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Living with HIV
Post-exposure prophylaxis (PEP)
History of neuropsychology
Soviet psychologist Alexander Luria (902-1977) coined the term “neuropsychology” in the 1950s. This psychological approach was first used on patients suffering from pathologies affecting the brain. According to Henri Hécaen, neuropsychology is a discipline that looks at superior mental functions as they relate to the brain’s structure.
Superior mental functions are, by analogy with a computer tower, the material (hard drive, memory card, wiring, etc.) that makes it possible for people to hear, listen, perform tasks, carry out projects, drive a car, play a musical instrument, experience emotions, learn new information, etc. In neuropsychology, all these are processes that pertain to neurology, cognitive functions, affect, personality and mental development.
To arrive at an understanding of these processes, the neuropsychologist uses tests that have been previously administered to people of different ages, genders and cultures. These tests are designed in such a way as to take into account education level and sometimes the environment (rural versus urban). The goal of the neuropsychologist is to find people’s strengths and weaknesses.
There are three possible diagnoses:
HIV associated neurocognitive disorders
Asymptomatic neurocognitive impairment
Mild neurocognitive disorder
This diagram presents the proportion of people with the neurocognitive difficulties that we call HAND. HAND affects from 23 to 69% of the HIV-positive population. It is divided into the following three categories: ANI, from 21 to 30%; MND, from 5 to 12%; HAD, from 1 to 2%. (Antorini et al, Neurology 2007).
As for every disease, there are comorbidities associated with HAND (e.g., alcohol or drug abuse, a stroke, anxiety or depression) that have an effect on cognitive capacities. These comorbidities make it difficult to establish a diagnosis of HAND.
You may wonder whether you are going to increasingly lose your mental faculties (such as memory). It may help to keep in perspective that as we age, our brains slow down, because we are losing brain cells. That process is normal. For people living with HIV, current research indicates that the evolution is not progressive. This means that if you are diagnosed with MND, it is possible that, with good medical care and by taking your antiretrovirals regularly, you will return to an almost normal and functional cognitive state. In fact, scientists say that the symptoms of cognitive difficulties can be mitigated.
— Dr. Emmanuel Tremblay, Ph.D., neuropsychologist