Assessment and Management of HIV-Associated Cognitive Impairment: Experience from a Multidisciplinary Memory Service for People Living with HIV
by
Kate Alford 1, Sube Banerjee 2,3, Eileen Nixon 4, Clara O’Brien 4, Olivia Pounds 4, Andrew Butler 5, Claire Elphick 3, Phillip Henshaw 3, Stuart Anderson 4 and Jaime H. Vera 1,4,5,*
Kate Alford 1, Sube Banerjee 2,3, Eileen Nixon 4, Clara O’Brien 4, Olivia Pounds 4, Andrew Butler 5, Claire Elphick 3, Phillip Henshaw 3, Stuart Anderson 4 and Jaime H. Vera 1,4,5,*
1
Department of Global Health and Infection, Brighton and Sussex Medical School, Brighton BN1 9PX, UK
2
Centre for Dementia Studies, Brighton and Sussex Medical School, Brighton BN1 9PX, UK
3
Sussex Partnership NHS Foundation Trust, Worthing BN13 3EP, UK
4
Brighton and Sussex University Hospitals NHS Trust, Brighton BN2 1ES, UK
5
Department of Medicine, Brighton and Sussex Medical School, Brighton BN1 9PX, UK
*
Author to whom correspondence should be addressed.
Brain Sci. 2019, 9(2), 37; https://doi.org/10.3390/brainsci9020037
Received: 29 November 2018 / Revised: 1 February 2019 / Accepted: 5 February 2019 / Published: 8 February 2019
(This article belongs to the Special Issue Update on HIV-Associated Neurocognitive Disorders (HAND))
As the HIV population ages, the prevalence of cognitive impairment (CI) is increasing, yet few services exist for the assessment and management of these individuals. Here we provide an initial description of a memory assessment service for people living with HIV and present data from a service evaluation undertaken in the clinic. We conducted an evaluation of the first 52 patients seen by the clinic. We present patient demographic data, assessment outcomes, diagnoses given and interventions delivered to those seen in the clinic. 41 patients (79%) of those seen in the clinic had objective CI: 16 (31%) met criteria for HIV-associated Neurocognitive Disorder (HAND), 2 (4%) were diagnosed with dementia, 14 (27%) showed CI associated with mental illness and/or drugs/alcohol, 7 (13%) had CI which was attributed to factors other than HIV and in 2 (4%) patients the cause remains unclear. 32 (62%) patients showed some abnormality on Magnetic Resonance Imaging (MRI) brain scans. Patients attending the clinic performed significantly worse than normative scores on all tests of global cognition and executive function. Interventions offered to patients included combination antiretroviral therapy modification, signposting to other services, case management, further health investigations and in-clinic advice. Our experience suggests that the need exists for specialist HIV memory services and that such a model of working can be successfully implemented into HIV patient care. Further work is needed on referral criteria and pathways. Diagnostic processes and treatment offered needs to consider and address the multifactorial aetiology of CI in HIV and this is essential for effective assessment and management.
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MDPI and ACS Style
Alford, K.; Banerjee, S.; Nixon, E.; O’Brien, C.; Pounds, O.; Butler, A.; Elphick, C.; Henshaw, P.; Anderson, S.; Vera, J.H. Assessment and Management of HIV-Associated Cognitive Impairment: Experience from a Multidisciplinary Memory Service for People Living with HIV. Brain Sci. 2019, 9, 37.
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