The impact of HIV-associated neuropsychological impairment on everyday functioning

HIV-1 infection can be associated with neuropsychological (NP) deficits ranging from subtle to severe. The purpose of this study was to evaluate the functional, or “real-world” impact of HIV-associated NP impairment in a group of 267 HIV-infected participants. All participants received comprehensive NP, neuromedical, and standardized functional evaluations that included laboratory measures of shopping, cooking, financial management, medication management and vocational abilities. Compared to NP-normal participants, those with NP impairment performed significantly worse on all laboratory measures of everyday functioning. Multivariate analyses revealed that the NP ability domains of Abstraction/Executive Function, Learning, Attention/Working Memory and Verbal abilities most strongly and consistently predicted failures on the functional battery. Both NP impairment and impairment on the functional battery were significantly associated with subjective experiences of cognitive difficulties, as well as unemployment and increased dependence in activities of daily living; multivariate prediction models that also considered depressed mood and biological measures of disease progression revealed that impairment on the functional battery and depression were the only unique predictors of all three indicators of “real-world” functioning. The current results add to growing evidence concerning the clinical significance of HIV-associated NP impairment. Objective, laboratory based functional measures, such as those used here, may compliment NP testing in future studies directed at understanding the impact on life quality of central nervous system disorders and their treatments. Finally, there is a need for additional research investigating the apparently independent effect of depression on level of everyday functioning in HIV infected persons.NOTE: Dr. Erin D. Bigler served as action editor during the course of this review. (JINS, 2004, 10, 317–331.)

[1]  Andrew J. Saykin,et al.  Nomenclature and research case definitions for neurologic manifestations of human immunodeficiency virus‐type 1 (HIV‐1) infection , 1991, Neurology.

[2]  M. Zweig,et al.  Receiver-operating characteristic (ROC) plots: a fundamental evaluation tool in clinical medicine. , 1993, Clinical chemistry.

[3]  D. Richman,et al.  Evidence for early central nervous system involvement in the acquired immunodeficiency syndrome (AIDS) and other human immunodeficiency virus (HIV) infections. Studies with neuropsychologic testing and magnetic resonance imaging. , 1987, Annals of internal medicine.

[4]  S. Finklestein,et al.  The predictive power of diagnostic tests and the effect of prevalence of illness. , 1983, Archives of general psychiatry.

[5]  J. Haxby,et al.  Assessment of AIDS-related cognitive changes: recommendations of the NIMH Workshop on Neuropsychological Assessment Approaches. , 1990, Journal of clinical and experimental neuropsychology.

[6]  M. Lawton,et al.  Assessment of older people: self-maintaining and instrumental activities of daily living. , 1969, The Gerontologist.

[7]  Michael J. Taylor,et al.  The impact of HIV-related neuropsychological dysfunction on driving behavior , 2000, Journal of the International Neuropsychological Society.

[8]  T. Salthouse,et al.  Influence of Experience on Age Differences in Cognitive Functioning , 1990, Human factors.

[9]  R. Camarda,et al.  Convergence nystagmus associated with Arnold-Chiari malformation. , 1991, Archives of neurology.

[10]  I Grant,et al.  Neuropsychological impairment in human immunodeficiency virus‐infection: implications for employment. HNRC Group. HIV Neurobehavioral Research Center. , 1994, Psychosomatic medicine.

[11]  I. Grant,et al.  Detecting significant change in neuropsychological test performance: A comparison of four models , 1999, Journal of the International Neuropsychological Society.

[12]  C. Hinkin,et al.  Medication adherence among HIV+ adults , 2002, Neurology.

[13]  Michael J. Taylor,et al.  The impact of HIV-related neuropsychological dysfunction on driving behavior , 1999, Journal of the International Neuropsychological Society.

[14]  T. Salthouse,et al.  Age-related differences in basic cognitive processes: implications for work. , 1994, Experimental aging research.

[15]  Byron Anderson,et al.  Dictionary of Occupational Titles , 1993 .

[16]  A. Salazar,et al.  Neuropsychological performance, mood, and complaints of cognitive and motor difficulties in individuals infected with the human immunodeficiency virus. , 1993, The Journal of neuropsychiatry and clinical neurosciences.

