Browsing by Author "Vally, Zahir"

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    HIV-associated neurocognitive disorders
    (AOSIS, 2011) Vally, Zahir
    HIV infection is associated with disturbances in brain function referred to as HIV-associated neurocognitive disorders (HAND). This literature review outlines the recently revised diagnostic criteria for the range of HAND from the earliest to the more advanced stages: (i) asymptomatic neurocognitive impairment; (ii) mild neurocognitive disorder; and (iii) HIV-associated dementia. Relevant literature is also reviewed regarding the differential impact upon component cognitive domains known to be affected in HAND, which in turn should ideally be targeted during clinical and neuropsychological assessments: psychomotor and information processing speed, learning and memory, attention and working memory, speech and language, executive functioning and visuospatial functioning. A discussion outlining the neuropsychological tools used in the diagnostic screening of HAND is also included. The central mechanisms of HAND appear to revolve primarily around psychomotor slowing and cognitive control over mental operations, possibly reflecting the influence of disrupted fronto-striatal circuits on distributed neural networks critical to cognitive functions. The accurate assessment and diagnosis of HAND depends on meeting the need for statistically sound neuropsychological assessment techniques that may be used confidently in assessing South African populations, as well as the development of relevant norms for comparison of test performance data.
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    The assessment and management of dementia
    (2010) Vally, Zahir
    South African family practitioners can expect to contend with rising rates of dementia as the aged segment of the population grows larger and HIV-related neuropsychiatric complications manifest with increasing prevalence. Family practitioners are often the first professional consulted by families concerned with a family member's suspected dementia. This fortunate position facilitates the early identification of cognitive difficulties, which, in turn, greatly increases the likelihood of optimal management. Dementia is best managed with a multidisciplinary-team approach that sees family practitioners fulfilling the role of key support to families and of the coordinators of multidisciplinary referrals and inputs. This article reviews the key diagnostic features of dementia and provides suggestions that may be utilised by physicians in the basic assessment of these features. It concludes with a summary of the most appropriate management plan to be adopted by family practitioners.