Diagnosing symptomatic HIV-associated neurocognitive disorders: self-report versus performance-based assessment of everyday functioning.

TitleDiagnosing symptomatic HIV-associated neurocognitive disorders: self-report versus performance-based assessment of everyday functioning.
Publication TypeJournal Article
Year of Publication2012
AuthorsBlackstone, K, Moore, DJ, Heaton, RK, Franklin, DR, Woods, SP, Clifford, DB, Collier, AC, Marra, CM, Gelman, BB, McArthur, JC, Morgello, S, Simpson, DM, Rivera-Mindt, M, Deutsch, R, Ellis, RJ, J Atkinson, H, Grant, I
Corporate AuthorsCNS HIV Antiretroviral Therapy Effects Research (CHARTER) Group
JournalJ Int Neuropsychol Soc
Date Published2012 Jan
KeywordsActivities of Daily Living, Adult, Aged, CHARTER, Cognition Disorders, Cohort Studies, Depression, Female, HIV Infections, HN Protein, Humans, Immunoenzyme Techniques, Internal, Lipopolysaccharide Receptors, Logistic Models, Male, Middle Aged, Motor Activity, Neuropsychological Tests, Psychiatric Status Rating Scales, Self Report, Sensitivity and Specificity, Statistics, Nonparametric, Young Adult

Three types of HIV-associated neurocognitive disorders (HAND) exist that are distinguished by presence and severity of impairment in cognitive and everyday functioning. Although well-validated neurocognitive measures exist, determining impairment in everyday functioning remains a challenge. We aim to determine whether Self-Report measures of everyday functioning are as effective in characterizing HAND as Performance-Based measures. We assessed 674 HIV-infected participants with a comprehensive neurocognitive battery; 233 met criteria for a HAND diagnosis by having at least mild neurocognitive impairment. Functional decline was measured via Self-Report and Performance-Based measures. HAND diagnoses were determined according to published criteria using three approaches to assess functional decline: (1) Self-Report measures only, (2) Performance-Based measures only, and (3) Dual-method combining Self-Report and Performance-Based measures. The Dual-method classified the most symptomatic HAND, compared to either singular method. Singular method classifications were 76% concordant with each other. Participants classified as Performance-Based functionally impaired were more likely to be unemployed and more immunosuppressed, whereas those classified as Self-Report functionally impaired had more depressive symptoms. Multimodal methods of assessing everyday functioning facilitate detection of symptomatic HAND. Singular Performance-Based classifications were associated with objective functional and disease-related factors; reliance on Self-Report classifications may be biased by depressive symptoms.

Alternate JournalJ Int Neuropsychol Soc
PubMed ID22114912
PubMed Central IDPMC3882265
Grant ListDA031098 / DA / NIDA NIH HHS / United States
T32 DA031098 / DA / NIDA NIH HHS / United States
P30 MH062512 / MH / NIMH NIH HHS / United States
MH 62512 / MH / NIMH NIH HHS / United States
N01 MH022005 / MH / NIMH NIH HHS / United States