[17]  T. Jernigan,et al.  Progressive cerebral volume loss in human immunodeficiency virus infection: a longitudinal volumetric magnetic resonance imaging study. HIV Neurobehavioral Research Center Group. , 1998, Archives of neurology.

[18]  Terry L. Jernigan,et al.  Magnetic Resonance Imaging Morphometric Analysis of Cerebral Volume Loss in Human Immunodeficiency Virus Infection , 1993 .

[19]  G. Chelune,et al.  Neuropsychological and Personality Correlates of Patients’ Complaints of Disability , 1986 .

[20]  Robert K. Heaton,et al.  Norms for Letter and Category Fluency: Demographic Corrections for Age, Education, and Ethnicity , 1999, Assessment.

[21]  R. Heaton,et al.  The Paced Auditory Serial Addition Task (Pasat): Norms For Age, Education, And Ethnicity , 1998, Assessment.

[22]  I. Grant,et al.  A comparison of clinical and automated interpretation of the Halstead-Reitan Battery. , 1981, Journal of clinical neuropsychology.

[23]  R. Heaton,et al.  Use of Neuropsychological tests to predict adult patients' everyday functioning. , 1981, Journal of consulting and clinical psychology.

[24]  K. Marder,et al.  Neuropsychologic impairment in early HIV infection. A risk factor for work disability. , 1995, Archives of neurology.

[25]  K. Marder,et al.  Multidisciplinary baseline assessment of homosexual men with and without human immunodeficiency virus infection. III. Neurologic and neuropsychological findings. , 1991, Archives of general psychiatry.

[26]  D. Loewenstein,et al.  Neuropsychological test performance and prediction of functional capacities among Spanish-speaking and English-speaking patients with dementia. , 1995, Archives of clinical neuropsychology : the official journal of the National Academy of Neuropsychologists.

[27]  Michael J. Taylor,et al.  Nature and vocational significance of neuropsychological impairment associated with HIV infection , 1996 .

[28]  R. Bornstein,et al.  Neuropsychological performance in asymptomatic HIV infection. , 1992, The Journal of neuropsychiatry and clinical neurosciences.

[29]  C. Hinkin,et al.  Medication adherence in HIV-infected adults: effect of patient age, cognitive status, and substance abuse , 2004, AIDS.

[30]  S. Gruber,et al.  The epidemiology of Parkinson's disease. A case-control study of young-onset and old-onset patients. , 1991 .

[31]  R. Benedict,et al.  Impact of human immunodeficiency virus type-1-associated cognitive dysfunction on activities of daily living and quality of life. , 2000, Archives of clinical neuropsychology : the official journal of the National Academy of Neuropsychologists.

[32]  John W. Ward,et al.  1993 revised classification system for HIV infection and expanded surveillance case definition for AIDS among adolescents and adults. , 1993, MMWR. Recommendations and reports : Morbidity and mortality weekly report. Recommendations and reports.

[33]  Brenda White,et al.  DEPARTMENT OF LABOR , 2006 .

[34]  S. Woods,et al.  Are Classification Accuracy Statistics Underused in Neuropsychological Research? , 2003, Journal of clinical and experimental neuropsychology.

[35]  Wilbur L. Smith,et al.  Erratum: ″Personality change disorder in children and adolescents following traumatic brain injury,″ (Journal of the International Neuropsychological Society (2000) vol. 6(3) (279-289)) , 1999 .

[36]  K. Marder,et al.  Clinical trials in HIV-associated cognitive impairment: Cognitive and functional outcomes , 2001, Neurology.

[37]  K. Marder,et al.  An Observed Performance Test of Medication Management Ability in HIV: Relation to Neuropsychological Status and Medication Adherence Outcomes , 1999, AIDS and Behavior.

[38]  A. d’Arminio Monforte,et al.  Medication adherence among HIV+ adults: Effects of cognitive dysfunction and regimen complexity , 2003, Neurology.

[39]  Michael J. Taylor,et al.  The HNRC 500-Neuropsychology of Hiv infection at different disease stages , 1995, Journal of the International Neuropsychological Society.