Neuropsychological tests associated with symptomatic HIV-associated neurocognitive disorder (HAND) in a cohort of older adults in Tanzania.

IF 2.6 4区心理学 Q2 CLINICAL NEUROLOGY Journal of the International Neuropsychological Society Pub Date : 2024-05-20 DOI:10.1017/S1355617724000201

Lachlan Fotheringham, Rachael A Lawson, Sarah Urasa, Judith Boshe, Elizabeta B Mukaetova-Ladinska, Jane Rogathi, William Howlett, Marieke C J Dekker, William K Gray, Jonathan Evans, Richard W Walker, Philip C Makupa, Stella-Maria Paddick

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Abstract

Objective: Human immunodeficiency virus (HIV)-associated neurocognitive disorder (HAND) prevalence is expected to increase in East Africa as treatment coverage increases, survival improves, and this population ages. This study aimed to better understand the current cognitive phenotype of this newly emergent population of older combination antiretroviral therapy (cART)-treated people living with HIV (PLWH), in which current screening measures lack accuracy. This will facilitate the refinement of HAND cognitive screening tools for this setting.

Method: This is a secondary analysis of 253 PLWH aged ≥50 years receiving standard government HIV clinic follow-up in Kilimanjaro, Tanzania. They were evaluated with a detailed locally normed low-literacy neuropsychological battery annually on three occasions and a consensus panel diagnosis of HAND by Frascati criteria based on clinical evaluation and collateral history.

Results: Tests of verbal learning and memory, categorical verbal fluency, visual memory, and visuoconstruction had an area under the receiver operating characteristic curve >0.7 for symptomatic HAND (s-HAND) (0.70-0.72; p < 0.001 for all tests). Tests of visual memory, verbal learning with delayed recall and recognition memory, psychomotor speed, language comprehension, and categorical verbal fluency were independently associated with s-HAND in a logistic mixed effects model (p < 0.01 for all). Neuropsychological impairments varied by educational background.

Conclusions: A broad range of cognitive domains are affected in older, well-controlled, East African PLWH, including those not captured in widely used screening measures. It is possible that educational background affects the observed cognitive impairments in this setting. Future screening measures for similar populations should consider assessment of visual memory, verbal learning, language comprehension, and executive and motor function.

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坦桑尼亚老年人群中与有症状的 HIV 相关神经认知障碍 (HAND) 相关的神经心理学测试。

目的：随着治疗覆盖率的提高、存活率的改善以及人口老龄化的加剧，东非地区与人类免疫缺陷病毒（HIV）相关的神经认知障碍（HAND）患病率预计将上升。本研究旨在更好地了解这一新出现的、接受过联合抗逆转录病毒疗法（cART）治疗的老年艾滋病病毒感染者（PLWH）群体目前的认知表型，因为目前的筛查措施缺乏准确性。这将有助于改进适用于这种情况的 HAND 认知筛查工具：方法：这是对坦桑尼亚乞力马扎罗山接受标准政府 HIV 诊所随访的 253 名年龄≥50 岁的 PLWH 进行的二次分析。每年对他们进行三次详细的当地低文化程度神经心理学评估，并根据临床评估和附带病史，按照弗拉斯卡蒂标准对他们进行HAND共识小组诊断：言语学习和记忆、分类言语流利性、视觉记忆和视觉建构测试对有症状的HAND（s-HAND）的接收器操作特征曲线下面积大于0.7（0.70-0.72；所有测试的P < 0.001）。在逻辑混合效应模型中，视觉记忆、语言学习（延迟回忆和识别记忆）、精神运动速度、语言理解能力和分类言语流畅性测试与症状性手足徐动症有独立相关性（所有测试的 p < 0.01）。不同的教育背景会造成不同的神经心理障碍：结论：在年龄较大、病情控制良好的东非 PLWH 患者中，有很多认知领域都受到了影响，其中包括那些广泛使用的筛查措施未涵盖的领域。在这种情况下，教育背景可能会影响所观察到的认知障碍。未来针对类似人群的筛查措施应考虑对视觉记忆、语言学习、语言理解以及执行和运动功能进行评估。

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来源期刊

Journal of the International Neuropsychological Society 医学-精神病学

CiteScore

5.40

自引率

3.80%

发文量

185

审稿时长

4-8 weeks

期刊介绍： The Journal of the International Neuropsychological Society is the official journal of the International Neuropsychological Society, an organization of over 4,500 international members from a variety of disciplines. The Journal of the International Neuropsychological Society welcomes original, creative, high quality research papers covering all areas of neuropsychology. The focus of articles may be primarily experimental, applied, or clinical. Contributions will broadly reflect the interest of all areas of neuropsychology, including but not limited to: development of cognitive processes, brain-behavior relationships, adult and pediatric neuropsychology, neurobehavioral syndromes (such as aphasia or apraxia), and the interfaces of neuropsychology with related areas such as behavioral neurology, neuropsychiatry, genetics, and cognitive neuroscience. Papers that utilize behavioral, neuroimaging, and electrophysiological measures are appropriate. To assure maximum flexibility and to promote diverse mechanisms of scholarly communication, the following formats are available in addition to a Regular Research Article: Brief Communication is a shorter research article; Rapid Communication is intended for "fast breaking" new work that does not yet justify a full length article and is placed on a fast review track; Case Report is a theoretically important and unique case study; Critical Review and Short Review are thoughtful considerations of topics of importance to neuropsychology and include meta-analyses; Dialogue provides a forum for publishing two distinct positions on controversial issues in a point-counterpoint format; Special Issue and Special Section consist of several articles linked thematically; Letter to the Editor responds to recent articles published in the Journal of the International Neuropsychological Society; and Book Review, which is considered but is no longer solicited.