NEU screen shows high accuracy in detecting cognitive impairment in older persons living with HIV

The NEUrocognitive (NEU) Screen is a practical tool proposed to screen for HIV-associated cognitive impairment in the clinical setting. This is a pencil-and-paper method that can be applied rapidly (<=10 minutes for administration) and has no copyright limitations. In this study, we aimed at investigating its diagnostic accuracy in an older population of persons living with HIV (PLWH), with cutoffs set at 30, 40, 50, and 60 years. Data were collected from a sample of 368 PLWH who underwent a comprehensive neuropsychological tests battery (gold standard). Results of statistical tests showed that accuracy of the NEU Screen increased with age of the participants. The highest degree of precision, with a sensitivity of 91% and specificity of 92%, was obtained for people ages 60 years or older (correct classification: 91%). These optimal results point to the great potential of the NEU Screen as a tool for detecting cognitive disorders in older PLWH

A “HOLTER” for Parkinson's disease: validation of the ability to detect on-off states using the REMPARK system

The treatment of Parkinson's disease (PD) with levodopa is very effective. However, over time, motor complications (MCs) appear, restricting the patient from leading a normal life. One of the most disabling MCs is ON-OFF fluctuations. Gathering accurate information about the clinical status of the patient is essential for planning treatment and assessing its effect. Systems such as the REMPARK system, capable of accurately and reliably monitoring ON-OFF fluctuations, are of great interest. Objective To analyze the ability of the REMPARK System to detect ON-OFF fluctuations. Methods Forty-one patients with moderate to severe idiopathic PD were recruited according to the UK Parkinson's Disease Society Brain Bank criteria. Patients with motor fluctuations, freezing of gait and/or dyskinesia and who were able to walk unassisted in the OFF phase, were included in the study. Patients wore the REMPARK System for 3 days and completed a diary of their motor state once every hour. Results The record obtained by the REMPARK System, compared with patient-completed diaries, demonstrated 97% sensitivity in detecting OFF states and 88% specificity (i.e., accuracy in detecting ON states). Conclusion The REMPARK System detects an accurate evaluation of ON-OFF fluctuations in PD; this technology paves the way for an optimisation of the symptomatic control of PD motor symptoms as well as an accurate assessment of medication efficacy.Peer ReviewedPostprint (published version

Estrategias de manejo clínico de los trastornos cognitivos en personas con el VIH-1

