Apathy, Depression, and Cognitive Performance in HIV-1 Infection

Abstract

The authors examined the relationship between apathy, depression, and cognitive performance in 48 HIV-1-seropositive and 21 seronegative (control) subjects, using reaction time (RT) and working memory tasks. Apathy, but not depression, was associated with working memory deficits among HIV-seropositive subjects. The cognitive-affective component of the Beck Depression Inventory (BDI), but not apathy, was associated with slowing and decreased accuracy on a choice RT task. The BDI cognitive-affective component was more closely associated than the BDI somatic component with both RT slowing and apathy. Results suggest that prominent symptoms of apathy, independent of depression, may be an important indicator of CNS involvement in HIV infection. Total BDI scores showed a less consistent relationship with neurocognitive performance, suggesting that somatic symptomatology is diagnostically ambiguous among HIV-infected subjects.

Relationship between psychiatric status and frontal–subcortical systems in HIV-infected individuals

“…However, these findings are consistent with other studies that used frontal-subcortical systems-dependent tests investigating cognitive flexibility, Stroop interference, working memory, and a different form of dual-task performance, each finding a similar relationship between performance on these tasks and the presence of apathy and/or irritability symptomatology (Castellon et al, 1998Paul et al, 2005a). The current study furthered this work by providing a direct comparison of apathy and irritability with anxiety and depression and by quantifying the extent to which apathy and irritability share predictive variance with dual-task performance.…”

“…It is possible that depression and anxiety symptomatology may relate to other neural systems affected by HIV that were not measured in the current study, although other work evaluating primary neuropsychological domains have thus far not found that to be the case (Castellon et al, 1998;Grant et al, 1993;Hinkin et al, 1992;Mapou et al, 1993;Perdices et al, 1992;Rabkin et al, 2000). Alternatively, these psychiatric features may be more related to psychological and psychosocial factors (Perdices et al, 1992).…”

“…Castellon et al (1998) found prominent symptoms of apathy to be associated with working memory deficits in HIV-positive individuals and, in a second study, found that prominent irritability and apathy were highly related to poorer performance on those neuropsychological tasks most dependent upon executive functioning . In contrast, Rabkin et al (2000) found that apathy was not related to performances across several neuropsychological domains, including frontal systems, in HIVseropositive (HIV+) individuals.…”

“…Irritability and apathy were measured by adaptations of the apathy and irritability subscales of the Neuropsychiatric Inventory (NPI), developed by Cummings and colleagues (1994) and modified for use with HIV-infected subjects (Castellon et al, 1998.…”

“…Several studies demonstrated a lack of relationship between depression and neuropsychological decrements in HIV-infected individuals (Castellon et al, 1998;Grant et al, 1993;Hinkin et al, 1992;Rabkin et al, 2000). Similarly, studies suggest that anxiety is not related to poor neuropsychological performances (Mapou et al, 1993;Perdices et al, 1992), but has been found to be associated with psychological and psychosocial symptoms (Perdices et al, 1992).…”