Deficits in Self-Awareness Impact the Diagnosis of Asymptomatic Neurocognitive Impairment in HIV

Abstract

A recent national survey of HIV + adults noted that nearly three-quarters of cognitively impaired individuals are categorized as having asymptomatic neurocognitive impairment (ANI), lacking documented compromise of everyday function. The clinical impact and long-term consequences of ANI are unknown and the importance of this asymptomatic diagnosis has raised concerns in clinical care settings where competing priorities often exist. In this study, we conducted structured tests of everyday functioning in a sample of HIV + subjects over 60 years of age and asked subjects to rate their performance relative to peers. We demonstrate that individuals with neuropsychological testing impairment often lack self-awareness of functional performance deficits. Specifically, ANI subjects rated functional performance similar to that of HIV-negative control subjects, despite noted deficits in objective measures of function. These findings have important implications for use of self-report of function in the diagnosis of HIV-associated neurocognitive disorders (HAND), likely underestimating symptomatic impairment.

The Montreal Cognitive Assessment to Screen for Cognitive Impairment in HIV Patients Older Than 60 Years

“…The parent study excluded subjects who had factors that would substantially affect cognition besides HIV infection or neurodegenerative disorder, as previously described. 16 We also excluded one patient from this analysis who was not able to complete the MoCA due to advanced dementia. Participants were recruited through community fliers and physician referrals as previously described, with no exclusion based on cognitive symptoms.…”

“…Participants were recruited through community fliers and physician referrals as previously described, with no exclusion based on cognitive symptoms. 16 …”

Psychiatric symptom burden in older people living with HIV with and without cognitive impairment: the UCSF HIV over 60 cohort study

“…Our findings provided further evidence that neuropsychiatric symptoms were not associated with cognitive functioning in older PLWH. As elsewhere proposed, patients with cognitive impairment may lack sufficient insight into their symptoms, impacting their ability to report symptoms accurately (Chiao et al, 2013). In the current study we used a self-completed and a proxy-report scale to assess neuropsychiatric burden in our sample, lessening the impact of potential lack of insight of cognitively impaired subjects.…”

“…Participants were required to provide contact information of a spouse, close friend or family member who could provide proxy information on the Neuropsychiatric Inventory-Questionnaire (NPI-Q). Participants with conditions that would significantly impact cognition aside from HIV were excluded; however, individuals were not selected or excluded solely due to cognitive symptoms (Chiao et al, 2013). All participants completed a 90-minute standardized, neuropsychological testing battery assessing multiple cognitive domains (see Supplemental Table 1).…”

Abbreviated Goal Management Training Shows Preliminary Evidence as a Neurorehabilitation Tool for HIV-associated Neurocognitive Disorders among Substance Users

“…Metacognition (i.e., “thinking about thinking”) is comprised of 1) conscious knowledge of cognitive processes (i.e., “metacognitive knowledge”), and 2) ability to monitor and regulate ongoing activities while engaging in a task (i.e., “online awareness”; Toglia & Kirk, 2000). Such abilities are commonly disrupted following injury to the prefrontal systems (i.e., anosgonosia; Kelley et al, 2002; Stuss, 2011), are associated with integrity of executive functions (Fernandez-Duque et al, 2000; Lysaker et al, 2008), and not surprisingly, appear to be disproportionately disrupted in both HIV and SUD compared to their neurologically healthy peers (e.g., Casaletto et al, 2014, 2015; Chiao et al, 2013; Le Berre et al, 2010). Of importance, there is consistent evidence suggesting that limitations in metacognition (i.e., poor awareness of neurocognitive impairments) are significantly associated with poorer motivation for treatment, risk of early attrition, and decreased skills learning (Fleming & Strong, 1999; Trudel, Tryon & Purdum, 1998).…”