Journal of the International Neuropsychological Society



The impact of HIV-associated neuropsychological impairment on everyday functioning


ROBERT K.  HEATON  a1 a2 c1 , THOMAS D.  MARCOTTE  a1 , MONICA RIVERA  MINDT  a4 , JOSEPH  SADEK  a1 , DAVID J.  MOORE  a3 , HEATHER  BENTLEY  a1 , J. ALLEN  MCCUTCHAN  a1 , CARLA  REICKS  a1 , IGOR  GRANT  a1 a2 and THE HNRC GROUP
a1 Department of Psychiatry, University of California at San Diego, San Diego, California
a2 VA San Diego Health Care System, San Diego, California
a3 San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California
a4 Department of Psychology, Fordham University, New York, New York

Article author query
heaton rk   [PubMed][Google Scholar] 
marcotte td   [PubMed][Google Scholar] 
mindt mr   [PubMed][Google Scholar] 
sadek j   [PubMed][Google Scholar] 
moore dj   [PubMed][Google Scholar] 
bentley h   [PubMed][Google Scholar] 
mccutchan ja   [PubMed][Google Scholar] 
reicks c   [PubMed][Google Scholar] 
grant i   [PubMed][Google Scholar] 

Abstract

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. a (JINS, 2004, 10, 317–331.)

(Received December 16 2002)
(Revised August 15 2003)
(Accepted August 21 2003)


Key Words: HIV; Activities of daily living; Everyday functioning; Cognition.

Correspondence:
c1 Reprint requests to: Robert K. Heaton, University of California, Department of Psychiatry (0603-G), 9500 Gilman Drive, La Jolla, CA 92093-0603.


Footnotes

a NOTE: Dr. Erin D. Bigler served as action editor during the course of this review.



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