title: Limitations to the identification of HIV-associated neurocognitive disorders in clinical practice.
abstract: OBJECTIVE
  The objective of this study was to establish the level of awareness of HAND among healthcare providers, the screening tools that are currently used in its detection and factors that limit cognitive assessments.
  
  
  METHODS
  We distributed a 12-item questionnaire to doctors and nurses who work in the Department of Genitourinary Medicine and Infectious Disease (GUIDE) service and also to doctors who work in the emergency department (ED) at St James Hospital.
  
  
  RESULTS
  35 surveys were collected, 54% (n = 19) from the GUIDE service and 46% (n = 16) from the ED. 82% (n = 29) of participants were doctors from interns to consultants. There was reasonable appreciation among participants with regards the prevalence of neurocognitive impairment (estimated at 29.1% among patients on HAART, and 39.3% among patients not on HAART). Screening tools were rarely used by GUIDE and ED clinicians (25% vs. 15% of the time). The Mini Mental State Examination (MMSE) was previously used by 37% (n = 13) of the group. Very few people had used the HIV Dementia Scale (HIVDS) 6% (n = 2). 34% of respondents felt that 'Orientation in Person, Place and Time was a sufficient screening tool for cognitive assessment'. Lack of time, exposed environment and lack of availability of screening tool were cited as limitations to cognitive screening in the ED environment.
  
  
  CONCLUSIONS
  This study examines awareness of HAND among healthcare providers and also reasons for inadequate assessment. There is a need for consensus on screening guidelines. A quick, easy to use and readily available screening tool may have a role in the acute setting in identifying high-risk patients.
authors.affiliation: Infectious Disease, Cork University Hospital, Cork, Ireland. deemorley@gmail.com
authors.forename: D
authors.initials: D
authors.lastname: Morley
authors.forename: P
authors.initials: P
authors.lastname: McNamara
authors.forename: S
authors.initials: S
authors.lastname: Kennelly
authors.forename: G
authors.initials: G
authors.lastname: McMahon
authors.forename: C
authors.initials: C
authors.lastname: Bergin
mesh_terms: D001364:Awareness; D003072:Cognition Disorders / Q000175:diagnosis* / Q000453:epidemiology; D004636:Emergency Service, Hospital / Q000592:standards; D004864:Equipment and Supplies / Q000600:supply & distribution*; D005260:Female; D006679:HIV Seropositivity; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000295:instrumentation; D009483:Neuropsychological Tests; D010819:Physician's Role / Q000523:psychology; D010820:Physicians / Q000523:psychology* / Q000592:standards; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome
keywords: HIV; neurocognitive impairment; survey study