Barcelona 2013
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| Abstract #173 - Psychological state | ||||
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Session: 6.3: Psychological state (Parallel) on Monday @ 11.00-13.00 in Auditorio Chaired by Barbara Hedge, Susannah Allison Authors: Presenting Author: Dr Tristan Barber - Mortimer Market Centre, United Kingdom |
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| Aim: Screening programmes for neurocognitive impairment (NCI), especially in asymptomatic individuals, are still a matter of controversy. The aims of this study were to describe the prevalence of NCI positive screen in HIV+ MSMs aged 18-50 years by use of Brief Neurocognitive Screen(BNCS) and to detect potential NCI predictors. | ||||
| Method / Issue: Demographics, medical history, current/nadir CD4 count, current/ peak viral load, ART and recreational drug/tobacco/alcohol use were recorded. Individuals were classified as "symptomatic" if they self-reported or perceived others reporting a reduction in mental functioning or ability to deal with things. Subjects were excluded from analysis if Patient Health Questionnaire(PHQ-9) score>10 and/or Generalised Anxiety Disorder questionnaire(GAD-7) score>15 and if memory problems were reported (Everyday Memory Questionnaire). The International HIV Dementia Scale (IHDS) and BNCS were used for NCI screen. A composite z-score for each subject was calculated based on the distance of their score from the mean in each of the 3 component tests of BCNS (normal=within 1 SD of mean). If impairment was suspected, further psychological and formal neuropsychometric testing(NPT) was offered. | ||||
| Results / Comments: Of 205 HIV+ individuals screened, 59(28.8%) were excluded for a mood disorder and 2 for not available mood data. From the 144 for analysis, 97(67%) were classified as symptomatic and 20(13.9%) had an abnormal z-score (13/20 (65%) symptomatic, p=0.33). Individuals with abnormal z-score were less likely to be educated at University level/beyond (40% vs. 62.1%, p=0.02) or in skilled work (45% vs. 81.5%, p <0.0001). There was no difference in current/ex recreational drug use (~80%), CD4 count and ART components. All patients with abnormal z were receiving ART. Median age differed between groups (normal z-score 41y vs. abnormal 44y, p<0.0001). Normal z scores were evenly spread between age-tertile groups, while 50% of those with an abnormal z were in the group >44y (p= 0.24). Of the 20 with abnormal z-score, 6 were offered NPT. Three attended and 1/3 showed impairment (not solely HIV-attributed due to co-morbidities). When 20/144 individuals not on ART were excluded from analysis, abnormal z-score was in addition less frequent in married/civil partners(0 vs. 26%; p 0.01) and associated with symptoms reported by others(33% vs. 12%; p 0.03). Abnormal IHDS correlated with an abnormal BNCS(p<0.0001).Use of IHDS would result in 31 positive screens (21.5%). | ||||
| Discussion: Among 144 HIV+ MSM 18-50 years without anxiety or depression, the overall prevalence of a positive screen with BCNS for NCI was approx. 14%. Significant rates of self-reported anxiety and depression, as well as current/previous recreational drug use were revealed. Patient-perceived NCI was not objectified. No HIV-related NCI was confirmed from the baseline screen. Ongoing follow-up will delineate NCI screen standing in everyday practice. | ||||
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