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Short term memory
Jan 6, 2006

Dear Dr. Horwath, I just read your response concerning short term memory dysfunction. I too have been experiencing a marked change in my short term memory exactly as the previous questioner described. I have spoken to my health professional(s) numerous times about this fact for over 4 years now. I have had to change providers several times in that time frame and I would like to report that none of them ever suggested any further testing nor do they even take this anomaly seriously. I used to be Medicaid eligible and maybe that is the real reason. Your advice seems on target for those people still able to pay for their own coverage and call their own shots, but for the thousands of others who depend on the gov't programs or some other program that only provides the minimum, what do you reccomend for them (us)? This memory abberation does affect my interactions with others and is especially noticeable among those who new me before this problem surfaced. In addition to the cuts in funding going on, is it not less likely that further testing from a specialist is possible? I sincerely think this memory issue is more pervasive in the long timers than is being noted or realized. Many thanks for your attention and interest in our well being.

Response from Dr. Horwath

In people with HIV-associated memory impairment, additional psychological testing may be quite helpful in better defining the nature of the problem. There are some specific tests, such as the HIV dementia scale, that can easily be administered by someone with only a little extra training. This test is especially helpful in identifying the slowed thinking that is often seen in early HIV-associated dementia. There are other more complex tests, such as the Trailmaking Test (I & II) and the Grooved Pegboard Test, which are usually administered by psychologists with training in testing, and are sometimes given as part of a battery of tests to identify a specific cognitive disorder.

Whether or not these tests are indicated or are likly to contribute to the management of the problem depends largely on the specific details of an individual case. Sometimes a simple assessment is all that is needed, and the treatment choices are clear. In other cases, the diagnosis is not clear, and additional testing can clarify the problem and point toward a more appropriate type of management.

In general, when memory impairment is caused by the direct effects of HIV on the brain, the most effective form of treatment is HAART, and its effectiveness for purposes of cognitive improvment is correlated with its success in lowering the viral load and improving the T cell count.

It is a shame that these tests are not more widely available for those who might benefit from them.



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