Two UNC neurologists are making significant strides in understanding neurological disorders across diverse global populations, from Latin America to Sub-Saharan Africa.
Monica Diaz, MD, MS, and Deanna Saylor, MD, MHS, are neuro-infectious diseases and neuro-immunology specialists. They are the newest members of the Institute for Global Health and Infectious Diseases, combining their expertise to address critical gaps in neurological care in underserved regions, and this includes people living with HIV. Their innovations in care will also serve patients in North Carolina.
“With effective treatment, a person living with HIV will have a normal lifespan,” said Myron Cohen, MD, Director of the Institute for Global Health and Infectious Diseases. “So nowadays, people living with HIV face the same problems as all of us. Having the neurology team on board is invaluable.”
Cognitive impairment is one example, which can manifest as difficulties with thinking, memory, attention, concentration, and movement, and may include behavioral changes and irritability. The impact of HIV on brain aging may also be accelerated, potentially leading to cognitive decline at an earlier age than in the general population.
Pioneering Work in HIV-Associated Neurocognitive Disorders
Dr. Diaz, whose research focuses on neuro-infectious diseases and neuro-immunology, has conducted extensive studies on HIV-associated neurocognitive disorder (HAND) in Peru since 2019. Her research shows that approximately 28% of people living with HIV experience some degree of cognitive impairment, with symptoms including difficulties with concentration, short-term memory loss, and executive function impairment. Currently, there is a significant lack of published guidelines for managing cognitive impairment in people living with HIV.
“Many patients living with HIV are referred to me in clinic because they have cognitive impairment, and they have difficulty doing daily activities and being independent,” said Dr. Diaz, assistant professor of neurology. “This places a big burden on family members and caregivers.”
Diaz has designed a 10-minute cognitive screening tool to detect HIV-associated neurocognitive disorder in Spanish-speaking patients in Peru. The tool is a modified version of the Tab-CAT (Tablet-based Cognitive Assessment Tool), originally developed by the University of California San Francisco as a one-hour assessment for detecting Alzheimer’s disease. Diaz says by adapting the tool specifically for HIV patients, from a one-hour test to a practical 10-minute format, it can be easily implemented in primary care settings.
Dr. Saylor, associate professor of neurology, has led parallel research on HIV-associated neurologic complications in Uganda, examining factors that contribute to cognitive impairment in people living with HIV and understanding why this impairment persists in some patients.
Together, they are exploring a collaboration that could improve care giver training for patients with dementia. They also want to compare different diagnostic criteria for HIV-associated cognitive impairment to determine which criteria should be used.
Collaborative Research on Multiple Sclerosis
The two are also collaborating on multiple sclerosis research, challenging the long-held belief that MS is rare in Africa and Latin America.
According to Dr. Saylor who is currently based in Zambia, it wasn’t that MS didn’t exist, it was that neurologists and MRI machines didn’t exist. She started the first National MS Registry.
“It’s been exciting to be part of this ground roots work, to hear the conversation shift from MS not existing in Africa to recognizing that it is under-diagnosed.”
A joint project will compare how patients receive MS diagnoses in Peru, Zambia, and North Carolina, potentially revealing critical insights about diagnostic barriers in different healthcare systems.
Transforming Neurological Care in Zambia
Dr. Saylor’s work extends beyond HIV research. In 2018, she established Zambia’s first neurology training program which has trained 19 neurologists to date. Meanwhile, her implementation of stroke care protocols has dramatically reduced inpatient mortality from 44% to 9%.
“We’ve applied implementation science to improve stroke care in Zambia, and we’re exploring how these protocols could benefit resource-limited settings in North Carolina as well.”
Saylor says gains have come from training Zambian nurses, providing the skills for good stroke care, that can prevent stroke-related complications. This includes training on urinary catheters to reduce catheter associated infections, swallow evaluations to reduce the risk of aspiration pneumonia and basic mobility assessments. Quality improvement measures are recognized each month and this keeps staff motivated.
“A lot of North Carolina hospitals do not have full time neurologists. I would like to see us take the lessons learned in Zambia to resource-limited settings across the state in order to improve outcomes.”
Leadership in Global Neurology
Beyond their research, both neurologists hold leadership positions in the Global Health section of the American Academy of Neurology—Dr. Saylor as chair and Dr. Diaz as vice-chair. Together, they organize monthly webinars for trainees and international investigators and maintain resources for global health opportunities in neurology.
On May 30, Dr. Saylor will lead the Institute’s Friday Conference with a discussion about HIV-associated stroke in Zambia.