Hakkers Charlotte S, Kraaijenhof Jordan M, van Oers-Hazelzet Esther B, Visser-Meily Anne J M A, Hoepelman Andy I M, Arends Joop E, Barth Roos E
1 Department of Internal Medicine and Infectious Diseases, University Medical Center Utrecht (UMCU) , Utrecht, The Netherlands .
2 Department of Rehabilitation, Physical Therapy Science & Sports, Brain Center Rudolf Magnus, University Medical Center Utrecht (UMCU) , Utrecht, The Netherlands .
AIDS Patient Care STDS. 2017 Sep;31(9):363-369. doi: 10.1089/apc.2017.0022. Epub 2017 Aug 7.
Neurocognitive impairment (NCI) is an increasingly important comorbidity in an ageing HIV+ population. Despite the lack of available treatment modalities, screening for NCI is recommended. In the UMC Utrecht, yearly NCI screening is done using the Montreal Cognitive Assessment (MoCA) tool and the HIV Dementia Scale (HDS). The aim of this study was to evaluate this screening protocol in relation to clinical outcomes and management. A retrospective cohort study was performed in suppressed adult HIV+ patients. Apart from the MoCa and the HDS, the Utrecht Scale for Evaluation of Rehabilitation-Participation (USER-P) and the Hospital Anxiety and Depression Scale (HADS) were performed. Patients scoring below average on cognitive screening tests or with subjective cognitive complaints were further evaluated using a standardized protocol, including optimizing cART and checking for somatic disorders. In patients with cognitive complaints and participation restrictions, cognitive rehabilitation was proposed. Two hundred eighty-six patients were screened. The vast majority were MSM with an average age of 49 years. One hundred forty-four out of 286 patients (50%) had an abnormal test score and/or had subjective cognitive complaints. Restrictions in participation were present in 23% of patients. Six patients on Efavirenz switched their regimes, as this drug is known for its potential central nervous system (CNS) side effects. A depressive component was present in 58 patients (40%). Five patients had a clinical relevant laboratory abnormality. Moreover, six patients were referred for cognitive rehabilitation, which resulted in a 100% success rate in set goals in the five evaluable patients. Although the protocol was not fully adhered to in all patients, it did result in detectable underlying causes of NCI in 59% of patients, and 21% was referred for further treatment. Moreover, cognitive rehabilitation appears to be a very successful intervention for patients with NCI who experience subjective complaints and participation restrictions.
神经认知障碍（NCI）在老龄化的HIV阳性人群中是一种日益重要的合并症。尽管缺乏有效的治疗方式，但仍建议对NCI进行筛查。在乌得勒支大学医学中心，每年使用蒙特利尔认知评估（MoCA）工具和HIV痴呆量表（HDS）进行NCI筛查。本研究的目的是评估该筛查方案与临床结局及管理的相关性。对病毒载量得到抑制的成年HIV阳性患者进行了一项回顾性队列研究。除了MoCa和HDS外，还使用了乌得勒支康复参与评估量表（USER-P）和医院焦虑抑郁量表（HADS）。认知筛查测试得分低于平均水平或有主观认知主诉的患者，使用标准化方案进行进一步评估，包括优化抗逆转录病毒治疗（cART）和检查躯体疾病。对于有认知主诉和参与受限的患者，建议进行认知康复治疗。共筛查了286例患者。绝大多数为男男性行为者，平均年龄49岁。286例患者中有144例（50%）测试得分异常和/或有主观认知主诉。23%的患者存在参与受限。6例服用依非韦伦的患者更换了治疗方案，因为已知该药物有潜在的中枢神经系统（CNS）副作用。58例患者（40%）存在抑郁成分。5例患者有临床相关的实验室异常。此外，6例患者被转诊进行认知康复治疗，在5例可评估患者中，设定目标的成功率为100%。尽管并非所有患者都完全遵循该方案，但它确实在59%的患者中发现了NCI的潜在病因，21%的患者被转诊接受进一步治疗。此外，对于有主观主诉和参与受限的NCI患者，认知康复似乎是一种非常成功的干预措施。
