Parkinson's disease and the influence of the forebrain dopaminergic system on dreaming

Bibliography: leaves 32-37.The purpose of the study was to investigate a hypothesis proposed by Solms (2000) to the effect that a forebrain dopaminergic mechanism is the final common path to dreaming. It was hypothesised that sufferers of Parkinson's disease (PO) would have decreased intensity and frequency of dreams - that is that PO disease may lead to cessation or reduced dreaming, reduced duration of dreams, reduced narrative complexity of dream and a change in dream emotion and that this will further decrease with the duration of the disease irrespective of the medication that the patient is taking. Self-report questionnaires (N=40) and the Most Recent Dream Report (Oomhoff, 1996) was used for assessment. PO patients were found to have shorter as well as more pleasant dreams. A correlation (p < .05) was found in the PO sample between duration of illness and emotional quality of dreams and dream duration. The specific hypothesis of the study was not fully supported. However, the findings do support the suggestion that dreaming is generated by the mesocortical-mesolimbic dopamine system

Neuropsychological, functional and behavioural outcome and predictors of outcome in a sample of traumatic brain injury litigants

Includes abstract.Includes bibliographical references (leaves 147-162).Generally, this study aimed to explore whether financial settlement in litigation influences outcome and recovery from closed head injury in a sample of traumatic brain injured (TBI) litigants who were tested and interviewed both during litigation (at time 1, or T1) and 1 year or more after case settlement (at time 2, or T2). More specifically, my major goals were to assess (a) changes between TI and T2 on outcome variables such as neuropsychological test scores and self- and other-reported cognitive function, behaviour, activities of daily living (ADL), and physical dependency (PD), and (b) the impact of demographic (e.g., years of education, employment status) and clinical (e.g., severity of injury, degree of post-traumatic amnesia, Glasgow Coma Scale score) variables on the aforementioned outcome variables

Neurocognitive impairment in treatment-experienced adults living with HIV attending primary care clinics in Zimbabwe

Background HIV affects the central nervous system resulting in HIV associated neurocognitive impairment (NCI) in approximately 50% of people living with HIV. It typically affects memory, learning, working memory, fine motor skills, speed of information processing, verbal fluency and executive functioning cognitive domains. NCI can affect adherence to antiretroviral therapy (ART), employability, driving ability and activities of daily living. NCI is not routinely screened for in Zimbabwe, and the burden is not known in this setting. The objectives of this study were: 1) To determine NCI prevalence using a comprehensive neuropsychological battery at two primary health care clinics in Harare; 2) To assess the pattern of cognitive impairment across cognitive domains using a gold standard neuropsychological (NP) battery in HIV-positive patients compared to HIV-negative controls. Methods Inclusion criteria: 18 years or older; minimum 7 years education; no neurological or psychiatric disorders. HIV-positive participants were on ART for ≥3 months; HIV-negative participants had a confirmed HIV negative status in the past month. A comprehensive NP battery, functional assessments, demographic and medical history questionnaires were administered. The NP battery consisted of tests assessing memory, learning, working memory, fine motor skills, speed of information processing, verbal fluency and executive functioning. Results Two-hundred-and-thirty-one participants were recruited. Of those, 155 were HIV-positive (Female = 70%, Age M = 37.8; SD 11.2) and 76 HIV-negative (Female = 63%, Age M = 31.2; SD 9.9). HIV-positive participants were on ART for an average of 6 years. NCI was present in 49.7% HIV positive participants. Compared to HIV-negative participants, the HIV-positive group had significantly poorer scores in 5 out of 7 cognitive domains. A good level of education is negatively correlated with NCI. Conclusions NCI prevalence in HIV-positive population Zimbabwe is consistent with global estimates. NCI persists in adults who are on ART. Routine assessment of NCI in adults attending primary care clinics using this adapted battery is therefore important so that they are identified early and are provided the necessary interventions

Assessment of neurocognitive deficits in people living with HIV in Sub Saharan Africa: A systematic review.

