Journal of the International Neuropsychological Society

Research Articles

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

K. Blackstonea1, D.J. Moorea2 c1, R.K. Heatona2, D.R. Franklin Jr.a2, S.P. Woodsa2, D.B. Clifforda3, A.C. Colliera4, C.M. Marraa4, B.B. Gelmana5, J.C. McArthura6, S. Morgelloa7, D.M. Simpsona7, M. Rivera-Mindta7, R. Deutscha2, R.J. Ellisa8, J. Hampton Atkinsona2 and I. Granta2

for the CHARTER Group

a1 San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology; San Diego, California, USA

a2 Department of Psychiatry, University of California, San Diego; San Diego, California, USA

a3 Department of Neurology, Washington University, St. Louis; St. Louis, Missouri, USA

a4 Department of Neurology, Mount Sinai School of Medicine; New York, New York, USA

a5 Departments of Neurology and Medicine (Infectious Diseases), University of Washington; Seattle, WA, USA

a6 Department of Pathology, University of Texas Medical Branch; Galveston, Texas, USA

a7 Department of Neurology, Johns Hopkins University; Baltimore, Maryland, USA

a8 Department of Neurosciences, University of California, San Diego; San Diego, California, USA


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)

(Received May 17 2011)

(Revised September 12 2011)

(Accepted September 13 2011)


c1 Correspondence and reprint requests to: D.J. Moore, Department of Psychiatry, University of California, San Diego; San Diego, CA. E-mail: