This chapter will address the issue of risk for HIV-associated neurocognitive disorder (HAND), focusing on HIV-associated dementia (HAD), among persons living with HIV in relationship to the risk for other dementias. Advances in effective antiretroviral therapy (ART) have led to an increase in the prevalence of older persons surviving with HIV – in addition to older persons who become infected by HIV later in life. Hence, HIV is no longer a disease of younger persons, and additional attention has been brought to bear against the plight of older persons living with HIV – not only as it pertains to treatment but also to prevention. The additional risk caused by aging among older persons living with HIV is complex to asses, and HIV infection is a research area that requires a robust approach to multiple other factors causing neurocognitive impairment with older age. The long-term and potentially neurotoxic exposure to ART and the deleterious consequences of chronic infection with HIV and its associated neuro-inflammation have been described for health. This aids in the understanding of dementia risk factors in this patient population, but the comorbidities (HIV- and non-HIV-associated) occurring among older persons living with HIV must also be addressed to properly assess the overall impact on dementia risk in this group. This need also warrants our examination of the risk factors for other dementias (and comorbid dementias) in persons living with HIV versus the general population through the assessment and quantification of modifiable and non-modifiable risk factors identified as major contributors toward dementia.

Nearly half of all HIV-positive individuals present with some form of HIV-associated neurocognitive disorder (HAND). The experiments described in this thesis examined the structural changes that occur in the brain as a result of HIV infection. While previous work has established that HIV targets the basal ganglia and fronto-striatal systems and impacts cortical and white matter pathways, it was unknown whether these changes occur in the absence of HAND. The studies described here focused on cognitively asymptomatic HIV+ individuals (CAHIV+) without HAND as determined by widely accepted neuropsychological performance guidelines. Experiment 1 utilized diffusion tensor imaging (DTI) to examine HIV-associated alterations in white matter (WM) fractional anisotropy (FA) in the absence of HAND in 23 HIV+ individuals and 17 control participants (HIV-) matched for age, education, and verbal IQ. The hypothesis was that CAHIV+ participants would show lower FA values than HIV- in the corpus callosum, frontotemporal, and parietal regions of interest (ROIs). CAHIV+ individuals demonstrated higher FA in the frontotemporal region and posterior corpus callosum, but lower FA in parietal WM relative to HIV- individuals. Experiment 2 utilized structural MRI to compare cortical thickness in 22 CAHIV+ individuals and 19 control participants (HIV-) matched for age, education, and verbal IQ. The hypothesis was that CAHIV+ participants would have thinner frontal, temporal, and parietal regions than HIV- participants. Reduced cortical thickness measures were identified in the cingulate and superior temporal gyri, with increased cortical thickness measures in the inferior occipital gyrus, for HIV+ participants compared to HIV-. Experiment 3 examined the relationship between the structural alterations identified in Experiments 1 and 2, neuropsychological performance on tests sensitive to HAND identification, and immunological characteristics in 30 HIV+ participants and 28 HIV- control participants. As hypothesized, regional FA values, cortical thickness, and viral load were related to neuropsychological composite scores for CAHIV+, but not HIV-. Together, results from these three studies suggest that regional FA and cortical alterations identified in CAHIV+ patients may contribute to the cognitive deficits often seen in later stages of HIV disease.

