Neuropsychiatric predictors of occupational persistence in HIV/AIDS.

It is well established that HIV (human immunodeficiency virus), the virus responsible for AIDS, directly attacks the central nervous system, altering cognition, behavior, and affect, and can result in a full dementia syndrome. HIV-associated neurocognitive complications, along with a myriad of other health threats, resulted in significant disability and unemployment for those infected. However, the advent of more effective antiretroviral medications used in combinations, along with homologous improvements in morbidity and mortality, have allowed for people living with HIV/AIDS to return to work, albeit not without challenges. Even mild cognitive impairment has been shown to affect employability and level of occupational functioning. The focus of this dissertation was to develop an understanding of the impact of HIV-associated neurocognitive challenges, the most common neuropsychiatric expression of HIV, on occupational persistence. This study analyzed existing data from a parent study conducted in New York City. The sample consisted of 116 community dwelling HIV positive men and women who were actively seeking employment after being unemployed subsequent to learning of their HIV status. The research design was a longitudinal prospective cohort study testing a multilevel growth model with a two- nested-level structure. The growth model examined individual differences in occupational persistence over a two year time period, testing multiple potential neuropsychological predictors and covariates. Changes in individual growth profiles were investigated, and possible explanations for observed differences were tested. The analysis found that memory is the most potent neuropsychological predictor of occupational success, both in terms of returning to work in the first six months of the study (event), as well as persisting on the job over time (two years). The second most influential neuropsychological predictor was executive functioning, which significantly influenced occupational persistence over time and an accelerated growth trajectory. These central findings along with other significant control interactions are discussed. The study limitations are discussed, along with opportunities for future research. The relevance of these findings is explored, specifically addressing the implications for social work practice and social work education

Characterizing the neurological impact of acute HIV infection and its outcomes after immediate initiation of antiretroviral therapy

HIV invades the central nervous system (CNS) during early infection and contributes to neurocognitive impairment during chronic infection. This thesis aims to investigate the neurological impact of acute HIV infection (AHI) and its outcomes after immediate initiation of antiretroviral therapy (ART). Section 1 of this thesis is an introduction to the persistence of HIV-associated neurocognitive disorder in the ART era, highlighting the need to study AHI to understand HIV neuropathogenesis. The main body of the thesis describes the outcomes of the RV254 Thai AHI cohort, in which all participants were enrolled during AHI and initiated ART within days after the diagnosis. Section 2 focuses on the findings during AHI, examining the determinant of HIV-1 RNA level in cerebrospinal fluid (CSF), the impact of concomitant syphilis, and the safety of performing lumbar punctures during AHI. Section 3 discusses the longitudinal outcomes of RV254 participants after ART, presenting their 6-year neurocognitive trajectory, the neuropsychological impact of switching from a Efavirenz-based ART to a Dolutegravir-based ART regimen, and the rare detection of HIV-1 RNA in CSF during plasma HIV-1 suppression (CSF HIV-1 escape). Section 4 explores the implications of CNS in HIV cure research. The findings suggest that HIV-1 invades the CNS during acute infection and causes abnormal neurological signs, neurocognitive dysfunction and depressive mood. Yet, prompt initiation of ART during AHI could reverse these abnormalities - RV254 participants on stable ART are generally free from neuropsychiatric complications frequently seen in other HIV-positive populations, highlighting the benefit of early ART in HIV infection

Progression Modeling of Cognitive Disease Using Temporal Data Mining: Research Landscape, Gaps and Solution Design

Dementia is a cognitive disorder whose diagnosis and progression monitoring is very difficult due to a very slow onset and progression. It is difficult to detect whether cognitive decline is due to ageing process or due to some form of dementia as MRI scans of the brain cannot reliably differentiate between ageing related volume loss and pathological changes. Laboratory tests on blood or CSF samples have also not proved very useful. Alzheimer�s disease (AD) is recognized as the most common cause of dementia. Development of sensitive and reliable tool for evaluation in terms of early diagnosis and progression monitoring of AD is required. Since there is an absence of specific markers for predicting AD progression, there is a need to learn more about specific attributes and their temporal relationships that lead to this disease and determine progression from mild cognitive impairment to full blown AD. Various stages of disease and transitions from one stage to the have be modelled based on longitudinal patient data. This paper provides a critical review of the methods to understand disease progression modelling and determine factors leading to progression of AD from initial to final stages. Then the design of a machine learning based solution is proposed to handle the gaps in current research

Self-perceived cognitive decline, neuropsychological functioning, and depressive symptoms in HIV+ Spanish-speakers

Within the United States, HIV is a growing epidemic that has important neuropsychological and functional consequences. Early detection and treatment of HIV-associated neurocognitive disorder (HAND) is associated with better outcomes. In major metropolitan areas such Los Angeles County, HIV disproportionately impacts the Latino community. For those individuals who are primarily Spanish-speakers, there may be limited access to comprehensive neuropsychological assessment in the preferred language. Consequently, self-reports of cognitive functioning are often relied on to help determine the presence of HAND. However, self-reports of cognitive decline may be influenced by factors such as depressed mood, variable motivation, and culture, raising important validity questions. To date, relatively few studies have focused on the combined use of Spanish-language, self-report measures of cognitive functioning and mood among primarily Spanish-speaking, HIV-positive individuals. The aim of this study was to explore the relationships among self-reported cognitive decline, neuropsychological functioning, and mood symptoms within this population. Archival data from a sample of 100 HIV+, primarily Spanish-speaking adults who participated in the parent study at a major medical center in Los Angeles were examined. Measures included Spanish-language versions of the Beck Depression Inventory, Cognitive Difficulties Scale- Patient Version, Medical Outcomes HIV Health Survey, and an acculturation measure. An array of neuropsychological measures was used to determine the presence of HAND. It was predicted that depressive symptoms would be positively associated with self-reported cognitive decline. This hypothesis was strongly supported by the results of correlational analysis. The results also showed that for individuals with HAND, the difference in BDI scores between participants with cognitive complaints and those without varied depending on whether the MOS-HIV or the CDS was used to assess cognitive complaints. The analyses revealed no significant impact of acculturation on the relationships among cognitive complaints, neuropsychological functioning, and depressive symptoms. The results of the present study highlight the complex relationship between neuropsychiatric and neuropsychological functioning in Spanish-speaking individuals infected with HIV. Clinical implications and limitations of the study are addressed. Future research that incorporates objective measures of neuropsychological functioning, the input of collateral informants, and self-report measures of mood and functional decline is recommended

