Feasibility of a Home-Based Speed of Processing Training Program in Middle-Aged and Older Adults With HIV.

There has been much optimism over the positive impact of combination antiretroviral therapy (cART) on life expectancy for people with HIV; however, those aging with HIV fear potential day-to-day challenges associated with the development of cognitive deficits. The presence of cognitive deficits has generated major safety concerns because it has been shown to impact driving, mobility, and employment. Given the efficacy of a computerized speed of processing training program administered in the laboratory to older adults and adults with HIV, this study was designed to determine the feasibility of using a home-based speed of processing training program to improve cognitive function in middle-aged and older adults with HIV. In this within-subject pre-post experimental design, 20 middle-aged and older adults (i.e., age of 40+ years) with HIV were administered a brief neuropsychological assessment to gauge their baseline cognitive function before participating in a 10-hour home-based computerized cognitive remediation training program. In addition to self-reported cognitive gains, a 6-week posttest indicated significant improvements on the Useful Field of View, a measure of speed of processing and possible transfer to the Timed Instrumental Activities of Daily Living test, a measure of everyday functioning. These findings show that speed of processing training can successfully improve cognitive function in this vulnerable population even when administered in remote settings such as the privacy of one's home.

The synergistic effects of HIV, diabetes, and aging on cognition: implications for practice and research.

Thanks to highly active antiretroviral therapy, many people infected with HIV will likely live into old age. Although this is a welcome prognosis, new issues are emerging that may complicate the ability to successfully age in this clinical population. HIV and aging independently are related to cognitive impairments, so there are concerns that those aging with HIV may be more at risk of such cognitive impairments. Moreover, highly active antiretroviral therapy itself can create metabolic disorders, such as prediabetes and/or frank type 2 diabetes, which have also been linked to poorer cognitive functioning. Thus, concerns increase that, as people age with HIV and develop comorbid metabolic disorders that may lead to type 2 diabetes, they will be at triple risk of developing cognitive impairments that can impair everyday functioning and reduce quality of life. This article explores these issues and provides implications for practice and research.

Predictors of improvement following speed of processing training in middle-aged and older adults with HIV: a pilot study.

Speed of processing training has been shown to improve cognitive functioning in normal older adults. A recent study demonstrated that middle-aged and older adults with HIV also improved on a measure of speed of processing and a measure of everyday functioning after such training. The primary objective was to examine what predicts the speed of processing training gains observed in the previous study. Participants were administered an extensive battery of demographic, psychosocial, and neuropsychological measures at baseline. They were randomized either to the speed of processing training group (n = 22) or to a no-contact control group (n = 24). Participants received approximately 10 hours of computerized speed of processing training. Predictors of training gains on the Useful Field of View (UFOV) Test and the Timed Instrumental Activities of Daily Living (TIADL) Test were examined through correlational analyses. In general, those who performed worse on the UFOV and TIADL at baseline demonstrated significantly more training gains. Also, higher HIV viral load, poorer medication adherence, a higher number of years diagnosed with HIV, and lower baseline scores on the Wisconsin Card Sorting Test (an executive functioning measure) were correlated with better TIADL training gains. TIADL performance improved in those with higher HIV viral load, poorer medication adherence, and poor executive functioning. Speed of processing training may be a way to improve everyday functioning and therefore quality of life in more medically and cognitively vulnerable adults with HIV.

The cognitive consequences of stigma, social withdrawal, and depression in adults aging with HIV.

In addition to the immune system, HIV also affects the nervous system. Even with highly active antiretroviral therapy helping reduce the impact of HIV on the body and brain, approximately 50% of individuals with HIV experience cognitive problems. As people age with HIV, there is growing concern that they will be at increased risk of developing cognitive problems that may have an impact on their everyday functioning (e.g., medication adherence) and quality of life. Unfortunately, HIV-related stigma, social withdrawal, and depression, which are common to the HIV experience, can also have direct and indirect negative consequences on cognition. Research and practice implications concerning these relationships are posited.

Neurological complications associated with HIV and AIDS: clinical implications for nursing.

This article provides a clinical nursing update on major neurological complications associated with HIV and AIDS. Life expectancy for those with AIDS has increased as a consequence of antiretroviral therapy, and thus, neurological complications remain a clinical challenge. Four significant diseases associated with HIV and AIDS are addressed: HIV-associated dementia, peripheral neuropathy, cryptococcal meningitis, and toxoplasmosis. Updated statistics, a review of pathophysiology, common manifestations, diagnostic tests, and standard treatments are discussed for each disease. Nursing considerations when caring for this population are reviewed and include assessment, safety, activities of daily living, pain management, and treatment adherence.

Training needs and evaluation of a neuro-HIV training module for non-physician healthcare workers in western Kenya.

BACKGROUND: Recent efforts to improve neurological care in resource-limited settings have focused on providing training to non-physician healthcare workers. METHODS: A one-day neuro-HIV training module emphasizing HIV-associated dementia (HAD) and peripheral neuropathy was provided to 71 health care workers in western Kenya. Pre- and post-tests were administered to 55 participants. RESULTS: Mean age of participants was 29 years, 53% were clinical officers and 40% were nurses. Self-reported comfort was significantly higher for treating medical versus neurologic conditions (p<0.001). After training, participants identified more neuropathy etiologies (pre=5.6/9 possible correct etiologies; post=8.0/9; p<0.001). Only 4% of participants at baseline and 6% (p=0.31) post-training could correctly identify HAD diagnostic criteria, though there were fewer mis-identified criteria such as abnormal level of consciousness (pre=82%; post=43%; p<0.001) and hallucinations (pre=57%; post=15%; p<0.001). CONCLUSIONS: Healthcare workers were more comfortable treating medical than neurological conditions. This training significantly improved knowledge about etiologies of neuropathy and decreased some misconceptions about HAD.

