Cognitive complaints, depression, medical symptoms, and their association with neuropsychological functioning in HIV infection: A structural equation model analysis.

Carter, Sherri L.; Rourke, Sean B.; Murji, Shemira; Shore, Douglas L.; Rourke, Byron P.

doi:10.1037/0894-4105.17.3.410

Cited by 127 publications

(64 citation statements)

References 62 publications

(79 reference statements)

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“…In contrast, depressive complaints were strongly associated with self-report of neurobehavioral problems in both countries. This finding also is consistent with what has been reported in North American HIV cohorts (Carter et al, 2003;Rourke et al, 1999).…”

Section: Discussionsupporting

confidence: 92%

Neurobehavioral effects of HIV-1 infection in China and the United States: A pilot study

Cysique

Jin

Franklin

et al. 2007

J. Inter. Neuropsych. Soc.

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The HIV epidemic in China has been increasing exponentially, yet there have been no studies of the neurobehavioral effects of HIV infection in that country. Most neuroAIDS research has been conducted in Western countries using Western neuropsychological (NP) methods, and it is unclear whether these testing methods are appropriate for use in China. Twenty-eight HIV seropositive (HIV+) and twenty-three HIV seronegative (HIV−) individuals with comparable gender, age, and education distributions were recruited in Beijing and the rural Anhui province in China. Thirtynine HIV+ and thirty-one HIV− individuals were selected from a larger U.S. cohort recruited at the HIV Neurobehavioral Research Center, in San Diego, to be matched to the Chinese sample for age, disease status, and treatment variables. The NP test battery used with the U.S. and China cohorts included instruments widely used to study HIV infection in the United States. It consisted of 14 individual test measures, each assigned to one of seven ability areas thought to be especially vulnerable to effects of HIV on the brain (i.e., verbal fluency, abstraction/executive function, speed of information processing, working memory, learning, delayed recall, and motor function). To explore the cross-cultural equivalence and validity of the NP measures, we compared our Chinese and U.S. samples on the individual tests, as well as mean scaled scores for the total battery and seven ability domains. On each NP test measure, the mean of the Chinese HIV+ group was worse than that of the HIV−group. A series of 2 × 2 analyses of variance involving HIV+ and HIV− groups from both countries revealed highly significant HIV effects on the Global and all Domain mean scaled scores. Country effects appeared on two of the individual ability areas, at least partly due to education differences between the two countries. Importantly, the absence of HIV-by-Country interactions suggests that the NP effects of HIV are similar in the two countries. The NP test battery that was chosen and adapted for use in this study of HIV in China appears to have good cross-cultural equivalence, but appropriate Chinese norms will be needed to identify disease-related impairment in individual Chinese people. To inform the development of such norms, a much larger study of demographic effects will be needed, especially considering the wide range of education in that country.

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Section: Discussionsupporting

confidence: 92%

Neurobehavioral effects of HIV-1 infection in China and the United States: A pilot study

Cysique

Jin

Franklin

et al. 2007

J. Inter. Neuropsych. Soc.

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show abstract

“…It is unclear whether NP impairment still produces worse medical outcomes in the context of HAART, but there is considerable evidence that even mild NP impairment is associated with reduced vocational functioning and other difficulties with cognitive aspects of everyday functioning: medication management, driving, and Instrumental Activities of Daily Living (IADLs; Carter et al, 2003;Heaton et al, 2004a;Hinkin et al, 2004;Marcotte et al, 2006). It is unknown whether any NP deficits that may be observed among HIV infected Chinese farmers would have the same relevance in their lives, or if such deficits could even be noticed by the patients and others around them.…”

