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Neuropsychological tests associated with symptomatic HIV-associated neurocognitive disorder (HAND) in a cohort of older adults in Tanzania
- Lachlan Fotheringham, Rachael A. Lawson, Sarah Urasa, Judith Boshe, Elizabeta B. Mukaetova-Ladinska, Jane Rogathi, William Howlett, Marieke C.J. Dekker, William K. Gray, Jonathan Evans, Richard W. Walker, Philip C. Makupa, Stella-Maria Paddick
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- Journal:
- Journal of the International Neuropsychological Society , First View
- Published online by Cambridge University Press:
- 20 May 2024, pp. 1-11
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- Article
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Objective:
Human immunodeficiency virus (HIV)-associated neurocognitive disorder (HAND) prevalence is expected to increase in East Africa as treatment coverage increases, survival improves, and this population ages. This study aimed to better understand the current cognitive phenotype of this newly emergent population of older combination antiretroviral therapy (cART)-treated people living with HIV (PLWH), in which current screening measures lack accuracy. This will facilitate the refinement of HAND cognitive screening tools for this setting.
Method:This is a secondary analysis of 253 PLWH aged ≥50 years receiving standard government HIV clinic follow-up in Kilimanjaro, Tanzania. They were evaluated with a detailed locally normed low-literacy neuropsychological battery annually on three occasions and a consensus panel diagnosis of HAND by Frascati criteria based on clinical evaluation and collateral history.
Results:Tests of verbal learning and memory, categorical verbal fluency, visual memory, and visuoconstruction had an area under the receiver operating characteristic curve >0.7 for symptomatic HAND (s-HAND) (0.70–0.72; p < 0.001 for all tests). Tests of visual memory, verbal learning with delayed recall and recognition memory, psychomotor speed, language comprehension, and categorical verbal fluency were independently associated with s-HAND in a logistic mixed effects model (p < 0.01 for all). Neuropsychological impairments varied by educational background.
Conclusions:A broad range of cognitive domains are affected in older, well-controlled, East African PLWH, including those not captured in widely used screening measures. It is possible that educational background affects the observed cognitive impairments in this setting. Future screening measures for similar populations should consider assessment of visual memory, verbal learning, language comprehension, and executive and motor function.
Four - Socialising heritage/socialising legacy
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- By Martin Bashforth, Mike Benson, Tim Boon, Lianne Brigham, Richard Brigham, Karen Brookfield, Peter Brown, Danny Callaghan, Jean-Phillipe Calvin, Richard Courtney, Kathy Cremin, Paul Furness, Helen Graham, Alex Hale, Paddy Hodgkiss, John Lawson, Rebecca Madgin, Paul Manners, David Robinson, John Stanley, Martin Swan, Jennifer Timothy, Rachael Turner
- Edited by Keri Facer, University of Bristol, Kate Pahl, Manchester Metropolitan University
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- Book:
- Valuing Interdisciplinary Collaborative Research
- Published by:
- Bristol University Press
- Published online:
- 05 April 2022
- Print publication:
- 05 April 2017, pp 85-106
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- Chapter
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Summary
Introduction
At some point during our inaugural research team workshop we started to generate many different ideas about how to increase participation in heritage decision-making. We tried to keep track as the questions flowed by writing recurring words on pieces of paper, to be linked, connected and ordered at some later point. The words were in some ways not surprising. Heritage, of course. Stewardship. Custodianship. Expert. Leadership. Institutions. Ownership. Differences/Tensions. Scale. Personal. Values. Voice (‘+ not heard’, was added in another hand in biro). So far, so predictable. These words, after all, index the big conceptual challenges that have been identified to a greater or lesser extent in heritage policy, practice and its research for the last four decades. Yet as we spoke, each of these terms started to change in dimension. As the different people around the table gave examples, and checked they understood each other's contributions, the familiar words were in the process of gathering new uncertainties and ambiguities as well as new colours, textures, shapes and potentials.
We were brought together by a funding scheme that supported not just collaborative research, but also its collaborative design. While we did have a shared interest in our overall question ‘how should heritage decisions be made?’, we – as you will see by how we describe ourselves – came to this question, and our first workshop, from quite different places and different trajectories. To frame it in the language implied by this book, we carried with us different inheritances – legacies – from our disciplines, professional backgrounds, organisations and places. As such, the other crucial thing we had in common was an interest in the potential for rethinking ‘heritage’ offered by drawing on many different perspectives and working across hierarchies and institutional boundaries. We used both these shared commitments and our different perspectives to collaboratively design our project.
In this chapter we tell the story of our project with the aim of showing how our research emerged through dynamic connections between know-how generated through practitioner reflections, dialogue, characterised by conversations between us as a project team and conceptual innovation, in terms of the way this allowed us to think about heritage and decision making differently.