Kognitiva sjukdomar är ett samlingsnamn för olika sjukdomar som framför allt påverkar en persons kognitiva funktioner men även till exempel kroppen och personens beteenden. Omkring 55 miljoner personer i världen beräknas ha en kognitiv sjukdom och i Sverige är siffran mellan 130 000–150 000. En stor andel av dessa bor hemma och ofta finns anhöriga som tar ett stort ansvar kring vården. Att vara anhörigvårdare kan upplevas som givande men det är ofta sammankopplat med en hög nivå av stress. Syftet med den här studien är att beskriva anhörigas upplevelser av att vårda en person med kognitiv sjukdom. Metoden för att svara på syftet är en allmän litteraturstudie, där data från 15 vetenskapliga artiklar analyserats och sammanställts. Resultatet delas in i två teman med tillhörande subteman: ”En omkullkastad tillvaro” och ”Att behöva anpassa sig till livsförändringen”. Slutsatsen blir att situationen som den anhörige hamnar i när en närstående får en kognitiv sjukdom ofta är mycket påfrestande. Det påverkar de flesta delar av livet, så som exempelvis vardagen, den egna hälsan, relationer och så vidare. Det finns ofta ett behov av stöd, både från människor i ens närhet och insatser från samhället. Den anhöriga behöver hitta strategier för att hantera den nya livssituationen för att motverka sådant som en låg upplevd livskvalitet och psykisk ohälsa. / Neurocognitive disorders are a group of different disorders that mainly affect a person ́s cognitive functions, but also domains as the physical body and the person ́s behavior. An estimated number of 55 million persons globally are diagnosed with some kind of neurocognitive disorder and the number in Sweden is among 130 000–150 000. The majority of the persons with a neurocognitive disorder live at home and in many cases they have a family member or friend who is responsible for the caregiving, an informal caregiver. The role of the informal caregiver can be rewarding, but it often comes with a high level of strain. The aim of this study is to describe the informal caregiver ́s experience of taking care of a person with neurocognitive disorder. The method that is used is a general literature review that contains data from 15 scientific papers. The data has been analyzed and compiled. The result was categorized in two themes and sub-themes: ”When life is turned upside down” and ”Having to adapt to the life change”. The conclusion is that the situation of being an informal caregiver is very stressful. It affects almost all aspects of one ́s life, including the everyday life, one ́s own health and relationships. The informal caregiver is in need of support from family and friends as well as formal support. The informal caregiver must find constructive coping strategies to deal with the new situation to avoid mental illness or low level of perceived quality of life.

No description available.

INTRODUCTION: HIV- associated neurocognitive disorder (HAND) and pathology are common manifestations of HIV-infection, and often persist in spite of controlled peripheral viremia. Severity of HAND can range from loss of concentration and psychological changes to frank dementia. Inflammatory host-immune responses and chemotaxis of immune cells into the CNS are thought to be integral to development of NeuroAIDS and HAND. OBJECTIVES: This studies' primary aim was to determine if significant differences existed between Substance P and NK1R expression in brain tissue samples of HIV-infected individuals with neurocognitive disorder or pathology. The secondary aim was to determine whether expression of HIV viral entry receptors CCR5 and CXCR4 correlate with expression of Substance P or NK1R. The tertiary aim of this study was to determine if age at death, CNS penetration-effectiveness of antiretroviral therapy, diagnosis before HAART, average plasma CD4, or abnormal alcohol or drug use increased prevalence of neurocognitive disease. STUDY DESIGN: Cross-sectional study of HIV-infected individuals (n=60) from the larger National NeuroAIDS Tissue Consortium Cohort. Pre-death demographic data, neurocognitive assessment, alcohol and drug use, ART regimens, date of diagnosis and death, and plasma CD4 levels, as well as pathology findings at autopsy and brain tissue samples were provided by the NNTC; expression levels of Substance P, NK1R, CCR5, and CXCR4 from brain samples were provided by Dr. Steven Douglas of The Children's Hospital of Philadelphia. RESULTS: In this sample of HIV-infected individuals, Substance P expression was significantly less in the cingulate cortex of individuals with (p=0.003). Within-subject expression patterns of CCR5 and truncated-NK1R in the cingulate cortex and cerebellum were both significantly altered by neuropathology and cannabis use; CCR5 expression was also significantly affected by opiate use. CCR5 and CXCR4 expression correlated strongly with truncated-NK1R expression. No between-subject factors significantly altered prevalence of neurocognitive impairment in this HIV-infected population. CONCLUSIONS: The study found significant changes in Substance P, NK1R, and CCR5 expression associated with neuropathology. Furthermore, in heterogeneous populations, expression patterns may be more important than overall level of expression in identifying risk factors for NeuroAIDS and other chronic diseases. / Epidemiology

