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Cognitive Rehabilitation Protocol in HIV/AIDS outpatients with ANI and MND: results and clinical applicability
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Reported by Jules Levin
CROI 2013
Alessandro Livelli12, Gian Carlo Orofino1, Lorenzo Pia3, Sinibaldo Carosella1, Mariana Farenga1, Valeria Ghisetti1, Andrea Calcagno3* and Pietro Caramello1
1. Division A of Infectious Diseases Amedeo di Savoia Hospital Turin;; 2. CRT-Giovanni Goria Foundation ;; 3. Dep. of Psychology, University of Turin, 3* Infectious Diseases Unit University of Turin
ABSTRACT
Background
By reason of proven effectiveness of cognitive rehabilitation in individuals with acquired brain damage, in our study we applied this method to HIV/AIDS patients with ANI or MND to improve their cognitive functioning.
Methods
234 HIV+ outpatients (167-71,4% male, 67-28,6% female, average age 50,47) were enrolled consecutively between 9/2011 to 06/2012. Entry criteria included: at least 6 months of treatment, stabilized clinical parameters, good knowledge of Italian, no comorbidity with psychiatric path. Alzheimer, encephalopathy, brain injuries, vascular disease, or current drugs abuse. 30 HAND patients (21 males, 9 female; median age 50 yrs, median CD4 count 595/μl, CDC disease stage was: 3 A, 13 B, 14 C, all patients HIV-RNA undetectable) were included in the study and divided into 2 groups: the experimental group (treatment N=15), group A, and the control group (no-treatment N=15), group B.
The project provided 5 steps: NC screening with MMSE and IHDS; NP test (T0); NP treatment for group A, standard of care for controls (gr. B);; NP Re-test for both groups (T1); follow-up at 3 months after treatment for group A (T2).
The rehabilitation has provided for a period of 3 months for a total of 36 sessions, and has been implemented through the use of specific computerized software (COG.I.T.O., NeuroVR), PC exercises and specific paper-pencil exercises. To test the hypothesized differential improvement between two groups, we compared the results of the two samples to the battery of NP tests at T0 and T1, with the help of statistical technique repeated measures ANOVA and post-hoc Bonferroni test surveys.
Results
The group A showed a significant improvement at T1, while group B showed a deterioration of neurocognitive performance at the same time; in 7 NP test was a significant difference between the 2 groups (Figure 2:RD: Rey auditory verbal learning test; VS: Verbal Span;; ROc-ROd: Rey-Osterrieth complex figure test copy-delayed recall;; FAB: Frontal Assessment Battery;; PVF: Phonemic Verbal Fluency.).
The subjects treated no longer meets the criteria for the diagnosis of hand into T1. The improvement occurred in T1 is persistent at followup.
Conclusions
Although the small number of patients, data clearly show the effectiveness of rehabilitation protocol clinical experience, thus identifying an intervention strategy effective in the treatment of ANI and MND.
References
1. Heaton RK, Clifford DB, Franklin DR JR, et al. HIV-associated neurocognitive disorders persist in the era of potent antiretroviral therapy: CHARTER study. Neurology. 2010;75:208796.
2. Giunta B, Ehrhart J, Obregon DF, et al. Antiretroviral medications disrupt microglial phagocytosis of -amyloid and increase its production by neurons: implications for HIV-associated neurocognitive
disorders. vol Brain. 2011 Jun 7;4(1):23.
3. National Institute of Health, National AIDS Center. Italian Guidelines use of antiretroviral drugs and the diagnostic-clinical management of people infected with HIV-1. July 2012.
http://www.salute.gov.it/imgs/C_17_pubblicazioni_1793_allegato.pdf (19.07.2012).
4. Cicerone KD, Langenbahn DM, Braden C, Malec JF, Kalmar, K , Fraas M, Felicetti T, Laatsch L, Harley JP, Bergquist T, Azulay J, Cantor J, Ashman T. Evidence-Based Cognitive
Rehabilitation: Updated Review of the Literature From 2003 Through 2008 Arch Phys Med Rehabilitation 2011 Apr;92(4):519-30.
5. Berlucchi G., Brain plasticity and cognitive neurorehabilitation. Neuropsychological rehabilitation 2011; 21: 570-78.
6. Riva G, GaggioliA, Grassi A,Raspelli S, Cipresso P, Pallavicini F, Vigna C, Gagliati A, Gasco S, Donvito G. NeuroVR 2--a free virtual reality platform for the assessment and treatment in
behavioral health care. Studies in health technology and informatics 2011; 163; 493-5.
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