2019 Ryan White HIV/AIDS Program CLINICAL CONFERENCE

Neuropsychological Testing

 Considerable overlap between HAND and Alzheimer’s disease 1,2  Cannot rely on cortical vs. sub- cortical pattern - Memory is one of many domains that can be perturbed in HAND 3 - Encoding vs. retrieval of informationmay help distinguish - Error-prone/impulsive in HAND confounds recognition memory

MoCA:errors due to impulsivity and executive planning (trails, cube, clock), flat learning curvewith OKmemory, phonemic fluency not great

1.Rubinetal JNeurovirol2019;2.Milanininetal;CurrentHIV/AIDSRpts32017;3.WoodsetalNeuropsychologyReviews2009

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Structural Brain Imaging

• Machine learning approach to differentiate 15 HAND vs. 80 Mild Cognitive Impairment due to Alzhiemer’s disease • Eight regions show promise to differentiate HAND from MCI (machine learning was >90% accurate)

Zhang etal,HamanBrainMapping2016

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CSF Alzheimer’s disease biomarkers Insufficient to differentiate HAND from AD

 Patients with HIV dementia have abnormalizes in a-beta, t- tau, and p-tau similar to AD 1

 Some a-beta and tau alterations in HIV dementia 2

 Amyloid-beta alterations in HAND similar to mildAD, total tau measures may help differentiate 3  Substantial overlap in a-beta and t- tau, p-tau measures may help differentiate 4

GisslenetalBMCNeurology2009;

1.BrewNeurology2005;2.GisslenetalBMCNeurology2009;Cliffordetal,Neurology2009;4.Krutetal JNeurolo2012

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