[pt] Além da utilização como teste de rastreio, tem-se utilizado o Teste do Desenho do Relógio (TDR) também na avaliação de funcionamento executivo em idosos. Em dissertação de mestrado, construiu-se e validou-se um método de pontuação que classificou as estratégias de construção do TDR. A presente tese tem o objetivo de investigar as estratégias de construção do TDR em idosos com comprometimento cognitivo. 86 idosos (28 controle, 45 com transtorno neurocognitivo leve e 13 com transtorno neurocognitivo maior) participaram dos dois estudos que compuseram a tese. O primeiro analisou as estratégias de construção do TDR e o perfil neuropsicológico dos idosos e o segundo verificou a validade clínica do sistema. Os resultados apresentaram que as subcategorias associadas a melhor funcionamento executivo diminuem ocorrência à medida que o comprometimento cognitivo se acentua e as subcategorias associadas a pior funcionamento executivo aumentam frequência. Verificou-se também que a Estratégia de Sequência Geral Atípica evidenciou validade clínica para diferenciar idosos com transtorno neurocognitivo maior dos demais grupos. Conclui-se que a análise qualitativa das Estratégias de Construção do TDR tem utilidade clínica como medida de funcionamento executivo. / [en] Besides being used as a screening test, the Clock Drawing Test (CDT) has also been used to assess executive functioning in the elderly. In previous study, a scoring method that classified the Construction Strategies of the CDT was constructed and validated. This tesis aims to investigate construction strategies of CDT in elderly with cognitive impairment. 86 elderly (28 controls, 45 with mild neurocognitive disorder and 13 with major neurocognitive disorder) were the participants of the thesis. It was subdivided in two studies. The first one analyzed older adult s Construction Strategies of the CDT and neuropsychological profiles. The second one verified clinical validity of the system. Results showed that the subcategories associated with better executive functioning decrease occurrence as cognitive impairment increases while the subcategories associated with worse executive functioning increase frequency. Atypical General Sequence Strategy also showed clinical validity to differentiate older adults with major neurocognitive disorder from other groups. As conclusion, it is verified that qualitative analysis of the Construction Strategies of the CDT has clinical utility as a measure of executive functioning.

Objetivos: Este trabalho teve como objetivo determinar a prevalência e os fatores associados às alterações neurocognitivas em uma coorte de pacientes portadores do HIV-1 vinda do Banco de Sangue do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo HC-FMUSP, com alto nível de adesão aos antirretrovirais e baixa prevalência de doenças oportunistas associadas ao vírus. Metodologia: A prevalência de alterações neurocognitivas associadas ao HIV (HAND) foi avaliada através de uma bateria neuropsicológica estruturada composta por 8 instrumentos, possibilitando uma abrangência maior em relação a quantidade de funções cognitivas superiores avaliadas e maior precisão na detecção das alterações. Resultados: A amostra foi composta por 54 pacientes e a análise dos dados mostrou elevada prevalência de HAND na amostra analisada (60%), independente do controle imunológico e virológico, com maior presença da forma assintomática (ANI), porém o resultado da forma leve (MND) também foi significativo, sendo próximo à porcentagem dos pacientes com a forma assintomática. Conclusão: Os resultados do estudo refletiram o cenário nacional e internacional mostrando a alta prevalência das alterações cognitivas associadas ao HIV, alertando os profissionais de saúde para a importância de identificação, diagnóstico e acompanhamento adequado desses pacientes. Os dados também mostraram a importância da presença do profissional da área de psicologia na equipe de saúde, oferecendo ao paciente o desenvolvimento de estratégias de atendimento mais específicas e eficazes / The main goal of this study was to determine the prevalence and factors associated with neurocognitive disorders in a cohort of 54 patients with HIV-1 from the Blood Bank of the Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo HC- FMUSP with high adherence to antiretroviral therapy and low prevalence of opportunistic diseases associated with the virus. Methods: The prevalence of HIV associated neurocognitive disorders (HAND) was evaluated through a structured neuropsychological battery of 8 tests, increasing the coverage of superior cognitive functions being evaluated and greater precision in the detection of cognitive alterations. Results: Data analysis showed a high prevalence of HAND in the population under analysis (60%), irrespective of the immunological and virologic control, with a greater presence of the asymptomatic form (ANI), but the occurrence of the mild form (MND) was also significant, being close to the percentage of patients with the asymptomatic form. Conclusion: The result of the study reflected the national and international scenario showing high prevalence of HIV associated neurocognitive disorders, alerting health professionals to the importance of identification, diagnosis and adequate follow-up of these patients. The data also showed the importance of the presence of the psychologist in the health team, offering to the patient more specific and effective care strategies

