Issues in HIV-associated Neurocognitive Disorder

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Australian Federation of AIDS Organisations

This presentation was given by Peggy Bain, Clinical Neuropsychologist, St Vincent’s Hospital, at the AFAO HIV Educators Conference, May 2010.

Health & Medicine

“ My memory is not what it used to be. Am I just getting older or is this something I should worry about?” Issues in HIV-associated Neurocognitive Disorder Peggy Bain Clinical Neuropsychologist St Vincent’s Hospital

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Updated terminology – HIV-associate neurocognitive disorder (HAND) – Antinori et al 2007 ,[object Object],[object Object],[object Object]

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Manifestations of HIV related impairment (Sidtis, 1994) ,[object Object],[object Object],[object Object],[object Object]

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Complaints warranting further consideration in HIV +ve individuals ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Complaints warranting further consideration in HIV +ve individuals (cont.) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Impact of Neurocognitive impairment ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Benefits of Early Detection ,[object Object],[object Object],[object Object],[object Object]

HIV, the aging brain and adherence ,[object Object],[object Object],[object Object]

HIV and the Aging Brain ,[object Object],[object Object],[object Object]

Multifactorial aetiology of cognitive/behavioural disorders in older HIV +ve adults (Valcour & McMurtray 2009) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

HIV +ve individuals with co-existing/co-morbid factors ,[object Object],[object Object],[object Object]

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Aging is associated with cognitive decline, and older subjects can have demonstrable cognitive impairment without crossing the threshold for dementia. This condition has been termed “mild cognitive impairment” (MCI), and these patients have an increased risk of developing dementia, especially Alzheimer disease (AD). Studies conducted in referral clinics have shown that patients with MCI progress to AD at a rate of 10% to 15% per year, and 80% of these patients have converted to AD after approximately 6 years of follow-up. The identification and classification of MCI can be a major challenge.

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The world’s population is ageing rapidly, and with it is coming to a significant increase in the number of older people with dementia. This increase presents major challenges for the provision of healthcare generally and for dementia care in particular, for as more people have dementia, there will be more people exhibiting behavioural and psychological symptoms of dementia (BPSD). BPSD exact a high price from both the patient and the caregiver in terms of the distress and disability they cause if left untreated. BPSD is recognisable, understandable and treatable. The recognition and appropriate management of BPSD are important factors in improving our care of dementia patients and their caregivers,

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Dementia dementedness could be a neurological disease that affects your ability to assume, speak, reason keep in mind and move. whereas Alzheimer’s malady is that the most typical reason for dementedness, several different conditions can also cause similar symptoms. a number of these disorders exacerbate with time and can't be cured, whereas others respond well to treatment and their symptoms will even be reversed. What will it mean once somebody is claimed to possess dementia? for a few folks, the word conjures up scarey pictures of crazy behavior and loss of management. In fact, the word dementedness describes a bunch of symptoms that has remembering loss, confusion, the shortcoming to downside solve, the shortcoming to finish multi-step activities like making ready a mean or equalisation a chequebook, and, generally temperament changes or uncommon behavior. dementedness is that the general term for a bunch of disorders. sure conditions will cause reversible dementias, like medication interactions, depression, nutriment deficiencies or thyroid abnormalities. it's necessary that these conditions be known early and be treated taken over so symptoms is improved. There are irreversible dementias called chronic dementias, of those Alzheimer’s malady is that the most typical. There square measure variety of different chronic dementias, however, which will appear as if Alzheimer’s, however have distinct or completely different|completely different} options which require special attention and different treatment. For those who have a lover that has one in every of the numerous completely different dementias, the road ahead is a really difficult one. urban center Ronald Reagan maybe aforementioned it best in Associate in Nursing interview with J.D. Heyman of individuals magazine, in December of 2003, she referred to as Alzheimer’s malady “the long goodbye” (Heyman, 2003). Dementia: Definition and designation dementedness is that the general term for a bunch of disorders that cause irreversible psychological feature decline as a results of varied biological mechanisms that injury brain cells. it's a really common downside, significantly within the older, and it's going to go unrecognized for quite it slow. Studies indicate that up to twenty or a lot of of persons UN agency have symptoms suggestive dementedness end up to possess treatable diseases and regarding 1/2 them can have medical specialty issues.(Shenk, 2001). many issues arise once attempting to determine whether or not or not a consumer is really insane. First, gentle defects in memory commonly occur with age, therefore any psychological testing has to take this under consideration. Secondly, as a result of dementedness is outlined as a loss of perform, with shoppers UN agency have a history of retardation, or previous learning or psychological feature disabilities it's necessary to get instructional and activity histories so as to establish if there.

