Functional Consequences of HIV-Associated Neuropsychological Impairment

Abstract

This review focuses on the "real world" implications of infection with HIV/AIDS from a neuropsychological perspective. Relevant literature is reviewed which examines the relationships between HIV-associated neuropsychological impairment and employment, driving, medication adherence, mood, fatigue, and interpersonal functioning. Specifically, the relative contributions of medical, cognitive, psychosocial, and psychiatric issues on whether someone with HIV/AIDS will be able to return to work, adhere to a complicated medication regimen, or safely drive a vehicle will be discussed. Methodological issues that arise in the context of measuring medication adherence or driving capacity are also explored. Finally, the impact of HIV/AIDS on mood state, fatigue, and interpersonal relationships are addressed, with particular emphasis on how these variables interact with cognition and independent functioning. The purpose of this review is to integrate neuropsychological findings with their real world correlates of functional behavior in the HIV/AIDS population.

Prevalence of neurocognitive disorders and depression in a Brazilian HIV population

“…Although the study design did not enable the directionality of this association to be determined, these data indicate the impact of neurocognitive impairment on the individuals' daily lives (23) .…”

“…Both neurocognitive disorders and depression can negatively impact quality of life, daily activities, and treatment adherence (21) (22) (23) . The objectives of this study were to determine the prevalence of neurocognitive impairment and depressive disorders in HIV+ patients, compare the performance of the IHDS with the performances of other neuropsychological assessment tools (TGT and DS) and a scale of instrumental activities of daily living, and evaluate the association between neurocognitive impairment and clinical-demographic variables.…”

Neuropsychiatric and Socioeconomic Status Impact Antiretroviral Adherence and Mortality in Rural Zambia

“…13,14 In a 2006 meta-analysis, poor adherence was found to be related to the cost of accessing medication, a lack of disclosure to one's spouse, alcohol use/misuse, and the complexity of the treatment regimen. 15 The presence of HIV-associated cognitive impairment might impact a person's capacity for good ART adherence, 16,17 but this has not been studied prospectively. Co-morbid psychiatric disorders, particularly if untreated, might adversely impact a person's capacity for adherence.…”

Structural brain markers are differentially associated with neurocognitive profiles in socially marginalized people with multimorbid illness.

“…Characterizing neurocognition is an important starting point given that it plays a central role in facilitating successful execution of everyday real-world activities in healthy and clinical populations (Fett et al, 2011;Morgan & Heaton, 2009). It is instrumental to complex activities such as medication adherence, financial management, driving ability, and interpersonal communications (Gorman, Foley, Ettenhofer, Hinkin, & van Gorp, 2009), all of which are especially relevant to a multimorbid population who already face numerous socioeconomic and psychosocial barriers that directly impact daily functioning. Indeed, neurocognition appears to have a unique contribution to real-world functioning even when other factors such as housing status and psychiatric symptoms are accounted for in marginalized persons (Stergiopoulos, Burra, Rourke, & Hwang, 2011).…”