HIV and Cognitive ImpairmentWhat's involved? | When is it required? | Referrals
There are a number of reasons why people with HIV can experience cognitive impairment:
- The virus can cause HIV associated neurocognitive disorder (HAND) of which HIV associated dementia (HAD) is the severest form;
- Infections such as toxoplasmosis or progressive multifocal leukoencephalopathy (PML) can occur when the immune system is weakened; or
- It may be the result of heavy alcohol or other drug use.
A neuropsychological assessment can often detect cognitive impairment prior to it being detected by sophisticated imaging techniques such as a CT or MRI scan. It can determine the presence and degree of cognitive impairment and whether medication has been effective in alleviating some of the symptoms of HIV Associated Dementia.
Based on the pattern of cognitive impairment, the likely causes of such symptoms may be determined. In addition, the neuropsychological assessment may provide valuable insight into how best to manage any areas of cognitive impairment and minimise their impact on the lives of the HIV positive person and their family and carers.
An assessment can be arranged through most health professionals, including: a GP, HIV specialist, nurse social worker or case manager. Where necessary, the Adahps psychologist can assist in linking an individual with various social and support services.
In situations where the client lives in regional or rural NSW, the Adahps psychologist can travel to perform assessments. To be eligible, an individual needs to be HIV positive and have a suspected cognitive impairment.
Neuropsychological assessments provide detailed information on an individual’s cognitive functioning, and usually involve three stages:
Stage 1: The psychologist will ask questions to obtain important information regarding an individual’s medical, social and psychiatric history, as well as any relevant family history.
Stage 2: The individual completes a variety of tests to assess a wide range of cognitive functions including: memory, attention, language and executive functioning (i.e. the ability to plan, organise, solve problems and show flexibility of thought).
Stage 3: Following completion of the report and consideration of the results, the individual is given feedback to discuss the results and recommendations. These results and recommendations are also shared with the referring doctor if appropriate.
Neuropsychological assessments are only one aspect of the overall assessment and management of cognitive impairment. A diagnosis will not be given on the basis of the outcomes of this assessment. It is also important to recognise that a neuropsychological assessment is not 100 per cent definitive. Results may be affected by a variety of factors including: motivation level, ill-health, extreme anxiety, low mood, fatigue or effects from medicines.
When is it required?
A neuropsychological assessment may be sought if it is necessary to provide:
- Comment on the nature of suspected or confirmed cognitive impairment: It can provide information on the likelihood of impairment being related to HIV/AIDS, neurological impairment, psychiatric problems or alcohol/drug related impairment.
- Ongoing monitoring of cognitive functioning: Assessments can be offered before and after the commencement of antiretroviral medications used to treat HIV, particularly those that are better able to penetrate virus activity in the brain.
- Comment on a person’s ability to cope independently.
- Advice on managing cognitive impairment.
Cognitive impairment can affect all areas of life including: social interactions, work, school, ability to manage finances, adherence to medication regimes, and the capacity to live independently.
Not all people with HIV will have cognitive impairment. For those who do, the degree and nature of their impairment will vary. As such, each individual will require different interventions to help manage any areas of difficulty.
Adahps case managers work with an individual, their family/carers, health providers, legal and financial guardians and other case managers to engage appropriate supports and maximise the potential of our clients.
To do this, a case management plan is developed which considers the results of neuropsychological assessments. The case management plan is provided to the individual and those involved in their care, and may include the following information gathered from the neuropsychological assessment:
- The nature of impairment and techniques to manage issues that are typically present in HIV/AIDS-related impairment.
- Likely changes in the individual’s behaviour and strategies to help manage these.
- Specific, personalised instructions to maximise attendance at appointments and to encourage adherence to medications.
- Strategies for hospital or residential care staff to apply if the individual’s behaviour is challenging and disruptive.
- Recommend counselling/therapy techniques if the individual requires psychological or psychiatric assistance.
- If employed, strategies that may maximise the individual’s potential at work.
- Strategies to address other problems (eg, difficulty maintaining social connections and problems assigning priorities).
To arrange a neuropsychological assessment call the Adahps’ intake number on ph: 9382 8600.