Evaluating the accuracy of self-report for the diagnosis of HIV-associated neurocognitive disorder (HAND): defining "symptomatic" versus "asymptomatic" HAND.

TitleEvaluating the accuracy of self-report for the diagnosis of HIV-associated neurocognitive disorder (HAND): defining "symptomatic" versus "asymptomatic" HAND.
Publication TypeJournal Article
Year of Publication2017
AuthorsObermeit, LC, Beltran, J, Casaletto, KB, Franklin, D, Letendre, S, Ellis, RJ, Fennema-Notestine, C, Vaida, F, Collier, AC, Marra, CM, Clifford, DB, Gelman, B, Sacktor, N, Morgello, S, Simpson, DM, McCutchan, JA, Grant, I, Heaton, RK
Corporate AuthorsCHARTER Group
JournalJ Neurovirol
Volume23
Issue1
Pagination67-78
Date Published2017 02
ISSN1538-2443
KeywordsActivities of Daily Living, Adult, Asymptomatic Diseases, CHARTER, Cognition, Cognitive Dysfunction, Disabled Persons, Female, HIV Infections, Humans, Internal, Male, Middle Aged, Psychiatric Status Rating Scales, Self Report, Severity of Illness Index
Abstract

The criteria for differentiating symptomatic from asymptomatic HIV-associated neurocognitive disorder require evaluation of (1) cognitive impairment, (2) daily functioning declines, and (3) whether the functional declines are attributable to cognitive versus physical problems. Many providers rely only on self-report to evaluate these latter criteria. However, the accuracy of patient-provided information may be limited. This study evaluated the validity of self-assessment for HIV-associated neurocognitive disorder (HAND) diagnoses by comparing objective findings with self-report of criteria 2 and 3 above. Self-reports were used to stratify 277 cognitively impaired HIV+ individuals into functionally dependent (n = 159) and independent (n = 118) groups, followed by group comparisons of objective functional problems. The dependent group was then divided into those who self-attributed their functional dependence to only cognitive (n = 80) versus only physical (n = 79) causes, for further comparisons on objective findings. The functionally dependent group was significantly worse than the independent group on all objective disability characteristics except severity of cognitive impairment, while those who attributed their dependence to physical (versus cognitive) factors were similar on all objective physical, cognitive, and functioning variables. Of note, 28 % of physical attributors showed no physical abnormalities on neuromedical examinations. Results suggest that patient report is consistently associated with objective measures of functional loss; in contrast, patient identification of physical versus cognitive causes is poorly associated with objective criteria. These findings caution against relying solely on patient self-report to determine whether functional disability in cognitively impaired HIV+ individuals can be attributed to strictly physical causes.

