• Reminder of vaccination (3rd dose)

    To ensure the effectiveness of vaccination against hepatitis A and B (Twinrix), three (3) doses are required :


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  • Affiliée à
    HIV and Neurocognitive Disorders

    Neuropsychology in Brief

    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.

    1. Neurological aspects (e.g., haemorrhage, stroke, tumour, etc.)
    2. Cognitive functions:
      1. Attention span (ability to reach a sufficient level of alertness to be capable of concentrating in a variety of situations). For example: I find it difficult to concentrate.
      2. Executive functions (process necessary for all behaviour that is autonomous and adapted to new or complex situations). For example: Going to do grocery shopping, driving a car.
      3. Mnestic functions (memory of facts, the knowledge or skills accumulated over the years). For example: I forgot where I parked my car; what was I coming to look for in the kitchen?
      4. Perception and orientation (representation and analysis of form, colour, depth, distance and the orientation of objects as well as their relationship in space). For example: perceiving one's environment.
      5. Motor skills (organization and control of body movements). For example: handling objects, drying one's hair, cutting vegetables.
      6. Language (ability to understand and to express an idea by writing or speaking).
    3. Affect (emotions, depression, anxiety, etc.)
    4. Personality (dependent, obsessional, narcissistic, borderline, antisocial, etc.)
    5. Development, both normal and abnormal, of an individual.

    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.

    Classification of HIV associated neurocognitive disorders (HAND)

    There are three possible diagnoses:

    • Asymptomatic neurocognitive impairment (ANI) is an absence of a decline in daily life. “Doctor, I feel very well and I don't understand why I have to keep taking my drugs.”
    • Mild neurocognitive disorder (MND) is a slight to moderate deficit affecting daily life and cognitive functions. "Doctor, I often forget things. At work it's okay, but not like before."
    •  HIV-associated dementia (HAD) is the most severe condition affecting daily life and cognitive functions. "Doctor, I lost my job and I'm having trouble figuring out my finances. I lose things and I find it hard to concentrate. When I talk, I have to search for my words."

    HIV associated neurocognitive disorders

    Asymptomatic neurocognitive impairment

    Mild neurocognitive disorder

    HIV-associated dementia

    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).

    Issues involved with a diagnosis of HAND

    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 



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