HIV-infected persons with bipolar disorder are less aware of memory deficits than HIV-infected persons without bipolar disorder

Abstract

Episodic memory deficits are common in HIV infection and bipolar disorder, but patient insight into such deficits remains unclear. Thirty-four HIV-infected individuals without bipolar disorder l(HIV+/BD−) and 47 HIV+ individuals with comorbid bipolar disorder (HIV+/BD+) were administered the Hopkins Verbal Learning Test-Revised and the Brief Visuospatial Memory Test-Revised to examine objective learning/memory functioning. Subjective memory complaints were assessed via the memory subscale of the Patient’s Assessment of Own Functioning Inventory. HIV+/BD+ individuals performed poorer on tests of visual learning and visual/verbal recall compared to HIV+/BD− participants (ps<0.05). Memory complaints only predicted verbal learning (at a trend level, p=0.10) and recall (p=0.03) among the HIV+/BD− individuals. Memory complaints were not associated with memory performance within the HIV+/BD+ group (ps>0.10). Memory complaints were associated with affective symptoms in both groups. These complaints were also predictive of immunosuppression, higher unemployment, and greater dependence on Activities of Daily Living among the HIV+/BD+ individuals (ps<0.05). Awareness of memory abilities was particularly poor among HIV+/BD+ individuals (i.e., objective learning/memory did not correspond to reported complaints), which has important implications for the capacity of these individuals to engage in error-monitoring and compensatory strategies in daily life. Memory complaints are associated with depressed mood regardless of group membership. Among HIV+/BD+ individuals, these complaints may also signify worse HIV disease status and problems with everyday functioning. Clinicians and researchers should be cognizant of what these complaints indicate in order to lead treatment most effectively; use of objective neurocognitive assessments may still be warranted when working with these populations.

Lifetime suicide attempt history, quality of life, and objective functioning among HIV/AIDS patients with alcohol and illicit substance use disorders

“…Thus, the significantly lower FAHI cognitive scores indicate that patients with a history of a suicide attempt perceive their functioning to be worse than those without a history of a suicide attempt, despite preforming similarly on objective measures of cognitive performance. Patients with a history of a suicide attempt possibly have poorer perceived cognitive functioning because they over-report their cognitive deficits, a finding in line with studies showing HIV/AIDS patients with mood disturbances tend to over-report cognitive deficits 7,51,52 .…”

Real-world impact of neurocognitive deficits in acute and early HIV infection

“…In concordance with these post-hoc findings, recent studies have also reported deleterious additive effects of MA and HIV, which are highly comorbid, on neurocognitive deficits (Weber et al 2012) and daily functioning outcomes (Blackstone et al 2013b). Similarly, Bipolar Disorder occurs at higher rates in HIV, and there are several studies elucidating its role in functional decline within HIV cohorts (e.g., Moore et al 2012; Blackstone et al 2012a). However, as Bipolar Disorder is highly complex and multifactorial (e.g., Pacchiarotti et al 2013), it remains to be seen which aspects of the disorder may be most involved in functional impairment (e.g., irritability, dysphoria, hedonism, and activation).…”

Attention-deficit/hyperactivity disorder among chronic methamphetamine users: Frequency, persistence, and adverse effects on everyday functioning

“…Our measurement of functional outcomes was predominately via self-report, which may be subject to bias. As such, future studies might include objective, performance-based measures of real-world functioning (see Blackstone et al, 2012). Although the high prevalence of MA+ and ADHD comorbidity was confirmed in the present study, the directionality of this relationship was not definitively determined.…”

“…Neurocognitive symptoms in daily life were assessed using the Patient's Assessment of Own Functioning Inventory (PAOFI; Chelune et al, 1986). PAOFI total scores were derived by summing the number of items with scores ≤ 3 (range 0-31), with higher total scores indicating more severe cognitive symptoms (Blackstone et al, 2012). The PAOFI was also used to determine participants’ employment status (employment was categorized as either full or part time).…”