Section: Introductionmentioning

confidence: 99%

Neurobehavioral effects of human immunodeficiency virus infection among former plasma donors in rural China

et al. 2008

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The HIV epidemic in China has expanded rapidly in recent years, but little is known about the prevalence and features of HIV Associated Neurocognitive Disorders (HANDs) in this part of the world. We administered a comprehensive Western neuropsychological (NP) test battery to 203 HIV+ and 198 HIV-former plasma donors in the rural area of Anhui province. We found that 26% in the HIV-sample, and 46% in the HIV+ sample were infected with HCV, which can also have CNS effects. To classify NP impairment, we developed demographically corrected test norms based upon individuals free of both infections (N=141). Using a global summary score, NP impairment was found in 34.2% of the HIV mono-infected group and 39.7% of the co-infected group, as compared to 12.7% of the uninfected controls (p<.001). HIV+ participants with AIDS were more likely to be impaired (43%) than non-AIDS individuals (29%, p<.05). Lastly, when all infection groups were combined, participants with NP impairment reported more cognitive complaints (p<.01) and increased dependence in everyday functioning (p=.01). In sum, NP impairment in this large rural Chinese sample was associated with both HIV and HCV infections, and the impairment's prevalence, severity, and pattern were similar to those reported by Western studies. Clinical significance of NP impairment in this population is suggested by the participants' reports of reduced everyday functioning. These findings indicate that HAND is likely to be an important feature of HIV infection in developing countries, underscoring the need for international efforts to develop CNS relevant treatments.

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“…Indeed discordance between self-reported cognitive functioning and objective indices of neuropsychological performance has been documented among HIVinfected individuals [95]. However, other research has found increased cognitive complaints to predict poorer neuropsychological test performance and thus supports a relation between self-reported cognitive complaints and neuropsychological skills among HIV-infected individuals [52]. Further, the majority of observed cognitive impairment among HIV-infected individuals in the post-ART era is mild, variable, and may go undetected (asymptomatic neurocognitive impairment, mild neurocognitive disorder [see 27]).…”

Section: Discussionmentioning

confidence: 88%

“…Indeed, the ecological validity of using neuropsychological tests to assess cognitive function having been questioned [48] due to the nature of laboratory settings for neuropsychological testing, the potential for interactive effects of increased demands on cognition in everyday settings and cognitive deficits, and compensatory strategies that may be effective for a laboratory-based task (e.g., Modified Wisconsin Card Sorting Task) but are not reflected in selfreported memory skills [49]. Although neuropsychological tests provide objective data for specific cognitive deficits, it has been argued that subjective cognitive measures are more sensitive indices for everyday memory functioning [see 50,51], such as patients' experience of everyday memory failures or milder, more variable cognitive struggles that fluctuate over time [e.g., [52][53][54]. Use of selfreport measures (i.e., meta-memory) may therefore provide a complimentary lens through which to examine the effects of problematic alcohol use on memory functioning among individuals with HIV.…”

Section: Introductionmentioning

confidence: 99%

Problematic Alcohol Use Among Individuals with HIV: Relations with Everyday Memory Functioning and HIV Symptom Severity

et al. 2013

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Problematic alcohol use has been shown to negatively impact cognitive functions germane to achieving optimal HIV health outcomes. The present study, a secondary data analysis, examined the impact of problematic alcohol use on aspects of everyday memory functioning in a sample of 172 HIV-infected individuals (22 % female; M age = 48.37 years, SD = 8.64; 39 % Black/nonHispanic). Additionally, we tested whether self-reported memory functioning explained the relation between problematic alcohol use and HIV symptom severity. Results indicated that problematic patterns of alcohol use were associated with lower total memory functioning, retrieval (e.g., recall-difficulty) and memory for activity (e.g., what you did yesterday) and greater HIV symptom severity. Memory functioning mediated the relation between problematic alcohol use and HIV symptom severity. However, the direction of this relation was unclear as HIV symptom severity also mediated the relation between problematic alcohol use and memory functioning. Findings highlight the importance of integrated care for HIV and alcohol use disorders and suggest that routine alcohol and cognitive screenings may bolster health outcomes among this vulnerable population.

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Cognitive complaints, depression, medical symptoms, and their association with neuropsychological functioning in HIV infection: A structural equation model analysis.

Cited by 127 publications

References 62 publications

Neurobehavioral effects of HIV-1 infection in China and the United States: A pilot study

Neurobehavioral effects of HIV-1 infection in China and the United States: A pilot study

Neurobehavioral effects of human immunodeficiency virus infection among former plasma donors in rural China

Problematic Alcohol Use Among Individuals with HIV: Relations with Everyday Memory Functioning and HIV Symptom Severity

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