AIDSImpact.com:: - Santa Fe, USA 2011

Abstract #110 - Over 50s Clinic: How to assess for neurocognitive disorders
Authors: Presenting Author: Ms Breda Ward - Chelsea and Westminster Hospital NHS Foundation Trust
Additional Authors: Dr. Shamela De Silva, Dr. Tristan Barber, Dr. Jose Catalan, Dr. Denise Ratcliffe, Dr. Alexander Margetts, Dr. David Asboe, Dr. Anton Pozniak, Dr. Marta Boffito,
Aim: As the HIV population ages, it is more likely that patients will have co-morbidities, polypharmacy, HIV-associated neurocognitive disorders, and social issues (such as isolation and financial difficulty) contributing to increased anxiety and depression. A dedicated clinical service for those individuals over the age of 50 was introduced at our centre in January 2009. The service includes formal psychological and neurocognitive assessments to optimize referral pathways.
Method / Issue: Following multi-disciplinary-team meetings with psychologists, psychiatrists, neurologists and HIV specialists, a FLOWCHART has been devised. This involves: i) GAD-7, a simple questionnaire (10 minute) used for screening and grading of generalised anxiety disorder; followed by referral to psychology with a score >10; ii) PHQ-9, a 10 minute questionnaire to score all DSM-IV criteria for depression. PHQ9 should be repeated six months later if scored >5, referrals psychology if >10 and to psychiatry to consider pharmacotherapy if >15 should follow; iii) questioning regarding concerns on memory, attention, cognition and whether others have noticed any changes in such functions; iv) in case of positive answers to these questions, the “Everyday Memory Questionnaire” (EMQ) is then administered as a subjective measure of memory failure in daily life; v) International HIV Dementia Scale (IHDS). If either are abnormal, the patient is referred to psychology, however if both are abnormal, they receive a full neuropsychometric test (vi) which entails 4 to 6 hours of investigation.
Results / Comments: Twenty HIV-infected males were seen in the Over 50s Clinic between September 2010 and February 2011. All were administered GAD-7 and PHQ-9 questionnaires and thirteen (65%) were also administered EMQ and IHDS, as provided positive answers to having concerns regarding memory, attention, and cognition. Two (10%) had a >10 score with GAD-7 and were referred to psychology, four (20%) had a score > 10 with PHQ-9 and were referred to psychology, three (15%) men with borderline scores between 5-10 were also referred to psychology. EMQ scores were impaired in two (15%) and IHDS scores were low (<12) in five (38%) patients. Four (20%) were referred for neuropsychometric testing, one (5%) was referred to psychiatry, and a brain MRI was requested in three (15%) patients.
Discussion: Excluding anxiety and depression when testing for HIV-associated neurocognitive disorders in individuals over 50 years of age is important, as mental slowing, memory loss, and motor disorders are common manifestation of these disturbances.
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