban adult sample.
ABSTRACT Considerable literature reflects the range of HIV-related neurocognitive complications, including relatively poor performance on tests of: movement and coordination; attention and concentration; reaction time; and mental flexibility. Efforts to develop appropriate screening techniques include the HIV Dementia Scale (HDS), a brief measure that has demonstrated promise but is lacking extensive independent evaluation. The present study examines the utility of the HDS in a sample of HIV-seropositive adults with a co-morbid history of psychiatric and substance use disorders. Forty subjects (65% male; mean age 41 years; mean education 12.2 years; 55% African American, 30% Caucasian) recruited for a study of the impact of brief psychotherapy on adherence to medications and medical appointments, relapse prevention, and/or enhancement of mental health functioning completed a battery of neuropsychological measures, including the HDS. Forty percent were identified as at high risk for significant cognitive-motor disorder (HDS total score < or =10). After controlling for age, education, illness (absolute CD4), and depressed mood, high-risk participants performed significantly worse on measures of simple and sustained divided attention, psychomotor speed, and working memory. However, only 25 of 40 (63%) were correctly classified based on their performance on traditional tests of neuropsychological functioning. Implications and limitations of the study are discussed.
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ABSTRACT: Certain organic antecedents such as fever, weight loss, diarrhoea and systemic infections often present with neurocognitive deficits (NCDs). However, routine HIV screening is not done in such cases. HIV can present with psychiatric and neurocognitive symptoms as highlighted in the two cases given below. Case 1, a housewife, had been exhibiting altered behaviour following a low-grade fever over the past 3 weeks, associated with muttering to self, talking irrelevantly, would wander away from home, had decreased sleep, loss of appetite, and neglected self-care. She had displayed impulsivity by jumping into a well. On admission, the patient was mute, lethargic and the cerebrospinal fluid (CSF) tested positive for cryptococcus. Her human immunodeficiency virus (HIV) status was positive. Case 2, a housewife, presented with one-month history of muttering to self, increased irritability, aggressive on minimal provocation, decreased sleep, loss of appetite, and suspiciousness towards family members. On provisional diagnosis of schizophrenia, the patient was started on low-dose antipsychotic drugs, which showed minimal improvement. There was a distinct slowness in her movements and she progressively lost weight. Routine investigations were normal but her HIV status was positive. It has recently come to light that HIV infection also presents with subtle manifestations of the central nervous system (CNS), which are distinct from NCD and, if harnessed, could enhance diagnostic sensitivity and reduce the ‘asymptomatic period’. Hence HIV testing is recommended in such cases.Indian Journal of Psychiatry 07/2006; 48(3):193-5. DOI:10.4103/0019-5545.31585
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ABSTRACT: Because of the multifactorial nature of neuropsychological tests, attention remains poorly defined from a neuropsychological perspective, and conclusions made regarding attention across studies may be limited due to the different nature of the measures used. Thus, a more definitive schema for this neurocognitive domain is needed. We assessed the applicability of Mirsky and Duncan's (2001) neuropsychological model of attention to a cohort of 104 HIV+ adults. Our analysis resulted in a five-factor structure similar to that of previous studies, which explained 74.5% of the variance. However, based on the psychometric characteristics of the measures comprising each factor, we offer an alternative interpretation of the factors. Findings also indicate that one factor, which is generally not assessed in clinical neuropsychology settings, may be more predictive of real-world behaviors (such as medication adherence) than those composed of traditional measures. Suggestions for further research in this important area are discussed.Journal of Clinical and Experimental Neuropsychology 04/2007; 30(1):53-62. DOI:10.1080/13803390601186684 · 2.16 Impact Factor