1 Oral Communication: COGNITIVE REHABILITATION IN HIV PATIENTSOral Communication: COGNITIVE REHABILITATION IN HIV PATIENTS. PILOT STUDY García-Torres A1,2, Vergara-Moragues E2,3, Piñón-Blanco A4, Vergara-de Campos A2, Pérez-García M1 1Centro de investigación Mente, Cerebro y Comportamiento (CIMCYC). Universidad de Granada. 2 Hogar GERASA. Unidad de enfermedades infecciosas Hospital de Puerto Real(Cádiz). 3 Departamento de Educación. Universidad Internacional de la Rioja (UNIR). 4 Unidad Asistencial de drogodependencias del Concello de Vigo-CEDRO.
2 BACKGROUND Cognitive neurorehabilitation: useful in other samples with cognitive impairment. brain injury (Cicerone et al., 2011) schizophrenia (Dickinson et al., 2010) Few studies in HIV population. Increased risk of mortality (Lescure et al., 2011) HAND Job loss (Rueda et al., 2010) Difficulties in daily functioning (Letendre et al., 2010) Quality of life (Tozzi et al., 2004) Reduced adherence to treatment (Waldrop-Valverde, 2014) Higher probability of dementia (Dore et al., 2000)
3 BACKGROUND Cognitive intervention studies in HIV patients SampleEvaluation design N Duration Boivin et al., 2010 Children computerized randomized 60 (28 VIH+ control, 32 VIH+ experimental) 10 sessions Vance et al., 2012 Middle-age and older Adults 46 (22 VIH+ experimental, 24 VIH+ control) Becker et al., 2012 Adults 60 (30 VIH+, 30 VIH-) 24 weeks
4 BACKGROUND Exploratory study The purpose of this exploratory study was to obtain pilot data from a group of HIV patients on the feasibility and efficacy of the neuropsychological program to determinate whether a larger, randomized trial is warranted. Participants were recruited in Gerasa (Infectious Diseases Unit, Hospital Puerto Real, Cádiz). Instruments: Neuropsychological battery, quality of life (MOS VIH), cognitive complaints, psychiatric symptoms (Anxiety and depressive scale (HADS), instrumental daily living questionnaire. García-Torres, A., Vergara-Moragues, E. y Vergara-Moragues, A.(2014). Proyecto GALA: un estudio piloto de evaluación e intervención neuropsicológica en el Hogar GERASA,. En A. Piñón (Ed.). Juegos terapéuticos: El Trisquel. Concello de Vigo. ISBN Vergara-Moragues E., García-Torres A., Pérez-García M. (2014, abril). Alteraciones neuropsicológicas y funcionales en personas con problemas de consumo de sustancias y VIH, ¿es posible la intervención para su mejora?. Comunicación presentada en las XLI Jornadas nacionales de Socidrogalcohol. Sevilla.
5 Exploratory study 26 patients in GERASA Meet inclusion criteria Yes No14 Baseline assesment 12 Exclusion Control group 7 patients Experimental group 7 patients Experimental mortality Post-test assesment 3 months: 4 patients Experimental mortality Post-test assesment 3 months: 4 patients 3 derivations to another resource 2 derivations and 1 exitus
6 BACKGROUND Exploratory study. Conclusions Comparing the initial assessments of each subject with the final assesment, we note that the subjects in the experimental group improved more than the control in cognitive complaint, cognitive functioning and quality of life. Qualitatively, the implementation of the program has been very positive in the dynamic center.
7 BACKGROUND Current study. Objectives To determine the effectiveness of implementing a neuropsychological program in people with HIV. - Study the relationship between cognitive impairment and adherence to treatment. - Study the relationship between cognitive complaints and cognitive impairment. - Study possible interactions between cognitive functioning, everyday functioning and quality of life.
8 METHODS Randomized, prospective study.Participants are recruited in Infectious Diseases Unit, Hospital Puerto Real, Cádiz. Exclusion criteria: Illiterate Psychiatric disorders Current/active CNS opportunistic infections Deaf or blind History of neurological disease including dementia Previous head trauma Currently or recently in methadone maintenance programs. Currently or recently in treatment with interferon for Hepatitis C. Inclusion criteria: - Age 18 to 65 years HIV Proficient in Spanish No active drug/alcohol abuse or dependence Informed consent
9 METHODS Variables: Demographic (age, gender, marital status, socioeconomic status, education level, criminal record, family support). Clinical (time since HIV diagnosis, CD4 cell count, viral load and antiretroviral treatment). By physician. Psychological Cognitive complaints (by self-reported check list. 7 areas: Concentration, reasoning, memory, learning, planning, communication, hand movements) Depression and anxiety symptoms : Anxiety and depressive scale (HADS). By self-reported. Quality of life: MOS-HIV questionnaire. By self-reported. Instrumental activities of daily living (IADL) questionnaire. By self-reported. Treatment adherence scale: SERAD 1.1. By self-reported.
10 METHODS Neuropsychological Battery Cognitive Domains TestsAttention/working memory - d2 - Digits (WMS) Memory and learning España-Complutense Verbal Learning Test (TAVEC) Brief Visuospatial Memory Test Revised (BVMT-R) Speed information processing - Symbol Digit Modalities Test - Trail Making Test A Executive functions - Tower of London Five Digits Trail Making Test B Language - Fhonetic verbal fluency: PMR - Semantic verbal fluency: Animals Motor skills - Grooved Pegboard - Tapping Test Cognitive reserve: Vocabulary (WAIS)+ school years
11 METHODS. Contact patients. Checkout inclusion/exclusion criteria. Informed consent Screening: NEU - + Baseline assesment: 200 patients Exclusion - ANI NMD HAD + Exclusion HAND IADL Participants randomized Experimental group: Neuropsychological program (50 patients) Control group: no therapeutic activities (50 patients) Post-test assesment 3 months Follow-up assesment 6 months
12 METHODS Intervention Program 36 sessions (3 per week)Adressed by a neuropsychology Therapeutic games (Multitasking Cubes, Trisquel), computerized software. All sessions structured “Trisquel” (Piñón-Blanco, 2009) “Multitasking Cubes” (Piñón-Blanco, 2010)
13 METHODS Intervention Program Therapeutic Module Issues to workNumber of sessions Self-awareness Impact of deficits in daily life Adjustment expectation of future 12 Restorative and compensatory techniques Attentional subsystems Work memory Memory subsystems Executive functions and emotions Decisions making Impulsivity Problem solving Emotional recognition
14 CONCLUSIONS The results of the exploratory study show that it is possible to use this type of neuropsychological program with HIV patients. Our experience shows that the therapeutic games can be a dynamic tool to treat cognitive impairment and improve quality of life in HIV patients. We are currently conducting the study with a large sample.
15 Acknowledgements: Dra. Esperanza VergaraUniversidad Internacional de la Rioja. UEI Hospital Puerto Real Dr. Miguel Pérez García y grupo de investigación Neuropsicología e Neuroinmunología Clínica. Universidad de Granada Adolfo Piñón y el equipo de CEDRO Dr. Antonio Vergara de Campos y UEI Hospital Puerto Real
16 Acknowledgements: Equipo terapéutico y pacientes de GERASA y Hospital de Puerto Real (Cádiz) Colaboradores externos: Dr. Jose Antonio Muñoz Moreno (Fundació Lluita contra la SIDA; Hospital Germans Trias i Pujol, Barcelona) Dr. Ignacio Valero (Hospital La Paz, Madrid) Alicia González (Hospital La Paz, Madrid)