Effort and neuropsychological performance in HIV-infected individuals on stable combination antiretroviral therapy

Abstract

The expression of cognitive symptoms associated with HIV varies over time and across individuals. This pattern may reflect transient contextual factors, including the degree of effort exerted by individuals undergoing cognitive testing. The present study examined whether effort corresponds to the expression of persistent HIV-related cognitive impairment among individuals receiving combination antiretroviral therapy (cART). HIV+ individuals (n = 111) averaged 48.2 (14.9) years of age 13.0 (2.7) years of education and HIV− individuals (n = 92) averaged 34.9 (17.2) years of age and 13.5 (1.9) years of education. Participants completed a neuropsychological battery and a clinically validated measure of effort (Test of Memory Malingering, Trial 1). Results revealed that the vast majority of HIV+ (85%) and HIV− (89%) individuals performed above published guidelines for adequate effort. Furthermore, the expression of cognitive impairment in HIV was not related to effort performance. The results were unchanged when examining HIV+ individuals with and without viral suppression. Finally, disability and disability-seeking status, and a proxy measure of apathy did not correspond to effort levels in HIV+ individuals. These findings suggest that variability in the expression of cognitive impairment in the cART era is unlikely to represent overt effort failures or other confounds unrelated to the disease. Persistent cognitive impairment in HIV likely represents historical and/or ongoing disease mechanisms despite otherwise successful treatment.

Performance validity test failure in clinical populations—a systematic review

“…49 Two studies reported validity results in people with HIV-in one study 15% of 111 people with HIV (stable on antiretroviral therapy) failed trial 1 of the TOMM (note, TOMM is usually scored on trial 2 or a delayed trial); and in another 17% of 30 failed the Amsterdam Short-Term Memory Test. 50 51 A study of neuropsychological performance in adults with sickle cell disease reported low failure rates on the TOMM and on RDS ≤6, but 33% of 43 failed RDS with a ≤7 cut-off. 52 candidates with essential tremor failed the WMT.…”

Online pharmacy navigation skills are associated with prospective memory in HIV disease

“…No participant in our sample met the Cogstate manual recommendations for questionable data integrity; however, we are not aware of any similar data checks for the NIH Toolbox and neither measure has validated embedded PVTs for HIV disease. Although prior studies support low base rates of PVT failures in participants with HIV (Paul et al, 2017;Woods et al, 2003), the validity of neuropsychological performance is an important component of neuropsychological assessment (Lippa, 2018). A fifth limitation is that we do not know the frequency of PM impairment in this sample, as there are no U.S. normative standards for the CAMPROMPT and the available U.K. norms are not adequately representative of the diverse older PWH in this study to warrant their application.…”

Cardiorespiratory Fitness Is Associated With Better White Matter Integrity in Persons Living With HIV

“…Raw test scores were converted into demographically adjusted (age, sex, race, and education) standardized z scores using appropriate normative standards (see Table, Supplemental Digital Content 1, http:// links.lww.com/QAI/B783, which summarizes results of individual cognitive tests). 27,28 The Z scores were averaged to create domain Z scores. The 4 domain Z scores were then averaged to create an overall cognition Z score.…”