People with neurocognitive disorders (NCD) condition called dementia are mainly taken care by family members. The number of people suffering from neurocognitive disorders is estimated to increase. Providing care for the person with NCD can be stressful and demanding which is why effective interventions to support caregivers are needed. Occupational therapy practitioners have unique knowledge of the person, environment and occupation and how those factors influence on individuals occupational performance. Occupational therapy ́s interventions to support caregivers with NCD have mainly concentrated on problems in the behaviour of person with NCD. The aim of this scoping review was to identify why some caregivers are managing better as a caregiver before any interventions have been done. What are those aspects of Person (P), Occupation (O) and Environment (E) that facilitate occupational performance (OP) when taking care for a person with NCD. PEO-model by Law et. al (Law et al., 1996) was utilized to formulate research question, in search words and in summarizing the results. The search from Ageline, Cinahl, Psycinfo and PubMed databases was done in January 2018 and went back 10 years. Results found 23 relevant articles for inclusion in the scoping review. Facilitating factors emphasized the supports of relationship seen as an overlap of caregivers and individuals with NCD on occupational performance. Facilitating personal factors of resilience, finding gains in caregiving, self -efficacy and religiosity were found to have an impact on care that the caregiver provides. Facilitative aspects of occupations highlighted importance of daily occupations as a source of well-being for both caregiver and person with NCD. In conclusion, facilitating aspects of relationships, personal factors and engagement in activities and hobbies supported occupational performance of both the caregiver and a person with NCD. Taking these factors into consideration could help target interventions more precisely to meet caregivers needs.

Objetivos: Este trabalho teve como objetivo determinar a prevalência e os fatores associados às alterações neurocognitivas em uma coorte de pacientes portadores do HIV-1 vinda do Banco de Sangue do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo HC-FMUSP, com alto nível de adesão aos antirretrovirais e baixa prevalência de doenças oportunistas associadas ao vírus. Metodologia: A prevalência de alterações neurocognitivas associadas ao HIV (HAND) foi avaliada através de uma bateria neuropsicológica estruturada composta por 8 instrumentos, possibilitando uma abrangência maior em relação a quantidade de funções cognitivas superiores avaliadas e maior precisão na detecção das alterações. Resultados: A amostra foi composta por 54 pacientes e a análise dos dados mostrou elevada prevalência de HAND na amostra analisada (60%), independente do controle imunológico e virológico, com maior presença da forma assintomática (ANI), porém o resultado da forma leve (MND) também foi significativo, sendo próximo à porcentagem dos pacientes com a forma assintomática. Conclusão: Os resultados do estudo refletiram o cenário nacional e internacional mostrando a alta prevalência das alterações cognitivas associadas ao HIV, alertando os profissionais de saúde para a importância de identificação, diagnóstico e acompanhamento adequado desses pacientes. Os dados também mostraram a importância da presença do profissional da área de psicologia na equipe de saúde, oferecendo ao paciente o desenvolvimento de estratégias de atendimento mais específicas e eficazes / The main goal of this study was to determine the prevalence and factors associated with neurocognitive disorders in a cohort of 54 patients with HIV-1 from the Blood Bank of the Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo HC- FMUSP with high adherence to antiretroviral therapy and low prevalence of opportunistic diseases associated with the virus. Methods: The prevalence of HIV associated neurocognitive disorders (HAND) was evaluated through a structured neuropsychological battery of 8 tests, increasing the coverage of superior cognitive functions being evaluated and greater precision in the detection of cognitive alterations. Results: Data analysis showed a high prevalence of HAND in the population under analysis (60%), irrespective of the immunological and virologic control, with a greater presence of the asymptomatic form (ANI), but the occurrence of the mild form (MND) was also significant, being close to the percentage of patients with the asymptomatic form. Conclusion: The result of the study reflected the national and international scenario showing high prevalence of HIV associated neurocognitive disorders, alerting health professionals to the importance of identification, diagnosis and adequate follow-up of these patients. The data also showed the importance of the presence of the psychologist in the health team, offering to the patient more specific and effective care strategies

