- Regularly review the PLHIV – annual assessment is recommended. Ask the PLHIV questions about changes they may have noticed.
- Be aware of risk factors for HAND and other general cognitive impairment.
- Identify, reduce, and treat preventable cognitive risk factors including:
- smoking
- reduce cholesterol and triglycerides.
- treat hypertension, diabetes, HCV.
- reduce alcohol intake,
- reduce or cease substance use.
- Encourage healthy eating strategies in combination with physical activity and sleep to restore metabolic normalcy and stimulate neuronal growth. Encourage weight loss if the person is above their optimum weight (30).
- Improve physical exercise. Aerobic exercise has a moderate favourable effect on cognitive function. Recommend activities to increase the heart rate (gardening, fast walking, dancing) for 30 minutes 4-5 times a week. Exercise can also have the added benefit of improving mood and general health (42).
- Assist the PLHIV who has S&S of cognition change to develop personal strategies such as using reminder notes and lists, using a diary (hard copy or on a device), have someone attend important appointments with them, use a visual prompt for appointments such as a whiteboard.
- It may be useful with the PLHIV’s permission to send letter to important or new medical appointments to explain any deficit so that the person learns about the PLHIV deficit and can adjust how they communicate with the person if necessary.
- Consider a referral to a local memory group, social groups, and exercise group. If the person feels apprehensive arrange for someone to escort them to the group initially.
- Develop a local guide for referral pathways for access to supportive care, such as occupational therapist, physiotherapist, dietitian, the National Disability Insurance Scheme (NDIS) and MyAged Care.
- Encourage the PLHIV to stay socially active; this may include joining groups or starting a new hobby (which can all be online) which will keep their brain active (puzzles, quizzes, art classes, learning new skills anything to stimulate the mind) (14).
- Consider legal issues when a person becomes diagnosed with cognitive impairment such as power of attorney, last will and testament and advanced care directives.
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