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Abin Abraham Mammen, Sharath Hullumani V, Jakka Rahul. Dementia can be broadly defined as depletion in cognitive performance which makes a person unable to meet multiple intellectual demands of daily life. Dementia is acquired, persistent impairment not by delirium in multiple areas of intellectual function. Some dementia types are progressive but others may be persistent or plateau. Sometimes in cases, the onset can be insidious, as is generally the case in AD, but in many cases, whether something develops after head trauma or stroke, the onset of dementia may be acute, particular. While most dementias are the result of changes in the brain structure, infections and metabolic causes can be treated with success. We are confronted with a diagnostic criterion as we delve into the area of dementia and the increasingly expanding area of dementia research.

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In this chapter I will first introduce the research topic dementia, its signs, and symptoms. This will then be followed by discussion of the scope of this thesis, and consequences of living with dementia. Equally, I will describe my personal and professional journey which prompted me to undertake a Ph.D. and how this assisted me to shape the focus of my Ph.D. topic. Lastly, the chapter will conclude with an overview of the thesis. Dementia refers to a broad category of diseases which cause a long-term effect to the brain and frequently a gradual decrease in one’s ability to think and deterioration in other mental functions (Burns et al., 2006). Other than mental illness, it can also be caused by injuries which result in a progressive dysfunction of both the cortical and sub-cortical functions as well as the loss of an individual’s cognitive ability as a result of physical and chemical changes of the brain. Dementia is one of the progressive diseases which get worse with time although for others it takes several years to reach a critical stage. Furthermore, the rate of progression largely depends on the underlying cause (Victor, 2010). There are 4 main types of dementia. They include; Alzheimer’s, Lewy body, front temporal lobe and vascular dementia. Alzheimer’s disease is believed to be caused by building up of tangles and amyloid plaques in the brain. Lewy body is caused by abnormal proteins which appear in the brain’s nerve cells thus impairing its functioning (Whitworth & Whitworth, 2010). Vascular dementia is caused by bleeding in the brain as a result of a stroke. Frontotemporal

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Discussion #1 What are the possibilities for change in Mrs. Smith’s current mental status? Mrs. Smith could be possibly experiencing delirium. Delirium is a sudden change in the mind that can cause confusion and a disrupted emotional state (Badii, 2018). Delirium can be caused by infections such as urinary tract infections or pneumonia, metabolic conditions such as hypoglycemia, certain medications, illicit drugs, alcohol withdrawal, a decrease of oxygen in the body, etc. (Badii, 2018). Mrs. Smith is diabetic, she could be experiencing a state of hypoglycemia which can lead to an acute state of confusion and change of behavior which can go unnoticed by the patient, family members, and physicians (Steckl, 2015). People with diabetes are at higher risk of developing dementia, Mrs. Smith has a history of both diabetes and hypertension which can lead to constriction of blood vessels, reduced oxygen to the brain, and cause damage to the brain overtime (Steckl, 2015). What is your top differential diagnosis? Give 3 reasons why you chose that diagnosis. My top diagnoses is delirium because Mrs. Smith had an abrupt change and experienced confusion, restlessness, poor appetite, and shows no signs of infection such as a fever which are related to delirium (Badii, 2018). How can you differentiate depression, dementia and delirium? Depression is a chronic illness that can lead to patients feeling uncontrollable sadness and hopelessness (McCance & Huether, 2014). Patients can experience agitation, insomnia, a decreased interest in activities or relationships, and a decrease in appetite which can later lead to weight loss (McCance & Huether, 2014). These symptoms can come abruptly and can last up to months, but patients will stay oriented (McCance & Huether, 2014). Dementia is a decline of brain function, it is progressive, and affects a person’s behavior, memory, orientation, and language (McCance & Huether, 2014). Dementia can be caused by trauma, atherosclerosis, increased intracranial pressure, neurodegeneration, and hydrocephalus and might not be relate to infections, and certain conditions/diseases like delirium (McCance & Huether, 2014). A patient’s behavior is usually not affected and are oriented within the first stages of dementia. The patients can show a slow irreversible decline that can last up to years (McCance & Huether, 2014). Delirium can have an abrupt onset, as mentioned above, and can lead to confusion, a disrupted emotional state, restlessness, poor appetite, and irritability (Badii, 2018). Delirium can be caused by infections such as urinary tract infections or pneumonia, metabolic conditions such as hypoglycemia, certain medications, illicit drugs, alcohol withdrawal, a decrease of oxygen in the body, etc. (Badii, 2018). Explain to Mrs. Smith’s daughter what treatment is needed and what you think her prognosis is. Delirium can be reversible. Treatment involves finding the cause and using the needed t.

