(PS6-86) Utility in psychological assessment and imaging in the diagnosis and treatment of HIV-associated neurocognitive disorder (HAND)

Abstract Text: This case study compares two neuropsychological profiles: a diagnosed HIV-associated neurocognitive disorder (HAND) and one without HAND. Both underwent psychological testing using the Wechsler Abbreviated Scale of Intelligence (WASI-II) and the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) to evaluate cognitive functioning. The evaluation included additional psychosocial factors and medication adherence in the evaluation. Neuroimaging confirmed HAND. CBT interventions to address specific cognitive deficits are highlighted. The first case is a 45-year-old white male HIV+ for 15 years with poor medication adherence. Patient reported difficulty with memory and attention and denied additional mental health concerns. Psychological testing revealed significant deficits in processing speed, memory, and executive function on the WASI-II. Additionally, the RBANS indicated severe deficits in delayed memory and visuospatial ability, all suggestive of the cognitive profile seen in HAND. Neuroimaging in this case revealed signs of atrophy and reductions in the volume of the hippocampus and frontal lobe. These data together were critical in confirming the diagnosis. The second case is a 63-year-old Hispanic male HIV+ adherent to medication. His data on the WASI-II showed intact cognitive function, with slight reductions in delayed memory and visual-spatial skills but no significant deficits. The RBANS results indicated difficulties with delayed memory and attention. Patient had a long-standing history of anxiety, poor sleep, high caffeine usage, and unmanaged cholesterol. His mental health history indicated there are several confounding variables that may better explain neurocognitive impairment. Neuroimaging did not show signs of atrophy or other abnormalities. Cognitive Behavioral Therapy (CBT) targeted interventions are essential for both cases. In the HAND case, CBT aimed at improving executive functioning, memory strategies, and coping skills. The therapy could also address adherence issues, improving the patient’s commitment to ART, thereby potentially reducing further neurocognitive decline. For the non-HAND case, CBT is used to enhance stress management, promote cognitive stimulation strategies, and ensure sustained adherence to ART to prevent any future cognitive deterioration. In conclusion, the neuropsychological testing, neuroimaging, and psychosocial factors all play pivotal roles in the assessment and treatment of cognitive impairment in individuals living with HIV. The comparison between these two cases highlights the importance of consistent medication adherence, psychosocial factors, and the utility of neuropsychological and imaging assessments in diagnosing and monitoring HAND. Moreover, targeted interventions, particularly CBT, can significantly improve outcomes by addressing specific cognitive deficits and barriers to care.