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

Published online by Cambridge University Press:  20 May 2024

Lachlan Fotheringham Open the ORCID record for Lachlan Fotheringham [Opens in a new window] ,
Rachael A. Lawson ,
Sarah Urasa ,
Judith Boshe ,
Elizabeta B. Mukaetova-Ladinska ,
Jane Rogathi ,
William Howlett ,
Marieke C.J. Dekker ,
William K. Gray  and
Jonathan Evans Open the ORCID record for Jonathan Evans [Opens in a new window]
...Show all authors
Lachlan Fotheringham
Affiliation:
Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK Cumbria Northumberland Tyne and Wear NHS Foundation Trust, UK
Rachael A. Lawson
Affiliation:
Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
Sarah Urasa
Affiliation:
Kilimanjaro Christian Medical University College, Moshi, Kilimanjaro, Tanzania
Judith Boshe
Affiliation:
Kilimanjaro Christian Medical University College, Moshi, Kilimanjaro, Tanzania
Elizabeta B. Mukaetova-Ladinska
Affiliation:
Department of Neuroscience, Behaviour and Psychology, University of Leicester, Leicester, UK
Jane Rogathi
Affiliation:
Kilimanjaro Christian Medical University College, Moshi, Kilimanjaro, Tanzania
William Howlett
Affiliation:
Kilimanjaro Christian Medical University College, Moshi, Kilimanjaro, Tanzania
Marieke C.J. Dekker
Affiliation:
Kilimanjaro Christian Medical University College, Moshi, Kilimanjaro, Tanzania
William K. Gray
Affiliation:
Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, UK
Jonathan Evans
Affiliation:
School of Health and Wellbeing, Glasgow University, UK
Richard W. Walker
Affiliation:
Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, UK Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
Philip C. Makupa
Affiliation:
Kilimanjaro Christian Medical University College, Moshi, Kilimanjaro, Tanzania Mawenzi Regional Referral Hospital, Kilimanjaro, Tanzania
Stella-Maria Paddick*
Affiliation:
Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK Gateshead Health NHS Foundation Trust, Gateshead, UK
*
Corresponding author: Stella-Maria Paddick; Email: stella-maria.paddick@ncl.ac.uk
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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.

Keywords

HIVneuropsychological testsmental status and dementia testscognitive dysfunctionagingAfrica South of the Sahara
Type
Research Article
Information
Journal of the International Neuropsychological Society , First View , pp. 1 - 11
Copyright
© The Author(s), 2024. Published by Cambridge University Press on behalf of International Neuropsychological Society

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