Orientador: Flávia Heloísa dos Santos / Resumo: Introdução: A doença renal crônica (DRC) atinge um percentual significativo de idosos, além de estar relacionada a uma série de comorbidades, em especial, o transtorno neurocognitivo leve (TNL). A diminuição da taxa de filtração glomerular está significativamente associada a déficits globais na cognição, função executiva, linguagem e memória. Em virtude disso, a triagem cognitiva é fundamental para a população com DRC. Objetivo geral: Estimar a prevalência de TNL em doentes renais crônicos em tratamento dialítico, comparando com um grupo controle (GC) pareado por sexo e idade, e contrastar o uso de diferentes instrumentos de screening para esta finalidade. Material e método: Estudo transversal, caso-controle, no qual foram avaliados 54 pacientes em HD (GHD) e 54 controles saudáveis (GC), pareados por sexo e idade. Os pacientes foram submetidos a avaliação neuropsicológica, compreendida por testes de triagem (Mini-Exame do Estado Mental – MEEM; Avaliação Cognitiva de Montreal – MoCA; Mini-Cog), teste de inteligência (Escala Wechsler Abreviada de Inteligência – WASI), avaliação de qualidade de vida (QV) (The Medical Outcomes Study 36 item Short-Form Health Survey- SF-36), sintomas de ansiedade e depressão (Inventário de Ansiedade de Beck – BAI; Inventário de Depressão de Beck), complementados por dados sociodemográficos, clínicos e laboratoriais. Resultados: O GHD tinha medianas de 60 anos (50-67; intervalo interquartil) de idade, tempo de tratamento de 23 meses (10-51) e 40,74... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Introduction: Chronic kidney disease (CKD) affects a significant percentage of the elderly, and is also related to a series of comorbidities, especially mild neurocognitive disorder (mNCD). The decrease in the glomerular filtration rate is significantly associated with global deficits in cognition, executive function, language and memory. As a result, cognitive screening is essential for the population with CKD. General objective: To estimate the prevalence of mNCD in patients with CKD undergoing dialysis, comparing to a control group (CG) matched by sex and age, and to contrast the use of different screening instruments for this purpose. Material and methods: Cross-sectional, case-control study, in which 54 patients on HD (HDG) and 54 healthy controls (CG), matched by sex and age, were evaluated. Patients underwent neuropsychological assessment, comprising screening tests (Mini-Mental State Examination - MMSE; Montreal Cognitive Assessment - MoCA; Mini-Cog), intelligence test (Wechsler Abbreviated Intelligence Scale - WASI), assessment of quality of life (QOL) (The Medical Outcomes Study 36 item Short-Form Health Survey- SF-36), symptoms of anxiety and depression (Beck Anxiety Inventory - BAI; Beck Depression Inventory - BDI), complemented by sociodemographic, clinical and laboratory data. Results: The HDG had medians of 60 years-old (50-67; interquartile range), treatment time of 23 months (10-51) and 40.74% had DM as the underlying disease. The groups did not differ in age... (Complete abstract click electronic access below) / Doutor