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Neurocognitive Impairment, HIV and Aging

Neurocognitive Impairment, HIV and Aging. Maggie Atkinson CWGHR 2009 Forum Toronto, ON Canada June 13, 2009. Cognitive impairment in HIV and Aging. What works? My experiences Lifestyle changes Brain Fitness Program Recommendations. HIV and HAART and NCI.

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Neurocognitive Impairment, HIV and Aging

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  1. Neurocognitive Impairment, HIV and Aging Maggie Atkinson CWGHR 2009 Forum Toronto, ON Canada June 13, 2009

  2. Cognitive impairment in HIV and Aging • What works? • My experiences • Lifestyle changes • Brain Fitness Program • Recommendations Maggie Atkinson, CWGHR, June 13, 2009

  3. HIV and HAART and NCI • 30—50% PWAs have cognitive impairments: • attention (particularly multi-tasking), • memory (particularly the efficiency in learning new information), • speed of cognitive processing (how fast a person conducts cognitive tasks) • and fine-motor skills • Some ART don’t cross blood/brain barrier • 30% on HAART may have some cognitive impairment S B. Rourke,T.Sota, S. Rueda, M. Atkinson, CAHR 2009 Poster

  4. Aging and Cognition • Aging causes Neurocognitive Decline • reduces cognition, memory, fine motor control, usable field of vision (UFOV), brain mass • Mild Neurocognitive Impairment • Cognitive symptoms: difficulty with memory, including trouble remembering names, misplacing items, forgetting details of conversations, etc Maggie Atkinson, CWGHR, June 13, 2009

  5. Complex AGE HAART HIV Brian Gazzard, !AS 2007 Plenary

  6. What can help the Brain? • Whatever helps the heart… • Lifestyle strategies • Diet, exercise, not smoking, stress- management, rest • But alcohol associated with  brain volume • Paul CA, Arch Neurol 2008;(10):1363-1367 Maggie Atkinson, CWGHR, June 13, 2009

  7. Lifestyle Change Sources • Pritikin Longevity Center, FL • The Pritikin Edge, Dr. Robert Vogel • Dr. Dean Ornish, Preventive Medicine Research Institute • The Spectrum; Reversing Heart Disease; • Everyday Cooking with Dr. Dean Ornish Maggie Atkinson, CWGHR, June 13, 2009

  8. Lifestyle Changes • Diet: fruits, vegetables, beans, soy, fish, whole grains, no added fat, non-fat dairy, no added salt, little or no coffee and alcohol • Vitamin D 1000-2000 IU/day • Exercise 6-7 days/week: cardio, resistance, flexibility • Stress management: meditation, yoga, Maggie Atkinson, CWGHR, June 13, 2009

  9. Yolanda Nave, 64 Ways to Beat the Blues, 1998

  10. Results of Pritikin Program • 23% decrease in cholesterol and LDL • 39% decrease in C-reactive protein • 30-46% decrease in insulin levels • 50% reversed Metabolic Syndrome • 83% of hypertensives achieved normal BP Maggie Atkinson, CWGHR, June 13, 2009

  11. What do we know about the Brain? • Strategies --symptoms, not cause • e.g., memory aides, lists • Myth: the brain can’t grow or change • Brain is plastic • David Doidge, The Brain that Changes Itself Maggie Atkinson, CWGHR, June 13, 2009

  12. PositScience.com • Michael Merzenich, founder • Brain Fitness Program Classic - auditory • Insight Program – visual cortex • Improves brain processing and memory in seniors Maggie Atkinson, CWGHR, June 13, 2009

  13. Brain Fitness Program Classic • Self administered • Computer program • 40 one hour sessions • 1 hr/day, 5 days/week 8 weeks Maggie Atkinson, CWGHR, June 13, 2009

  14. IMPACT Study (Improvements in Memory with Plasticity-based Adaptive Cognitive Training) • Randomized, controlled, double blinded, multi-center, prospective • Mayo Clinic, UCSF, Smith GE, • J. Am. Geriatr. Soc. 2009 Apr; 57(4):594-603 • 524 healthy adults, aged 65-94 Maggie Atkinson, CWGHR, June 13, 2009

  15. IMPACT Results • 131% increase in brain processing speed • Improved memory by ten years • Got better at tasks in BFP • Improvements generalized to multiple standard memory tests • 75% pts self reported positive changes Maggie Atkinson, CWGHR, June 13, 2009

  16. My Results with BFP • 54% increase in brain processing speed • Better word recall, short term memory • Improved hearing • Improved handwriting • Improved self confidence Maggie Atkinson, CWGHR, June 13, 2009

  17. Cognitive Rehabilitation in HIV/AIDS: A Case Study Demonstrating the Benefits of the Brain Fitness Program • S.B. Rourke, T. Sota, S. Rueda, M. Atkinson, CAHR 2009, Poster • 52 yr old gay male, NCI • Battery of neuropsych tests pre- and post- BFP • 34% increase in brain processing speed on BFP • Self reported improved long and short term memory, multi-tasking, dexterity

  18. Cognitive Abilities Pre- and Post- InterventionS.B. Rourke, T. Sota, S. Rueda, M. Atkinson, Cognitive Rehabilitation in HIV/AIDS , CAHR 2007

  19. Best for Brain Health • Progressively challenging • Mentally Rewarding • Novel or surprising • Demanding of focused attention Brain Fitness Program, www.positscience.com

  20. Recommendations • Learn to play music • Learn a language • Jigsaw puzzles, >500 pieces • Play ball, or even juggle • Crochet or knit • Use your “other” hand • Dancing – waltz vs. tango lessons study • Bridge, crossword puzzles – ‘up the ante’ Maggie Atkinson, CWGHR, June 13, 2009

  21. Recommendations • Study of Brain Fitness Program in HIV • Studies needed in strategies that have worked in age-related NCI • HAART regimens include drugs that cross blood/brain barrier when possible Maggie Atkinson, CWGHR, June 13, 2009

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