Factors contributing to impaired self-awareness of cognitive functioning in an HIV positive and at-risk population

Abstract

Purpose To examine the association between self-awareness of cognitive impairment and age, selected mood disorders, and type and severity of cognitive impairment in a sample of individuals with HIV/AIDS and at risk for HIV. Method 75 subjects, 52 HIV+ and 23 at risk for HIV completed a psychosocial interview, the Patient’s Assessment of Own Functioning (PAOF) questionnaire, and a battery of neuropsychological tests. Based upon the differences between their clinical impairment and self-reported impairment, subjects were classified as being “Underestimators”, “Good Awareness”, or “Impaired Awareness” with regard to self-awareness. Results Those with more severe cognitive impairment were less aware than those with normal or borderline cognitive impairment. A one-way ANOVA suggested that the Impaired Awareness group differed significantly from the Underestimators on the Rey Figure Immediate and Delayed Recall tasks, and from both the Underestimators and Good Awarenesss groups on the Digit Symbol Substitution Task. There were significant differences among all awareness groups on the test of Simple Reaction Time. Furthermore there is some suggestion that age may contribute to impaired self-awareness. The role of HIV in self-awareness remains unclear, as both, individuals with HIV and at risk, demonstrated impaired self-awareness. Conclusions Overall, impaired awareness was associated with poorer test performance, suggesting a relationship between awareness and sustained complex attention and visual spatial processing. This research has implications for understanding factors contributing to poor awareness among individuals with cognitive impairment.

Evaluating the accuracy of self-report for the diagnosis of HIV-associated neurocognitive disorder (HAND): defining “symptomatic” versus “asymptomatic” HAND

“…While everyday functioning difficulties are elevated in depressed individuals, the subjective perception of both physical disability severity (Severeijns et al 2001) and cognitive deficits (Farrin et al 2003) can also be significantly influenced by psychological distress. Across the literature, poor mood is a robust predictor of self-reported quality of life (e.g., Pompili et al 2013), as well as less accurate self-awareness (e.g., Juengst et al 2012), and increased complaints of cognitive difficulties (e.g., van Gorp et al 1991). Therefore, it is no surprise that our results showed that self-reported cognitive attribution was primarily associated with current mood and lifetime depression, but not with objective measures of physical and cognitive impairments.…”

“…However, when the self-assessment relates to more complex concepts, such as general cognitive ability (e.g., “Am I unemployed for only physical reasons?” versus “Am I unemployed?”), inaccuracy is seen in up to 50 % of individuals with HIV (i.e., metacognitive deficit; Blackstone et al 2012). In instances of meta-cognitive deficits, self-reported neurocognitive difficulties are often related to affective distress rather than objective performances across cognitive domains (Hinkin et al 1996; van Gorp et al 1991; Blackstone et al 2012; Juengst et al 2012). HIV-associated neurocognitive impairment increases the risk of these metacognitive disturbances (Casaletto et al 2014; Juengst et al 2012), even in cases of mild and asymptomatic neurocognitive impairment (Chiao et al 2013).…”

“…In instances of meta-cognitive deficits, self-reported neurocognitive difficulties are often related to affective distress rather than objective performances across cognitive domains (Hinkin et al 1996; van Gorp et al 1991; Blackstone et al 2012; Juengst et al 2012). HIV-associated neurocognitive impairment increases the risk of these metacognitive disturbances (Casaletto et al 2014; Juengst et al 2012), even in cases of mild and asymptomatic neurocognitive impairment (Chiao et al 2013). Of ecological relevance, such difficulties in awareness are linked to poorer everyday functioning outcomes among these individuals (Blackstone et al 2012).…”

Memory-Based Strategies for Antiretroviral Medication Management: An Evaluation of Clinical Predictors, Adherence Behavior Awareness, and Effectiveness

“…Additionally, lack of adherence behavior awareness is important for clinicians and researchers when evaluating patients (i.e., accuracy of self-reported adherence behaviors may be biased) and recommending the most appropriate ART regimen or strategy use (e.g., enlisting social support may be most appropriate for a patient with poor insight rather than encouraging the patient to use internal strategies). HIV individuals may be imprecise in determining adherence strategy effectiveness due to concurrent cognitive impairment, which may impact one’s ability to objectively assess such abilities(43), or possibly due to lack of feedback from such suboptimal strategy use (i.e., they do not feel sick). Regardless, awareness of functional abilities, including adherence, is an important skill that is necessary for successful independent functioning, and is therefore an important area for intervention in this population (e.g., awareness-training).…”

The University of California San Diego performance-based skills assessment: a useful tool to detect mild everyday functioning difficulties in HIV-infected patients with very good immunological condition

“…Usually, EF is measured by IADL scale (Instrumental Activities of Daily Living, Lawton and Brody 1969), but this tool has shown low sensitivity in patients with no overt dementia, and, as a self-reported questionnaire, it is sensitive to errors due to retrospective recall, cognitive deficits, statedependent biases (e.g., depressed mood), affective distress, and level of insight (Heaton et al 2004). Furthermore, selfreported attributions may be closely related to poor metacognition, often affected by HAND (Casaletto et al 2014;Juengst et al 2012), even in case of MND and ANI (Chiao and Blizinsky 2013). Considering these limitations, MND is likely underrated, and a misdiagnosis of asymptomatic HAND could result in delayed interventions, more rapid disease progression, imprecise clinical recommendations, and an increased risk of public health concerns (Obermeit et al 2017).…”