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Diagnosing Symptomatic HIV-Associated Neurocognitive Disorders: Self-Report Versus Performance-Based Assessment of Everyday Functioning

Published online by Cambridge University Press:  24 November 2011

K. Blackstone ,
D.J. Moore ,
R.K. Heaton ,
D.R. Franklin Jr. ,
S.P. Woods ,
D.B. Clifford ,
A.C. Collier ,
C.M. Marra ,
B.B. Gelman  and
J.C. McArthur
...Show all authors
K. Blackstone
Affiliation:
San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology; San Diego, California, USA
D.J. Moore*
Affiliation:
Department of Psychiatry, University of California, San Diego; San Diego, California, USA
R.K. Heaton
Affiliation:
Department of Psychiatry, University of California, San Diego; San Diego, California, USA
D.R. Franklin Jr.
Affiliation:
Department of Psychiatry, University of California, San Diego; San Diego, California, USA
S.P. Woods
Affiliation:
Department of Psychiatry, University of California, San Diego; San Diego, California, USA
D.B. Clifford
Affiliation:
Department of Neurology, Washington University, St. Louis; St. Louis, Missouri, USA
A.C. Collier
Affiliation:
Department of Neurology, Mount Sinai School of Medicine; New York, New York, USA
C.M. Marra
Affiliation:
Department of Neurology, Mount Sinai School of Medicine; New York, New York, USA
B.B. Gelman
Affiliation:
Departments of Neurology and Medicine (Infectious Diseases), University of Washington; Seattle, WA, USA
J.C. McArthur
Affiliation:
Department of Pathology, University of Texas Medical Branch; Galveston, Texas, USA
S. Morgello
Affiliation:
Department of Neurology, Johns Hopkins University; Baltimore, Maryland, USA
D.M. Simpson
Affiliation:
Department of Neurology, Johns Hopkins University; Baltimore, Maryland, USA
M. Rivera-Mindt
Affiliation:
Department of Neurology, Johns Hopkins University; Baltimore, Maryland, USA
R. Deutsch
Affiliation:
Department of Psychiatry, University of California, San Diego; San Diego, California, USA
R.J. Ellis
Affiliation:
Department of Neurosciences, University of California, San Diego; San Diego, California, USA
J. Hampton Atkinson
Affiliation:
Department of Psychiatry, University of California, San Diego; San Diego, California, USA
I. Grant
Affiliation:
Department of Psychiatry, University of California, San Diego; San Diego, California, USA
*
Correspondence and reprint requests to: D.J. Moore, Department of Psychiatry, University of California, San Diego; San Diego, CA. E-mail: djmoore@ucsd.edu
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Abstract

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. (JINS, 2012, 18, 79–88)

Keywords

HIV/AIDSCognition disordersActivities of daily livingInfectious diseaseSelf assessmentsEmployment
Type
Research Articles
Information
Journal of the International Neuropsychological Society , Volume 18 , Issue 1 , January 2012 , pp. 79 - 88
Copyright
Copyright © The International Neuropsychological Society 2011

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