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Dementia can be a daunting diagnosis, but Shanti Homes offers a glimmer of hope in the fight against this debilitating condition. With its compassionate staff, specialized care, and commitment to enhancing the lives of those affected by dementia, Shanti Homes stands as a ray of hope in the journey towards effective treatment and improved quality of life. Families can find solace knowing that their loved ones are in the hands of professionals dedicated to providing the best possible

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Researchers have shown that individuals with mental retardation or with developmental disabilities are at a greater risk of developing health problems and among others dementia than the general population. As the literature points out, dementia is characterized by progressive loss of cognitive functions, until the individual has lost all independency and ability in daily life. It is therefore necessary to carry out a systematic assessment throughout the developmental phases at the beginning of these signs. The purpose of this paper is to present the importance of systematic assessment of early symptoms of unspecified dementias in people with developmental disabilities. The methodology is based on the pre-dementia analysis of two study cases followed by a 2-year period. In conclusion, it can be argued that the diagnosis of dementia in people with developmental disabilities, in the early stages, has become difficult because of the lack of reliable and standardized criteria and diagnostic procedures and difficulties to investigate cognitive decline versus an already vulnerable developmental disability base. Therefore, in people with developmental disabilities, a diagnosis of dementia needs to be done based on changes in mental status from basic functioning. This helps a clinician to determine an accurate diagnosis in later years as hypothetically results from two case studies with later subcortical dementia. However, this endeavour remains to be discussed widely by mental health specialists, public health and cognitive neuroscience in order to determine whether this contribution provided actually has the power of explanation understandable or is understandable by the part of interest.

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Dementia, a multifaceted condition affecting millions worldwide, presents a unique challenge to both individuals and societies. In this presentation, we delve into the intricacies of dementia, offering a comprehensive exploration of its various forms, symptoms, and impacts on individuals and their families. We begin by unraveling the scientific underpinnings of dementia, shedding light on the neurological processes that contribute to cognitive decline. From Alzheimer's disease to vascular dementia and beyond, we examine the diverse range of conditions that fall under the umbrella of dementia, each with its own distinct characteristics and challenges. Moving beyond the clinical aspect, we explore the profound personal and societal ramifications of dementia. Through compelling case studies and firsthand accounts, we illuminate the lived experiences of those affected by dementia, highlighting the emotional toll it takes on individuals and their loved ones. Moreover, we address the pressing need for increased awareness and understanding of dementia within our communities. By dispelling myths and misconceptions surrounding the condition, we strive to foster a more compassionate and inclusive society that supports individuals living with dementia. Ultimately, this presentation serves as a call to action, urging stakeholders from all sectors to join forces in the fight against dementia. Through education, advocacy, and innovation, we can work towards a future where individuals with dementia receive the care, respect, and dignity they deserve

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