OBJECTIVE: People living with HIV (PLWH) are at risk for HIV-Associated Neurocognitive Disorders (HAND)/Neurocognitive Impairment (NCI). HIV prevalence in Sub-Saharan Africa (SSA) is high, but neuropsychological screening and testing for NCI among HIV-infected individuals is not done frequently. This systematic review aims to establish how NCI among HIV-infected individuals is being assessed in SSA, if and how the tests are adapted, if norms exist and identify personnel who administer them. METHOD: We searched PubMed, Medline, EBSCO, PsycINFO, and Web of Science. Two reviewers screened the articles for inclusion and risk of bias. We included studies from SSA with a comprehensive neuropsychological assessment battery. RESULTS: We retrieved 212 articles and 23 articles met inclusion criteria. The most commonly used tests were the Color Trails Test 1, Color Trails Test 2, and the WAIS III Digit Symbol Test. Some tests were translated into French (Cameroon), Luganda (Uganda), Chichewa (Malawi), isiXhosa (South Africa), and Afrikaans (South Africa). Some verbal learning tests were adapted to reflect culturally appropriate language. Test administrators were either non-specialized personnel supervised by clinical neuropsychologists or clinical psychologists. CONCLUSION: Overall, the tests used are similar to the tests being used globally to assess NCI among HIV-infected individuals and there is a general consistency across countries. However, there is generally a lack of norms for the tests and the process of adaptation is not always well described. Future research should establish whether these tests measure neuropsychological constructs as successfully as they do in western populations where the tests were developed

Task Shifting and Delivery of Behavioral Medicine Interventions in Resource-Poor Global Settings: HIV/AIDS Treatment in sub-Saharan Africa

sub-Saharan Africa is home to almost three-quarters of all individuals living with HIV/AIDS in the world. Yet, sub-Saharan Africa also has one of the most severe shortages of trained medical and behavioral health care workers in the world to tackle the needs of the huge epidemic. This gap between HIV-related treatment needs and staff resources has presented the need for “task shifting” or “task sharing,” defined as delegating tasks to less specialized health care workers, and/or considering ways of sharing tasks across a clinical team. Task shifting has been a key implementation strategy for increasing access to antiretroviral therapy (ART) to treat HIV/AIDS across sub-Saharan Africa. For behavioral medicine, task shifting can be used for the delivery of behavioral health interventions for HIV medication adherence and co-occurring mental health problems. In this chapter, we aim to demonstrate how the efforts to use task shifting for rolling out ART programs in sub-Saharan Africa can inform behavioral medicine task shifting efforts to expand access to evidence-based ART adherence counseling and mental health interventions in HIV care in sub-Saharan Africa. We focus specifically on examples of task shifting cognitive behavioral therapy (CBT) for ART adherence, depression, and substance use among individuals living with HIV/AIDS in sub-Saharan Africa. Although there have been few examples to date of task shifting CBT in the context of HIV care in sub-Saharan Africa, we use these promising early examples to inform future considerations for adapting and implementing CBT using a task shifting model in this population

HIV testing and sero-prevalence among methamphetamine users seeking substance abuse treatment in Cape Town

Methamphetamine use is highly prevalent in parts of South Africa, and there is concern this will contribute to the country's substantial HIV epidemic. We examined the feasibility of implementing routine HIV testing at a community-based substance abuse treatment centre in Cape Town and determined the HIV sero-prevalence among methamphetamine users seeking treatment at this site. In this cross-sectional study, 293 participants completed measures of demographics, substance use and HIV treatment. HIV sero-prevalence was determined by a rapid finger-prick HIV test, and prior HIV diagnosis was confirmed via clinic records. The majority of participants were male and self-identified as 'Coloured', with a mean age of 28 years. The HIV sero-prevalence was 3.8%. Of the 11 participants who tested HIV positive, four were newly diagnosed. HIV-positive and HIV-negative participants were comparable on demographic and substance use factors. Uptake of HIV testing among all clients at the drug treatment centre increased from <5% prior to study initiation to 89% after study completion. Measures implemented to ensure high rates of HIV testing were regarded as sustainable. Our study suggests that integrating routine HIV testing into substance abuse treatment is feasible in a community-based health centre. The low HIV prevalence among this sample of treatment-seeking methamphetamine users highlights the potential benefits of supporting expanded efforts to optimise HIV prevention with this young adult population. [Gouse H, Joska JA, Lion RR, Watt MH, Burnhams W, Carrico AW, Meade CS. HIV testing and sero-prevalence among methamphetamine users seeking substance abuse treatment in Cape Town. Drug Alcohol Rev 2016;35:580-583]