Predictors of cognition in adults with HIV: implications for nursing practice and research.

The objective of this study was to identify predictors of cognitive performance among adults with HIV. Participants completed demographic, psychosocial, and mental and physical health questionnaires as well as cognitive measures of speed of processing, psychomotor ability and visuomotor coordination, attention and working memory, reasoning, and executive function. Hierarchical regression analyses were used to examine predictors of cognitive performance for each cognitive measure. Possible predictors included age, gender, socioeconomic status, Wide Range Achievement Test 3 Reading score (quality of education), social networks score, hardiness score, mood disturbance score, medical problems composite score, psychoactive drug use composite score, HIV chronicity, CD4+ lymphocyte cell count, and HIV medication usage. Model 1 examined demographic factors, and model 2 examined the contribution of the remaining variables on cognitive performance. Results revealed that several factors were predictive of cognitive functioning, with the individual regression models for each measure explaining 8% to 48% of the variability in performance. Overall, this study posits that among adults with HIV, the most consistent predictors of poorer cognition included older age, poorer reading ability, more depressed mood, CD4+ lymphocyte cell count less than 200, and lack of HIV medication usage. Results suggest that those aging with HIV are subject to decreases in cognitive functioning.

Lost the feel for the game: meanings of onset and diagnosis of AIDS dementia for significant others.

The onset and diagnosis of AIDS dementia marks a new dimension to living with HIV, an aspect few imagine or are equipped for. As a result of the profound changes that AIDS dementia makes to the ways the person with HIV acts, the life of significant others is similarly altered. Drawing on the metaphor of "the game" from Bourdieu's work on habitus, I explore how the onset and subsequent diagnosis of AIDS dementia comes to signify for significant others a moment in which life is permanently altered, whereby they no longer have the feel for the game. With AIDS dementia, life ("the game") is altered. Significant others feel that AIDS dementia is not a normal or acceptable AIDS illness: fears are contested, secrets managed and disclosed, and relations strained. This change in play further marginalizes significant others, and increases their sense of alterity from others living with and affected by HIV alone, because dementia is not the socially acceptable way of being ill with HIV.

The difficult, demanding, and demented AIDS patient in long-term care.

Demented AIDS patients in long-term care present interconnected medical, ethical, and management problems. The patient's right to care must be considered in the context of the obligations owed to other residents and to staff members. A principled analysis should focus on substantive and procedural issues: the concept of autonomy must be modified by notions of accommodation to the needs of others; procedural fairness should guide discussions. A dynamic analysis should identify the various parties, their conflicting interests, and possible routes for resolving differences.

HIV-related encephalopathy.

This article discusses different models of care in the UK for the small number of patients with HIV-related encephalopathy. A combination of intensive community support, residential care and respite care has been shown to be more effective than hospital care. The authors emphasise the importance of early neuropsychological assessment, the provision of a broad range of services with an appropriate skill mix of carers and the need for staff education and support.

Neuroscience nurses' intentions to care for persons with HIV/AIDS.

The purpose of this study, which was based on Ajzen's theory of planned behavior, was to determine the extent to which personal attitudes, subjective norms and perceptions of behavioral control influence the intentions of nurses to care for persons with HIV/AIDS. Questionnaires measuring the concepts of attitudes, subjective norms, perceived behavioral control and intention to care for persons with HIV/AIDS were completed by 368 members of a neuroscience nursing organization. Hierarchial regression analysis was used to determine if nurses' intentions were predicted by their attitudes and subjective norms, and if perceived behavioral control would add to the prediction. Attitudes accounted for a significant percent of variance when entered at the first step, and perceived behavioral control accounted for a significant increase in variance when entered at the second step. In the final model, only perceived behavioral control contributed significantly to the prediction of intention.

Assessing patients with HIV-associated dementia.

HIV-associated dementia may pose communication challenges to healthcare staff. It is essential to obtain an accurate assessment of the confusion in order to achieve a baseline from which to evaluate a patient. It is important to communicate in a way that conveys worth and value to the patient. The expertise of the multidisciplinary team should be drawn on when working with such patients.

Dementia-related behaviors in Alzheimer's disease and AIDS.

In both Alzheimer's disease (AD) and AIDS, family members vary in their perceptions of the individual's ability to control his or her cognitive or behavioral functioning. Family members who believe that the behaviors are unintentional generally experience less distress than do family members who believe that the individual has control over his or her thoughts or behaviors. The manifestations of intellectual and cognitive dysfunction of AD and AIDS are strikingly similar. Impairments of memory, concentration, and abstract thinking; confusion and disorientation; and slowed mental capacities are among the shared symptomatology, and may eventually become the catalysts for family caregiving. It is imperative that clinicians and researchers collaborate in further investigation in order to ease the burden on family caregivers and facilitate adaptations of caregiving methods.

AIDS dementia complex: guidelines for nursing care.

AIDS dementia complex is one of the most common neurological problems associated with HIV-related illness. To date, the nursing care of individual with AIDS dementia complex has not been explored to any extent. As a basis for examining aspects of nursing care, the epidemiology, neuropathology, clinical presentation and diagnosis of AIDS dementia complex are reviewed and medical management considered. Using the stages of AIDS dementia complex, guidelines for nursing care are proposed. These guidelines are a basis for developing individualized care to enhance the abilities of persons with AIDS dementia complex and to support caregivers.