Screening and diagnosis

There are several screening tools for HAND, such as the Montreal Cognitive Assessment, and the International Dementia Scale,[9] Cogstate. [10]

but there is no one tool which can be used across all settings. [11] Some tests are sensitive to moderate but not to mild cognitive decline.[12] The Mini Mental Status Exam (MMSE)[13] is not useful in this context as HIV cognitive impairment affects the sub-cortex of the brain but the MMSE can be used to screen for other forms of cognitive impairment such as that caused by Alzheimer's disease. If clinical neurological examination is not freely available, asking people with HIV and their caregivers about changes to their activities of daily living is a useful starting point.

No known biological markers have been identified to support a definitive diagnosis of HAND.[14] The gold standard for HAND diagnosis is formal neuropsychological tests completed by a specially trained clinical neuropsychologist with or without radiological tests such as magnetic resonance imaging (MRI).[15]  Therefore, multiple detection methods such as clinical review, functional review and neurological imaging are necessary. The diagnosis of HAND is also often made through a process of excluding other conditions (e.g. excluding new opportunistic infections, progressive multifocal leukoencephalopathy, and cryptococcal meningitis).[16]  This approach presents challenges for clinicians as there are a number of confounding and comorbid conditions such as depression or alcohol-related brain damage that may complicate the diagnosis. Further, people with HIV may downplay their signs and symptoms, or their caregivers may attribute behaviours to other causes such as ageing or poor mental health.

As people with HIV age, they may be at risk of other neurologic disorders associated with ageing such as vascular dementia and Alzheimer's disease.[17] Thus, the complexities around neurological health for people with HIV may be increasing.