HIV infection is associated with impairments in prospective memory (ProM), an aspect of episodic memory that refers to the ability to execute a future intention, such as remembering to take a medication at a specific time. The current study sought to examine the relationship between HIVassociated ProM impairment and the successful management of independent activities of daily living (IADLs). In a cohort of 66 HIV-infected individuals, ProM accounted for a significant proportion of variance in self-reported IADL dependence over and above that which was explained by retrospective memory and current affective distress. Analysis of component cognitive processes revealed that the relationship between HIV-associated ProM deficits and IADL dependence was driven by impaired cue detection and self-initiated intention retrieval. Results were not better explained by demographic factors, HIV disease severity, psychiatric comorbidity, or substance use. Collectively, these data support the potential incremental ecological validity of ProM as a predictor of dependence in IADLs among persons living with HIV infection. KeywordsHuman immunodeficiency virus; neuropsychological assessment; episodic memory; activities of daily living HIV-associated Prospective Memory Impairment Increases Risk of Dependence in Everyday FunctioningThe human immunodeficiency virus (HIV) crosses the blood-brain barrier and often leads to neuropathological changes (e.g., syncytia and synaptodendritic injury), which primarily affect the basal ganglia, frontal neocortex, hippocampus, and cerebral white matter (González-Scarano, & Martín-García, 2005 has improved systemic disease outcomes and diminished the incidence of frank dementia among persons infected with HIV, the prevalence of milder forms of HIV-associated neurocognitive impairment remains a significant public health problem (McArthur, 2004). The neurobehavioral syndrome of HIV infection is most consistent with dysregulation of frontostriato-thalamo-cortical circuits and is typically marked by mild-to-moderate bradyphrenia, bradykinesia, executive dysfunction, and deficits in episodic memory (e.g., Reger, Welsh, Razani, Martin, & Boone, 2002). As many as one-half of individuals with HIV-associated neurocognitive impairment experience problems independently managing their instrumental activities of daily living (IADLs; Heaton et al., 2004). Neuropsychological impairment contributes to decrements in medication management (e.g., Albert et al., 1999), automobile driving (Marcotte et al., 1999), and vocational functioning (e.g., van Gorp, Baerwald, Ferrando, McElhiney, & Rabkin, 1999), even after considering the effects of HIV disease severity and psychiatric distress (e.g., depression).Deficits in episodic memory are among the strongest neuropsychological predictors of IADL declines in HIV (e.g., Andrade et al., 2005;Benedict, Mezhir, Walsh, & Hewitt, 2000;Heaton et al., 1994;van Gorp et al., 2007). Episodic memory impairment is evident in approximately 50% of individuals infected with HIV (e.g...

Optimal adherence to antiretroviral medications is critical to the effective long-term management of HIV infection. Although prospective memory (ProM; i.e., "remembering to remember") has long been theorized to play an important role in medication adherence, no prior studies have evaluated whether HIV-associated ProM impairment possesses unique predictive value in this regard. Results from this study demonstrate a robust association between ProM impairment and self-reported medication management in 87 HIV-infected persons currently prescribed antiretroviral medications. Specifically, more frequent ProM complaints and performance deficits on both laboratory and semi-naturalistic ProM tasks were all independently related to poorer self-reported medication management. A series of hierarchical regression analyses revealed that HIV-associated ProM impairment accounted for a significant amount of variance in self-reported medication management beyond that which was explained by other factors known to predict nonadherence, including mood disorders, psychosocial variables, environmental structure, and deficits on a traditional battery of neuropsychological tests. Overall, these findings support the hypothesis that ProM captures a unique and largely untapped aspect of cognition that is germane to optimal medication adherence. The potential benefits of individualized remediation strategies that are informed by conceptual models of ProM and specifically target medication adherence warrant further exploration.

The construct of prospective memory (ProM), or "remembering to remember," is hypothesized to play a critical role in normal activities of daily living and has increasingly been the focus of clinical research over the past 10 years. However, the assessment of ProM as part of routine clinical care is presently hampered by the paucity of psychometrically sound, validated ProM tests available in the neuropsychological literature. The Memory for Intentions Screening Test (MIST;Raskin, 2004) is a user-friendly, comprehensive measure of ProM that demonstrates preliminary evidence of construct validity. Extending this research, this study evaluated the psychometric characteristics of the MIST in a sample of 67 healthy adults. Despite a mildly restricted range of scores, results revealed excellent inter-rater reliability, adequate split-half reliability, and satisfactory inter-relationships between the MIST summary score, subscales, and error types. Analysis of demographic correlates showed that the MIST was independently associated with both age and education, but not with sex or ethnicity. These findings broadly support the psychometric properties of the MIST, specifically its reliability and expected relationships with demographic characteristics. Recommendations are provided regarding future research to enhance the clinical usefulness of the MIST. Keywords reliability; test construction; neuropsychological assessment; episodic memory The construct of prospective memory (ProM) has garnered considerable interest within the clinical neuropsychology literature over the past 10 years (McDaniel & Einstein, 2007). ProM is an aspect of declarative (i.e., episodic) memory that describes the formation, maintenance, and execution of future intentions, and is highly dependent upon prefrontal (e.g., Brodmann's area 10; Simons et al., 2006), as well as medial temporal (e.g., hippocampal) neural systems (e.g., Martin et al., 2007a). Colloquially, ProM is referred to as "remembering to remember" and is commonly illustrated by such daily activities as remembering to take a medication at the appropriate time, remembering to return a telephone call, or remembering to pay the monthly household bills. It is therefore understandable why clinical researchers so often herald the ecological validity of ProM. In fact, it has been posited that ProM plays a central role in the independent performance of instrumental activities of daily living (IADLs; e.g., medication adherence), perhaps even more so than other higher-level cognitive functions (e.g., retrospective episodic memory). For example, misremembering the name of a prescribed medication after being queried by , 2007); namely, the MIST: 1) requires the delayed execution of intended actions; 2) requires that the intended action be performed in the context of an ongoing foreground (i.e., distractor) task; and 3) provides a constrained window of time in which the intention may be initiated and executed. Specifically, the MIST is a standardized measure in which participants are aske...

Failures of episodic retrospective memory (RetM) are among the most frequently reported cognitive complaints endorsed by individuals living with HIV infection. The present study sought to examine the nature, frequency, and determinants of self-reported complaints of prospective memory (ProM) in HIV, which is a singly dissociable and ecologically relevant aspect of episodic memory involving the execution of future intentions. Seventy-five HIV seropositive individuals and 60 seronegative volunteers were administered the Prospective and Retrospective Memory Questionnaire (PMRQ) as part of extensive neuropsychological, psychiatric, and medical research assessments. The HIV sample endorsed more frequent ProM complaints in daily life than the seronegative group, particularly on items requiring self-initiated cue detection and retrieval. Within both study groups, ProM complaints were significantly more frequent than RetM complaints. Although the HIV sample was impaired relative to the seronegative group on an objective, performance-based ProM test, self-reported ProM complaints did not correspond to actual ProM abilities. However, greater frequency of self-reported ProM complaints was moderately associated with increased fatigue, as well as with symptoms of anxiety and depression. Consistent with prior research on RetM in HIV, results indicate that affective distress contributes to a metamemory deficit for HIV-associated ProM impairment, which highlights the potential importance of assessing both self-reported and performance-based ProM in clinical and research neuroAIDS evaluations.