|LETTER TO EDITOR
|Year : 2015 | Volume
| Issue : 1 | Page : 43
Use of international HIV dementia scale in assessment of neurocognition
Sunil Kumar Raina
Department of Community Medicine, Dr. Rajendra Prasad Government Medical College (RPGMC), Tanda, Himachal Pradesh, India
|Date of Web Publication||27-Jan-2015|
Sunil Kumar Raina
Department of Community Medicine, Dr. Rajendra Prasad Government Medical College (RPGMC), Kangra, Tanda, Himachal Pradesh
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Raina SK. Use of international HIV dementia scale in assessment of neurocognition. Int J Nutr Pharmacol Neurol Dis 2015;5:43
Read with interest an article entitled "Assessment of neurocognitive functions in HIV/AIDS patients on HAART using international HIV dementia scale" published in Int J Nutr Pharmacol Neurol Dis (2014;4:252-5).  The authors of this work deserve an appreciation for their effort. The study is an important addition to the medical literature on neurocognitive functions in HIV/AIDS. However, I have a few concerns regarding this study. The authors state that, the prime objective of this study was to assess the status of neurocognitive functions among HIV-infected individuals on HAART, using the International HIV Dementia Scale (IHDS). The authors concluded that the prevalence of neurocognitive impairment was higher in their study population.
The authors have actually reported on the outcome, using a screening tool (IHDS in this case) which is applicable for the assessment of dementia and not for the neurocognitive functions. This is because, the neurocognitive disorders (NCDs) is a group of disorders, which includes "dementia, delirium, amnestic and other cognitive disorders." The authors however have reflected on dementia only. Therefore, using the IHDS for the identification of the neurocognitive dysfunctions is not appropriate. Furthermore, as the IHDS has been identified as a useful screening test to identify the individuals at risk for HIV dementia in the industrialized world and the developing world, full neuropsychological testing should be performed to confirm a diagnosis of HIV dementia.  The authors have used a valid screening tool for the assessment of dementia, but use of this tool only will not be able to provide us with the prevalence of dementia among patients on highly active antiretroviral therapy (HAART). A literature review on estimating the prevalence of dementia in different settings reveals that, the studies are generally conducted using a two phase strategy: (1) A screening phase and (2) a clinical phase. ,, The screening is generally conducted by using a screener like the MMSE or its modified versions and identifying suspects for clinical evaluation. The authors could have similarly identified suspects for clinical evaluation (for dementia), after administering the IHDS as a screening tool. The clinical assessment of dementia would involve a careful and detailed clinical history to determine the precise features of intellectual loss if any. The subjects should be examined for three categories of symptoms: Cognitive or intellectual, functional, and psychiatric or behavioral.
| References|| |
Saini S, Barar KV. Assessment of neurocognitive functions in HIV/AIDS patients on HAART using International HIV Dementia Scale. Int J Nutr Pharmacol Neurol Dis 2014;4:252-5.
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Raina SK, Raina S, Chander V, Grover A, Singh S, Bhardwaj A. Is dementia differentially distributed? A study on the prevalence of dementia in migrant, urban, rural and tribal elderly population of Himalayan region in northern India. N Am J Med Sci 2014;6:172-7.
Raina S, Razdan S, Pandita KK, Raina S. Prevalence of dementia among Kashmiri migrants. Ann Indian Acad Neurol 2008;11:106-8.