DoR Communicatory - December 2014

The December 2014 issue of the the Division of Research newsletter.https://digitalcommons.fiu.edu/research_newsletter/1003/thumbnail.jp

Measuring the Burden of Neglected Tropical Diseases: The Global Burden of Disease Framework

Reliable, comparable information about the main causes of disease and injury in populations, and how these are changing, is a critical input for debates about priorities in the health sector. Traditional sources of information about the descriptive epidemiology of diseases, injuries, and risk factors are generally incomplete, fragmented, and of uncertain reliability and comparability. The Global Burden of Disease (GBD) study has provided a conceptual and methodological framework to quantify and compare the health of populations using a summary measure of both mortality and disability, the disability-adjusted life year (DALY)

DoR Communicator - November 2014

https://digitalcommons.fiu.edu/research_newsletter/1015/thumbnail.jp

Cost-utility analysis in Alsheimer´s disease

Alzheimer s disease (AD) is a neurodegenerative disorder causing dementia, a syndrome of gradual loss of cognitive function causing impairment in social and occupational functioning. This leads to substantial loss in quality of life and premature death for persons with the disease, associated suffering for their families and large costs to society. In parallel to the aging of the population the world prevalence is predicted to threefold within the next 40 years, creating a challenge for researchers and decision-makers to make better treatments available. Further, improved methods for economic evaluation in AD are needed to identify the optimal treatment strategies. The overall objective of this thesis is to explore the application of cost-utility analysis in AD and address key methodological challenges and data needs. In paper I, prediction functions for simulating disease progression and economic endpoints in a decision-analytic model were estimated. Three year follow-up data from the Swedish Alzheimer Treatment Study (SATS) on the natural course of AD of 435 patients commencing treatment with donepezil and their care setting and costs of care was analyzed. A simplified model in which cognition (representing the underlying course of disease) and the ability to perform activities of daily living (ADL) (representing patient care need) was assumed to predict the provision of care. According to the estimated statistical functions, cognition was found to be the key predictor of ADL-ability which itself was the main predictor of care setting and costs of care. In paper II, we used contingent valuation methods to elicit caregivers willingness-to-pay (WTP) for reductions in patient care need. In total, 517 caregivers of AD patients in four countries (Spain, Sweden, UK and US) were interviewed. The mean WTP for a one hour reduction per day was estimated at between £59 and £144 per month depending on country. The income of the caregiver was the only consistently significant determinant of WTP across all countries. In paper III, we assessed predictors of the costs of care of 1,222 AD patients in four countries (Spain, Sweden, UK and US), both residing in the community and in residential care settings. Cognition, ADL-ability, behavioural symptoms and costs of care (RUD-Lite) were assessed via a patient and caregiver interview. Cost estimates ranged between £1,000 to £5,000 per patient and month, increasing with disease severity and higher in residential care settings. ADL-ability was the most important predictor of costs but part of the variation was also explained by cognition and behavioural symptoms. In paper IV, the key components and drivers of costs of care in a clinical trial sample of 2,744 mild to moderate AD patients were identified. Costs were assessed with RUD-Lite at baseline and every 6 months over the 18 months trial. Informal care constituted 82-86 percent of total costs, whereas community care and patient accommodation constituted an equal share of 12-16 percent. Informal care also had the strongest correlation with disease severity measures including cognition, ADL-ability, global function and behavioural symptoms. In conclusion, cognition, ADL-ability and behavioural symptoms are all important indicators of care need in AD and should be considered in economic modelling. Caregivers have a substantial willingness to pay for reductions in care need. Informal care is the key cost component in clinical trials in mild to moderate AD. Health utility estimates of AD patients are highly dependent on the methodology including choice of instrument, respondent and utility tariffs

Dementia and cognitive impairment in French-speaking Sub-Saharan Africa: a comprehensive review on moving out of the shadows of neglect

Dementia is a global public health problem with increasing prevalence and incidence worldwide. The African continent is expected to bear the biggest brunt of the burden of dementia by 2050 because of the rapid demographic changes, including rapid population growth, an increase in life expectancy, and ageing. However, French-speaking Sub-Saharan African (FS-SSA) countries are underrepresented in research on dementia in Africa. While the reasons are diverse and complex, linguistic and cultural barriers to research, disproportionately affect these countries and may be significant factors. Any efforts, therefore, to redress the burden of dementia in Africa must consider the specific demographic, cultural, and linguistic characteristics of FS-SSA countries. This scoping review explores the current state of knowledge in dementia and cognitive impairment in Sub-Saharan Africa, highlighting research gaps and specific patterns unique to FS-SSA Africa. We identify pathways for research to bridge the knowledge gaps on dementia in FS-SSA as part of the global endeavor to tackle dementia worldwide