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Basic HIV Primary Care

Screening for Mental Health Conditions

Activity 6B. Screening for Dementia

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Learning Objective Performance Indicators

  • Explore the interrelationship among mental health conditions, HIV acquisition, and risk of HIV transmission
  • Discuss the association between major depression and the increased risk for mortality in persons with HIV
  • List common screening tools for mental health conditions
  • Explain how to integrate screening tools for mental health conditions into primary HIV care
  • Summarize the approach to screening for HIV-associated neurocognitive disorders

A patient is given the IHDS screening. The following observations are made:

  • 13 taps performed during the motor speed test
  • 2 sequences performed during the psychomotor speed test
  • the words "dog" and "bean" are recalled without assistance
  • the word "hat" is recalled after the semantic clue "piece of clothing?" is given

Instructions

Use the International HIV Dementia Scale (IHDS) tool to score the results obtained during the screening of this patient.

International HIV Dementia Scale (IHDS)

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Here is a short summary about the tool explaining in brief its efficacy.

  • This tool is not meant to be viewed by the patient during the test. The provider should use it as a guide and demonstrate all actions to the patient with their own hands.
  • The timers will emit audio cues at the beginning and end of the time period.
  • To perform this test follow the steps in order below:

dog

hat

bean

red

  1. Give four words to recall (dog, hat, bean, red) – 1 second to say each.
  2. Then ask the patient all four words after you have said them,
  3. Repeat words if the patient does not recall them all immediately.
  4. Tell the patient you will ask for recall of the words again a bit later.

Have the patient tap the first two fingers of the non-dominant hand as widely and as quickly as possible.

2 illustrations corresponding to the motion described above.

Count the number of taps performed in 5 seconds:

5 seconds

Start Timer




Scoring:
≥ 15 taps = 4 points
11-14 taps = 3 points
7-10 taps = 2 points
3-6 taps = 1 point
0-2 taps = 0 points

Have the patient perform the following sequence of movements with the non-dominant hand as quickly as possible:

3 illustrations corresponding to the listed steps below.
1. Clench hand in fist on flat surface.
2. Put hand flat on surface with palm down.
3. Put hand perpendicular to flat surface on the side of the 5th digit.


Demonstrate and have patient perform twice for practice.

Count the number of sequences performed in 10 seconds:

10 seconds

Start Timer




Scoring:
≥ 4 sequences = 4 points
3 sequences = 3 points
2 sequences = 2 points
1 sequence = 1 point
unable to perform = 0 points

Ask the patient to recall the four words:

Select the words recalled below: (1 point each)



For words not recalled, prompt with a semantic clue as follows:

Select the words recalled using clue. (0.5 points each)

 

Results and Interpretation

 

Final Score: 0 points

Interpretation:

  • This is the sum of the scores on items 1-3. The maximum possible score is 12 points. A patient with a score of ≤10 should be evaluated further for possible dementia.

Acknowledgement

  • The International HIV Dementia Scale (IHDS) was developed by Dr. Ned C. Sacktor, Professor of Neurology, Johns Hopkins Medicine.
  • Reproduced with permission from Dr. Ned C. Sacktor.

Sources

  • Sacktor NC, Wong M, Nakasujja N, et al. The International HIV Dementia Scale: a new rapid screening test for HIV dementia. AIDS. 2005;19:1367-74

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Activity Question

You should answer this question after completing the activity.

You must answer all of the questions before checking your work.

What is the final IHDS point score for this patient, and what is the interpretation?

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