Dokument: Die Evaluation einer neuen Screening-Methode für HIV-assoziierte neurokognitive Störungen
| Titel: | Die Evaluation einer neuen Screening-Methode für HIV-assoziierte neurokognitive Störungen | |||||||
| Weiterer Titel: | The evaluation of a new screening method for HIV associated neurocognitive disorder | |||||||
| URL für Lesezeichen: | https://docserv.uni-duesseldorf.de/servlets/DocumentServlet?id=41246 | |||||||
| URN (NBN): | urn:nbn:de:hbz:061-20170308-083825-1 | |||||||
| Kollektion: | Dissertationen | |||||||
| Sprache: | Deutsch | |||||||
| Dokumententyp: | Wissenschaftliche Abschlussarbeiten » Dissertation | |||||||
| Medientyp: | Text | |||||||
| Autor: | van den Bosch, Ana [Autor] | |||||||
| Dateien: |
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| Beitragende: | Prof. Dr. Arendt, Gabriele [Gutachter] PD Dr. Neuen-Jacob, Eva [Gutachter] | |||||||
| Stichwörter: | HIV, HIV assoziierte neurokognitive Störungen | |||||||
| Dewey Dezimal-Klassifikation: | 600 Technik, Medizin, angewandte Wissenschaften » 610 Medizin und Gesundheit | |||||||
| Beschreibungen: | Bei einer Infektion mit dem HI-Virus kommt es neben der Ausbildung eines Immundefekts auch zu einem Befall des zentralen Nervensystems. Unbehandelt kann dies zu einer Entwicklung einer HIV-assoziierten Demenz (HAD) führen. Die Inzidenz der HAD ist durch den großen Fortschritt in der Therapie der HIV-Erkrankung stark gesunken. Jedoch ist die Prävalenz der leichteren Formen, asymptomatisches neuropsychologisches Defizit (ANPD) und mildes neurokognitives Defizit (MNCD), stetig angestiegen. All diese Entitäten werden unter dem Begriff „HIV-associated Neurocognitive Disorder“ (HAND) zusammengefasst.
Dies macht es notwendig, neue und kürzere Untersuchungsmethoden im Sinne eines „Short Neuro-AIDS Screenings“ (SNAS) zu entwickeln, die es ermöglichen, HIV-positive Patienten mit einem Risikoprofil für die Entwicklung von „HAND“ und Patienten mit bereits bestehender kognitiver Beeinträchtigung frühzeitig zu entdecken, um ein weiteres Fortschreiten zu verhindern und die Lebensqualität der Patienten zu verbessern. Weiterhin sollte eine solche Screening-Methode schnell verfügbar und bei einem niedergelassenen Neurologen durchführbar sein. Dies ist mit der üblichen umfassenden neuropsychologischen Testung, die bisher nur in spezialisierten HIV-Zentren angeboten wird, nicht möglich. Ziel dieser Arbeit war, eine neue Test-Methode („MyNeuro“) zu evaluieren und ihren Stellenwert als Teil eines Screenings zu überprüfen. Dazu wurde eine Patienten-Population gebeten, zusätzlich zu der standardisierten, bereits etablierten ausführlichen neuropsychologischen Testung, wie sie seit 1987 in der neurologischen HIV-Ambulanz Düsseldorf durchgeführt wird, eine Auswahl an Tests ebenfalls analog in digitaler Form (iPad) zu absolvieren. Zuvor wurden die Standardwerte für diese digitalen Tests an einer gesunden Kontrollgruppe ermittelt. Die Ergebnisse der klassischen Testdurchführung wurden anschließend mit denen der digitalen Testdurchführung verglichen. Der Vergleich der beiden Testmethoden zeigte, dass die Ergebnisse weitestgehend konform sind, sodass „MyNeuro“ als geeignete Kurztestmethode angesehen werden kann. Fallen diese Tests pathologisch aus, sollte eine anschließende ausführliche neuropsychologische Untersuchung in einem spezialisierten Zentrum angeschlossen werden. Die Ergebnisse dieser Kurztestreihe müssen außerdem im Zusammenhang mit weiteren laborchemischen Parametern wie der Viruslast, der CD4+-Zellzahl und dem klinischen Zustand des Patienten interpretiert werden. Damit erfüllt dieses Testverfahren die Anforderungen an eine „Short Neuro-AIDS Screening“-Methode und könnte eine frühere und bessere Identifizierung von HIV-Patienten mit „HAND“ ermöglichen.Even though the incidence of HIV associated dementia has decreased over the last years due to the progress in combined antiretroviral therapy (cART), the prevalence of the milder forms of HIV associated neurocognitive disorder (HAND), asymptomatic neurocognitive impairment (ANI) and mild neurocognitive disorder (MND), have increased constantly. These different forms of HAND can be diagnosed by a detailed battery of neuropsychological tests covering all cognitive domains (Frascati diagnostic criteria). Over the last few years it has become more and more important to develop a screening tool for HAND, especially for the milder forms, since it has been shown that HAND has a big impact on quality of life, adherence to medication and employment, quality of life and even expectancy of life. Moreover recent studies demonstrated that there is a potential progression of symptoms for all subcategories of HAND. It is therefore necessary that a screening tool is able to detect the milder forms of HAND, especially ANI to provide those with a more careful clinical guidance and observation for deterioration. This is a debility of most currently available screening tools. Furthermore the gold standard neuropsychological testing is very time-consuming and not generally available. The examination has to be performed by neuropsychologist. A useable screening tool should therefore be relatively easy to administer, rapidly feasible and applicable for non-specialists. Another important limitation to most screening tools is the lack of construct validity for all entities of HAND. Tests like for example the Montreal cognitive assessment (MOCA), mini-mental state examination (MMSE) and International HIV Dementia Scale (IHDS) have been examined and have shown different results regarding sensitivity and specifity to mild forms of HAND In our study we evaluated a new computerized, brief screening tool (“MyNeuro”) for the detection of all forms of HAND to provide an easy applicable screening method for outpatient as well as non-neurologist sectors. We compared this screening tool with the usual neuropsychological assessment regarding not only performance results but also experiment set-up and and procedure. | |||||||
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| Lizenz: |  Urheberrechtsschutz | |||||||
| Fachbereich / Einrichtung: | Medizinische Fakultät | |||||||
| Dokument erstellt am: | 08.03.2017 | |||||||
| Dateien geändert am: | 08.03.2017 | |||||||
| Promotionsantrag am: | 20.05.2016 | |||||||
| Datum der Promotion: | 26.01.2017 |
