Neurocognitive Impairment, HIV and Aging

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Neurocognitive Impairment, HIV and Aging

• Maggie Atkinson
• CWGHR 2009 Forum
• Toronto, ON Canada
• June 13, 2009

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Cognitive impairment in HIV and Aging

• What works?
• My experiences
• Lifestyle changes
• Brain Fitness Program
• Recommendations

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HIV and HAART and NCI

• 3050 PWAs have cognitive impairments
• attention (particularly multi-tasking),
• memory (particularly the efficiency in learning
  new information),
• speed of cognitive processing (how fast a person
  conducts cognitive tasks)
• and fine-motor skills
• Some ART dont cross blood/brain barrier
• 30 on HAART may have some cognitive impairment

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Aging and Cognition

• Aging causes Neurocognitive Decline
• reduces cognition, memory, fine motor control,
  usable field of vision (UFOV), brain mass
• Mild Neurocognitive Impairment
• Cognitive symptoms difficulty with memory,
  including trouble remembering names, misplacing
  items, forgetting details of conversations, etc

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Complex
AGE
HAART
HIV
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What can help the Brain?

• Whatever helps the heart
• Lifestyle strategies
• Diet, exercise, not smoking, stress- management,
  rest
• But alcohol associated with ? brain volume
• Paul CA, Arch Neurol 2008(10)1363-1367

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Lifestyle Change Sources

• Pritikin Longevity Center, FL
• The Pritikin Edge, Dr. Robert Vogel
• Dr. Dean Ornish, Preventive Medicine Research
  Institute
• The Spectrum Reversing Heart Disease
• Everyday Cooking with Dr. Dean Ornish

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Lifestyle Changes

• Diet fruits, vegetables, beans, soy, fish, whole
  grains, no added fat, non-fat dairy, no added
  salt, little or no coffee and alcohol
• Vitamin D 1000-2000 IU/day
• Exercise 6-7 days/week cardio, resistance,
  flexibility
• Stress management meditation, yoga,

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Results of Pritikin Program

• 23 decrease in cholesterol and LDL
• 39 decrease in C-reactive protein
• 30-46 decrease in insulin levels
• 50 reversed Metabolic Syndrome
• 83 of hypertensives achieved normal BP

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What do we know about the Brain?

• Strategies --symptoms, not cause
• e.g., memory aides, lists
• Myth the brain cant grow or change
• Brain is plastic
• David Doidge, The Brain that Changes Itself

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PositScience.com

• Michael Merzenich, founder
• Brain Fitness Program Classic - auditory
• Insight Program visual cortex
• Improves brain processing and memory in seniors

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Brain Fitness Program Classic

• Self administered
• Computer program
• 40 one hour sessions
• 1 hr/day, 5 days/week
• 8 weeks

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IMPACT Study (Improvements in Memory with
Plasticity-based Adaptive Cognitive Training)

• Randomized, controlled, double blinded,
  multi-center, prospective
• Mayo Clinic, UCSF, Smith GE,
• J. Am. Geriatr. Soc. 2009 Apr 57(4)594-603
• 524 healthy adults, aged 65-94

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IMPACT Results

• 131 increase in brain processing speed
• Improved memory by ten years
• Got better at tasks in BFP
• Improvements generalized to multiple standard
  memory tests
• 75 pts self reported positive changes

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My Results with BFP

• 54 increase in brain processing speed
• Better word recall, short term memory
• Improved hearing
• Improved handwriting
• Improved self confidence

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Cognitive Rehabilitation in HIV/AIDS A Case
Study Demonstrating the Benefits of the Brain
Fitness Program

• S.B. Rourke, T. Sota, S. Rueda, M. Atkinson, CAHR
  2009, Poster
• 52 yr old gay male, NCI
• Battery of neuropsych tests pre- and post- BFP
• 34 increase in brain processing speed on BFP
• Self reported improved long and short term
  memory, multi-tasking, dexterity

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Cognitive Abilities Pre- and Post-
InterventionS.B. Rourke, T. Sota, S. Rueda, M.
Atkinson, Cognitive Rehabilitation in HIV/AIDS ,
CAHR 2007
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Best for Brain Health

• Progressively challenging
• Mentally Rewarding
• Novel or surprising
• Demanding of focused attention

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Recommendations

• Learn to play music
• Learn a language
• Jigsaw puzzles, 500 pieces
• Play ball, or even juggle
• Crochet or knit
• Use your other hand
• Dancing waltz vs. tango lessons study
• Bridge, crossword puzzles up the ante

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Recommendations

• Study of Brain Fitness Program in HIV
• Studies needed in strategies that have worked in
  age-related NCI
• HAART regimens include drugs that cross
  blood/brain barrier when possible