DOI10.1007/s13365-016-0474-z
Alternate JournalJ. Neurovirol.
PubMed ID27557777
PubMed Central IDPMC5325815
Grant ListP30 AI027767 / AI / NIAID NIH HHS / United States
U01 AI035042 / AI / NIAID NIH HHS / United States
R01 AG042165 / AG / NIA NIH HHS / United States
R01 MH084796 / MH / NIMH NIH HHS / United States
R01 NS079166 / NS / NINDS NIH HHS / United States
R01 MH080150 / MH / NIMH NIH HHS / United States
R01 AG034852 / AG / NIA NIH HHS / United States
P50 DA026306 / DA / NIDA NIH HHS / United States
R21 DA037667 / DA / NIDA NIH HHS / United States
R01 MH094159 / MH / NIMH NIH HHS / United States
HHSN271201000030C / MH / NIMH NIH HHS / United States
U24 MH100931 / MH / NIMH NIH HHS / United States
U01 AI074521 / AI / NIAID NIH HHS / United States
P30 MH075673 / MH / NIMH NIH HHS / United States
R01 MH092225 / MH / NIMH NIH HHS / United States
U2G PS000623 / PS / NCHHSTP CDC HHS / United States
R44 AI068543 / AI / NIAID NIH HHS / United States
R03 MH103995 / MH / NIMH NIH HHS / United States
U01 AI069481 / AI / NIAID NIH HHS / United States
UM1 AI069495 / AI / NIAID NIH HHS / United States
R01 MH058076 / MH / NIMH NIH HHS / United States
M01 RR000036 / RR / NCRR NIH HHS / United States
HHSN271201000036C / MH / NIMH NIH HHS / United States
R01 MH104134 / MH / NIMH NIH HHS / United States
F31 DA035708 / DA / NIDA NIH HHS / United States
R01 MH078737 / MH / NIMH NIH HHS / United States
R01 NS072005 / NS / NINDS NIH HHS / United States
R25 MH080663 / MH / NIMH NIH HHS / United States
R01 DA037611 / DA / NIDA NIH HHS / United States
T32 DA031098 / DA / NIDA NIH HHS / United States
R01 NR012907 / NR / NINR NIH HHS / United States
UM1 AI069481 / AI / NIAID NIH HHS / United States
U01 NS032228 / NS / NINDS NIH HHS / United States
U01 AI069432 / AI / NIAID NIH HHS / United States
R01 NS034235 / NS / NINDS NIH HHS / United States
R21 NR015009 / NR / NINR NIH HHS / United States
R01 DA039775 / DA / NIDA NIH HHS / United States
R01 NR014449 / NR / NINR NIH HHS / United States
U01 AI068636 / AI / NIAID NIH HHS / United States
U01 MH083501 / MH / NIMH NIH HHS / United States
R01 MH101017 / MH / NIMH NIH HHS / United States
N01MH22005 / MH / NIMH NIH HHS / United States
R56 HL129881 / HL / NHLBI NIH HHS / United States
U13 MH081676 / MH / NIMH NIH HHS / United States
RF1 AG015301 / AG / NIA NIH HHS / United States
HHSN271201000027C / MH / NIMH NIH HHS / United States
R01 NR012657 / NR / NINR NIH HHS / United States
P01 AI057005 / AI / NIAID NIH HHS / United States
U01 AI069495 / AI / NIAID NIH HHS / United States
UL1 TR000067 / TR / NCATS NIH HHS / United States
P30 MH062512 / MH / NIMH NIH HHS / United States
R01 AG048650 / AG / NIA NIH HHS / United States
UL1 TR000448 / TR / NCATS NIH HHS / United States
U01 MH083506 / MH / NIMH NIH HHS / United States
P30 AI027757 / AI / NIAID NIH HHS / United States
N01 MH022005 / MH / NIMH NIH HHS / United States
R01 NS080655 / NS / NINDS NIH HHS / United States
K30 RR022681 / RR / NCRR NIH HHS / United States
R01 AI111806 / AI / NIAID NIH HHS / United States
R01 DA036165 / DA / NIDA NIH HHS / United States
R01 MH083552 / MH / NIMH NIH HHS / United States
R01 MH107345 / MH / NIMH NIH HHS / United States
R01 NS081196 / NS / NINDS NIH HHS / United States
R01 MH095621 / MH / NIMH NIH HHS / United States
R01 NS082120 / NS / NINDS NIH HHS / United States
R01 MH085608 / MH / NIMH NIH HHS / United States
U10 NS077384 / NS / NINDS NIH HHS / United States
R01 MH099733 / MH / NIMH NIH HHS / United States
R01 AI047033 / AI / NIAID NIH HHS / United States
R01 MH060720 / MH / NIMH NIH HHS / United States
DP1 DA037979 / DA / NIDA NIH HHS / United States
R01 AI125026 / AI / NIAID NIH HHS / United States
UM1 AI120176 / AI / NIAID NIH HHS / United States
R43 AI068543 / AI / NIAID NIH HHS / United States
UM1 AI068636 / AI / NIAID NIH HHS / United States
R01 AG022381 / AG / NIA NIH HHS / United States
R21 DK105917 / DK / NIDDK NIH HHS / United States