Abstract #2728  -  Neuropsychological profiles of HIV+ patients undergoing neurorehabilitation
Authors:   Presenting Author:   DR SIMON RACKSTRAW - MILDMAY HOSPITAL
Additional Authors:  Dr Alison Jones,
Aim: Mildmay hospital provides an inpatient assessment and rehabilitation service for HIV positive adults, specialising in rehabilitation for those with HIV related neurological disorders. Many of these patients are late diagnoses or have been lost to follow up and present with HIV encephalopathy and other AIDS defining diagnoses that have led to cognitive difficulties. The neuropsychological profiles of this group of patients has been poorly described in the UK, since the era of HAART ,and data from the literature suggests a changing pattern of impairments in the era of HAART. This could have implications for providing ongoing care and for neurorehabilitation
Method / Issue: We conducted a cross sectional study looking at the neuropsychological profiles of 22 HIV+ inpatients with cognitive difficulties admitted for neurorehabilitation. Neuropsychological evaluation assessed specific domains considered by previous studies to be affected by HIV including, immediate and delayed memory, executive function, language, visuo-spatial abilities, attention and processing speed, using the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), the DKEFS verbal fluency test and the Trail Making Test (A and B). Qualitative information was also gathered from the patient to aid interpretation of the results.
Results / Comments: Results were compared to historic age matched controls. 20/22 had impaired information processing speed with 17/22 being severely impaired in this domain. Executive function testing revealed impairments in 17/22 in switch tasks with 15/22 being severely impaired, and impairments in 21/22 in Trail Making tasks with 4/22 being severely impaired. Immediate memory impairment was demonstrated in 19/22 on a list recall task and 14/22 on a story recall task, with 15/22 and 9/22 being severely impaired respectively. Impairment in delayed memory was demonstrated by 18/22 on a list recall task and 10/22 on a story recall task with severe impairment demonstrated by 13/22 and 10/22 respectively. 8/22 demonstrated impairments in visuospatial function with 5/8 severely impaired. 13/22 demonstrated impairments in language functions with 12/22 demonstrating severe impairments. The results suggest that within this cohort severe impairment is more prevalent in the domains of information processing speed, executive function and immediate and delayed memory. Language and visuo-spatial abilities were less severely affected in this cohort.
Discussion: The current findings lend some support to previous research in the literature whilst offering new perspectives on the cognitive impairment experienced by HIV+ patients undergoing neurorehabilitation. In particular, the results suggest significant executive function difficulties in this cohort, which has implications for ongoing adherence to antiretroviral therapy and ability to initiate activities of daily living in the community upon discharge.
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