Browsing by Subject "neurocognitive"

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    Adaptation of aphasia tests for neurocognitive screening in South Africa
    (2010) Mosdell, Jill; Balchin, Ross Malcolm; Ameen, Ozayr Sale
    Two aphasia tests — the Cookie Theft Test and the Boston Naming Test — were adapted to help eliminate western cultural, language and education bias in neurocognitive screening in South Africa. These tests were among the commonly used tests initially chosen for inclusion in a larger neurocognitive screening battery currently being developed and translated for use in South Africa — the Groote Schuur Neurocognitive Battery. The adaptations were made employing quantitative and qualitative converging lines of evidence to evaluate their efficacy. This evidence included consultation with clinicians at Groote Schuur Hospital and translators knowledgeable in Afrikaans and isiXhosa language and culture, qualitative feedback from the research participants, and the results on the tests. The adapted tests were piloted by testing 30 neurocognitively intact controls consisting of equal numbers of Afrikaans, English and isiXhosa speakers, comparing their scores to their performances on the original tests. Three aphasic patients were also briefly tested. Results indicate that the adaptations made to the tests improved the performance of controls over the original versions, and tentatively suggest that the adapted tests should be able to screen for aphasia. This pilot study recommends further changes to the Groote Schuur Naming Test before its introduction into the battery ahead of its validation.
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    Neuropsychiatric complications of efavirenz in children with HIV-1 infection
    (2018) Hammond Charles; Eley Brian
    Background: Efavirenz is associated with transient neuropsychiatric manifestations but the impact on neurocognition is unknown. Genetically determined black South Africans who are slow metabolizers of efavirenz may be at risk of toxicity. This study describes neuropsychiatric and neurocognitive manifestations of South African children with suspected efavirenz neurotoxicity. Method: This retrospective study describes clinical features of 12 children with suspected efavirenz neurotoxicity (2008 – 2014). Results: Twelve children were referred (aged 3 years 4 months to 12 years, mean 7 years 8 months; 8 indigenous African (black) and 4 mixed ancestry). Six had acute neuropsychiatric manifestations after 2-8 weeks (mean 5 weeks) on efavirenz including drowsiness, seizures, sleep disturbances, behavioural changes, ataxia and slurred speech. Symptoms resolved over a few weeks in four. Two black children were phenotypically slow metabolizers with high plasma efavirenz concentrations above normal range resulting in discontinuation of efavirenz. Nine children had neurocognitive concerns potentially exacerbated by long-term efavirenz (6-72 months therapy; mean 31 months), and showed poor performance in all neurocognitive domains. Conclusion: Efavirenz causes transient neuropsychiatric adverse effects and may contribute to poor longterm neurocognitive outcomes in HIV-infected children. Genetically slow metabolizers are at risk of neurotoxicity. Prospective studies comparing efavirenz-treated and efavirenz-naïve children are needed.