El VIH penetra al sistema nerviós central (SNC) en els primers dies després de la infecció sistèmica i duu a terme una invasió que pot produir dany o disfunció neuronal i, com a conseqüència, trastorns cognitius. Malgrat l'ús del tractament antiretroviral, els trastorns cognitius en persones amb VIH són freqüents i la majoria d'estudis mostren que entre un 20-50% de les persones que viuen amb el VIH (PVIH) els continuen desenvolupant. Aquestes alteracions s'han vinculat a una pitjor qualitat de vida, pitjor funcionament a la vida diària, majors taxes d'atur, major ús de recursos del sistema de salut, pitjor adherència a la teràpia antiretroviral i, fins i tot, un major risc de mortalitat. Per tot això, la seva detecció, prevenció i tractament haurien de ser prioritaris. La detecció i el monitoratge dels trastorns cognitius en les PVIH poden oferir avantatges clínics per a les persones que els experimenten. Actualment, però, el seu diagnòstic implica recursos humans i econòmics i no disposem d'estratègies terapèutiques amb suficient evidència científica de la seva eficàcia. És per aquests motius que aquesta tesi doctoral pretén augmentar el coneixement actual sobre els procediments per a la detecció dels trastorns cognitius en persones amb VIH, així com sobre possibles estratègies terapèutiques. Amb aquesta intenció s'han portat a terme tres estudis. El primer avalua la precisió d'una eina de cribratge, el NEU Screen, per a la detecció de trastorns cognitius en PVIH en diferents grups d'edat. El segon investiga l'impacte sobre el SNC d'una estratègia de tractament basada en el començament de la teràpia antiretroviral durant la infecció recent (<3 mesos des de la data estimada de transmissió). El tercer examina l'eficàcia i seguretat de dos tractaments coadjuvants, el liti i la rivastigmina transdèrmica, per a la millora dels trastorns cognitius associats al VIH.El VIH es capaz de penetrar en el sistema nervioso central (SNC) en los días siguientes a la infección sistémica, producir una invasión que puede originar daño o disfunción neuronal y como consecuencia trastornos cognitivos. A pesar del uso del tratamiento antirretroviral, los trastornos cognitivos en personas que conviven con el VIH (PVIH) son frecuentes y la mayoría de los estudios muestran que entre un 20-50% de las PVIH los desarrollan. Dichas alteraciones se han vinculado con una peor calidad de vida, peor funcionamiento en la vida diaria, mayores tasas de desempleo, mayor uso de recursos del sistema de salud, peor adherencia a la terapia antirretroviral, así como un mayor riesgo de mortalidad. Es por eso que la detección, prevención y tratamiento de estos trastornos deberían ser prioritarios. La detección y monitorización de los trastornos cognitivos en PVIH podrían ofrecer ventajas clínicas para las personas que los experimentan. Sin embargo, actualmente su diagnóstico implica recursos humanos y económicos importantes y no disponemos de estrategias terapéuticas con suficiente evidencia científica de su eficacia. Esta tesis doctoral pretende aumentar el conocimiento actual sobre los procedimientos para la detección de los trastornos cognitivos en PVIH, así como sobre sus estrategias terapéuticas. Con esta intención se han realizado tres estudios. El primero evalúa la precisión de una herramienta de cribado, el NEU Screen, para la detección de trastornos cognitivos en PVIH en diferentes grupos de edad. El segundo investiga el impacto sobre el SNC de una estrategia de tratamiento basada en el inicio temprano de la terapia antirretroviral. El tercero examina la eficacia y la seguridad de dos tratamientos coadyuvantes, el litio y la rivastigmina trasdérmica, para la mejora de los trastornos cognitivos asociados al VIH.HIV can penetrate the central nervous system (CNS) in the first days after systemic infection and carry out an invasion that can cause neuronal damage or dysfunction and consequently cognitive disorders. Despite the use of antiretroviral treatment, cognitive disorders in people living with HIV (PLWH) are frequent and the studies show that 20-50% of PLWH can develop them. These alterations have been linked to a poorer quality of life, worse functioning in daily living, higher unemployment rates, greater use of health system resources, poorer adherence to antiretroviral therapy and higher risk of mortality. For these reasons, detection, prevention and treatment of these disorders should be a priority. Detection and monitoring of cognitive disorders in PLWH could offer clinical advantages for people who experience them. However, its diagnosis currently involves significant human and financial resources and we do not have therapeutic strategies with sufficient scientific evidence of its efficacy. This doctoral thesis aims to increase the current knowledge on the procedures for the detection of cognitive disorders in PLWH as well as on their therapeutic strategies. Three studies have been carried out. The first evaluates the precision of a screening tool, the NEU Screen, for the detection of cognitive disorders in PLWH in different age groups. The second investigates the impact on the CNS of a treatment strategy based on the early initiation of antiretroviral therapy. The third examines the efficacy and safety of two adjuvant treatments, lithium and transdermal rivastigmine, for the improvement of cognitive disorders associated with HIV

A “HOLTER” for Parkinson's disease: validation of the ability to detect on-off states using the REMPARK system

The treatment of Parkinson's disease (PD) with levodopa is very effective. However, over time, motor complications (MCs) appear, restricting the patient from leading a normal life. One of the most disabling MCs is ON-OFF fluctuations. Gathering accurate information about the clinical status of the patient is essential for planning treatment and assessing its effect. Systems such as the REMPARK system, capable of accurately and reliably monitoring ON-OFF fluctuations, are of great interest. Objective To analyze the ability of the REMPARK System to detect ON-OFF fluctuations. Methods Forty-one patients with moderate to severe idiopathic PD were recruited according to the UK Parkinson's Disease Society Brain Bank criteria. Patients with motor fluctuations, freezing of gait and/or dyskinesia and who were able to walk unassisted in the OFF phase, were included in the study. Patients wore the REMPARK System for 3 days and completed a diary of their motor state once every hour. Results The record obtained by the REMPARK System, compared with patient-completed diaries, demonstrated 97% sensitivity in detecting OFF states and 88% specificity (i.e., accuracy in detecting ON states). Conclusion The REMPARK System detects an accurate evaluation of ON-OFF fluctuations in PD; this technology paves the way for an optimisation of the symptomatic control of PD motor symptoms as well as an accurate assessment of medication efficacy.Peer Reviewe