Neurocognitive impairment plagues older PLHIV

Healthcare providers and other care partners need greater awareness and training on neurocognitive impairment, mental health, and comorbidities that afflict older people living with HIV (PLHIV), suggests a Singapore study.

“With improved survival among PLHIV, many are confronted with age associated comorbidities and geriatric syndromes,” the researchers said. “Neurocognitive impairment is one of the three most frequent conditions that affect quality of life of PLHIV despite achieving viral suppression.”

The database of PubMed was searched for articles and clinical guidelines from September 2021 to August 2022 using a combination of keywords associated with neurocognitive impairment in PLHIV. The researchers then reviewed citations from selected articles for additional studies.

Older PLHIV were usually frailer than their uninfected counterparts, afflicted with comorbidities, and at higher risk of cognitive impairment. Causes for such impairment were multifactorial, multidimensional, and complex. [Proc Singap Healthc 2023;doi:10.1177/20101058231160605]

To manage neurocognitive impairment in older PLHIV, the researchers suggested identifying and improving predisposing factors, physical function, social, and psychological health with appropriate care navigation, which would only be possible through interdisciplinary collaboration among stakeholders.

Education, research, and collaboration among physicians from different specialities (ie, neurology, infectious disease, geriatric medicine, psychiatry, and family medicine), HIV specialty nurses, allied health professionals, and community partners could improve diagnosis and treatment, leading to better management of neurocognitive impairment in this population, according to the researchers.

“Although there are many factors that affect health-related quality of life of PLHIV, neurocognitive impairment is like ‘a fog that impacts everything’,” they said. Neurocognitive impairment, along with its associated behaviour and psychological symptoms, could prevent an individual to do self-care and manage activities of daily living. [Qual Life Res 2022;31:3019-3030]

“Therefore, it becomes very challenging for PLHIV to maintain employment, manage chronic medical conditions and medications. The problem is compounded with the lack of comprehensive care to meet the needs of PLHIV, resulting in poorer quality of care and health outcomes,” the researchers noted.

Challenges

Current practices in Singapore involve annual screening of chronic diseases by infectious disease physicians for older PLHIV in addition to managing HIV disease and opportunistic infection. Appropriate vaccination is also provided in accordance with local and international guidelines.

PLHIV are referred to a cognitive specialist when the patients themselves, their families, or physician report cognitive difficulties. However, challenges in the management of neurocognitive impairment in the older PLHIV exist, according to the researchers.

First, it is difficult to integrate screening for neuro-cognition and psychiatric conditions, with limited consultation time and resources for the primary clinician. Second, aetiological factors need assessment, which can be time consuming as well. Finally, older PLHIV have several comorbidities and complex management issues.

“They tend to present with multiple geriatric syndromes, including impaired cognition and mental health, which complicates the management of any condition in this population,” the researchers said. [J Acquir Immune Defic Syndr 2015;69:161-167]

“These individuals would benefit from comprehensive assessments, referral to other services as required, case management, further health investigations and in-clinic advice,” they added. [Brain Sci 2019;9:37]