Cognitive Performance, as well as Depression, Alcohol Use, and Gender, predict Anti-Retroviral Therapy Adherence in a South African Cohort of People with HIV and Comorbid Major Depressive Disorder

Depression and cognitive impairment, which commonly coexist in people with HIV (PWH), have been identified as potential barriers to optimal antiretroviral therapy (ART) adherence. We investigated associations between cognitive performance, depression (as well as other sociodemographic, psychosocial and psychiatric variables) and ART adherence in a South African cohort of PWH with comorbid major depressive disorder (MDD). Cognitive performance and ART adherence were assessed at two time points 8 months apart (N-baseline = 105, Nfollow-up = 81). Adherence was indicated by self-report, objective measures (Wisepill usage and plasma tenofovir-diphosphate levels), and HIV viral suppression. Mixed-effects regression models examined associations across both time points. Univariate models detected no significant associations between cognitive performance (globally and within-domain) and ART adherence. Multivariate modelling showed increased depression severity (beta = - 0.54, p < 0.001) and problematic alcohol use (beta = 0.73, p = 0.015) were associated with worse adherence as measured subjectively. Being female (OR 0.27, p = 0.048) and having better global cognitive performance (OR 1.83, p = 0.043) were associated with better adherence as indicated by viral suppression. This study identifies poor global cognitive performance, as well as depression and problematic alcohol use, as potential barriers to optimal ART adherence in PWH and comorbid MDD. Hence, clinicians could consider assessing for cognitive deficits, depression, and problematic alcohol use, and should endeavour to provide the appropriate support so as to improve adherence

Sex Differences in the Cognitive Performance of a South African Cohort of People With HIV and Comorbid Major Depressive Disorder

Women with HIV (WWH) may be more vulnerable to cognitive impairment than men with HIV (MWH), which may be explained by the direct effects of HIV or by sociodemographic and psychiatric characteristics. We recruited 105 people with HIV (PWH; 76 women) with incomplete antiretroviral therapy adherence, comorbid major depressive disorder, and socioeconomically disadvantaged backgrounds. Participants completed neuropsychological testing and measures gathering sociodemographic, medical, and psychiatric information. We compared WWH and MWH cognitive performance using unadjusted and adjusted regressions, and within each respective group, we explored predictors of cognitive performance. Results showed no significant between-sex differences in cognitive performance, both globally and within domains. Fewer years of education (β = 0.94), illiteracy (β = 4.55), and greater food insecurity (β = −0.28) predicted lower cognitive performance in WWH but not MWH. We conclude that sex differences in PWH are likely due to sample characteristics representing broader inequalities, rather than true biological differences

Tryptophan degradation is associated with risk-taking propensity in methamphetamine users with treated HIV infection

Few studies have examined neuroimmune pathways that could contribute to impulsivity in people living with HIV who use substances. Eighty-four methamphetamine-using, sexual minority men with an undetectable HIV viral load were administered the Balloon Analogue Risk Task (BART), a behavioral measure of risk-taking propensity. We examined the associations between kynurenine/tryptophan ratio and phenylalanine/tyrosine ratio with BART scores using multiple linear regression. A higher kynurenine/tryptophan ratio was independently associated with greater BART scores (Beta = 0.25; 95% CI = 0.05 – 1.23; p = 0.034). The phenylalanine/tyrosine ratio was not significantly associated with BART scores. Findings support the need for further research to elucidate the neuroimmune mechanisms linking tryptophan degradation with impulsivity to catalyze the development novel pharmacologic treatments for people living with HIV who use methamphetamine