Psychobehavioural Factors Associated With Neurocognitive Test Performance in HIV-Positive Persons Attending A Regional Hospital In Accra, Ghana

Abstract

Background: The Human Immunodeficiency Virus (HIV) can enter the brain and attack nerve cells, leading to problems of mental functioning collectively known as neurocognitive impairment (NCI). Globally, it is estimated that almost half of all treated HIV patients have some form of NCI. The primary method of diagnosing NCI is for an examiner to administer a battery of neuropsychological/neurocognitive assessments. There are very few studies of neuropsychological assessments in Ghana, due in part to limited resources for such testing. Therefore, the full burden of NCI in Ghana is unknown. HIV-positive Ghanaians may endorse certain psychological and behavioural traits that could contribute to mild or severe cases of NCI. The aim of the study was to explore neurocognitive performance in a group of HIV-positive adults in Ghana, and investigate the possible factors that contribute to their performance. Method: This study investigated NCI in 104 HIV-positive Ghanaians attending an antiretroviral therapy clinic at Ridge Hospital in Accra, using a selection of brief non-invasive neuropsychological assessments as well as the International HIV Dementia Scale. Behavioural factors (alcohol use, depression, and medication adherence) as well as demographic factors were assessed to determine any association with performance on neurocognitive assessments and NCI risk. Linear regression and Receiver Operating Characteristic (ROC) analyses were used to determine which factors had a significant effect on neurocognitive performance. Result: About 48% of the participants met the criteria for neurocognitive impairment risk, according to the International HIV Dementia Scale. Advanced age, low education, and risk of depression were significantly associated with neurocognitive impairment. University of Ghana http://ugspace.ug.edu.gh xii The Trail Making Test was highly accurate at identifying neurocognitive impairment in the group (area under curve = 0.7214). Conclusion: HIV-positive Ghanaians may be at risk for some degree of neurocognitive impairment, even when on ART medication. Depression may be co-morbid with impairment. Certain neurocognitive tests like the Trail Making Test are best for measuring neurocognitive impairment. Further research is needed to map the extent of cognitive complications.