The impact of HIV-associated neuropsychological impairment on everyday functioning

Abstract

HIV-1 infection can be associated with neuropsychological (NP) deficits ranging from subtle to severe. The purpose of this study was to evaluate the functional, or "real-world" impact of HIV-associated NP impairment in a group of 267 HIV-infected participants. All participants received comprehensive NP, neuromedical, and standardized functional evaluations that included laboratory measures of shopping, cooking, financial management, medication management and vocational abilities. Compared to NP-normal participants, those with NP impairment performed significantly worse on all laboratory measures of everyday functioning. Multivariate analyses revealed that the NP ability domains of Abstraction0Executive Function, Learning, Attention0Working Memory and Verbal abilities most strongly and consistently predicted failures on the functional battery. Both NP impairment and impairment on the functional battery were significantly associated with subjective experiences of cognitive difficulties, as well as unemployment and increased dependence in activities of daily living; multivariate prediction models that also considered depressed mood and biological measures of disease progression revealed that impairment on the functional battery and depression were the only unique predictors of all three indicators of "real-world" functioning. The current results add to growing evidence concerning the clinical significance of HIV-associated NP impairment. Objective, laboratory based functional measures, such as those used here, may compliment NP testing in future studies directed at understanding the impact on life quality of central nervous system disorders and their treatments. Finally, there is a need for additional research investigating the apparently independent effect of depression on level of everyday functioning in HIV infected persons. (JINS, 2004, 10, 317-331.)

Neurobehavioral effects of HIV-1 infection in China and the United States: A pilot study

“…Consistent with U.S. findings on the impact of HIV-associated neurocognitive impairment on instrumental activities of daily living (Heaton et al, 2004a) and employment (Albert et al, 1995;Heaton et al, 1994), we found, in the Chinese HIV+ group, a correlation between NP functioning and complaints of cognitive difficulties in everyday life (i.e., PAOFI), and also a modest association between unemployment status and overall level of NP performance. However, given the major cultural and lifestyle differences in these two countries, much more research is needed to understand the functional consequences of general and specific neurocognitive deficits in China.…”

“…Within the context of HIV infection, results of NP testing have shown robust associations with structural and functional brain imaging (Jernigan et al, 1993;Stout et al, 1998), as well as with postmortem neuropathology findings (Cherner et al, 2002;Everall et al, 1999;Masliah et al, 1997;Moore et al, 2006). Moreover, NP impairment in HIV-infected persons has been shown to be an independent predictor of early mortality Mayeux et al, 1993) and to be strongly predictive of a wide variety of difficulties in activities of daily living (Heaton et al, 2004a).…”

A Longitudinal Analysis of the Impact of Physical Activity on Neurocognitive Functioning Among HIV-Infected Adults

“…Mixed-effects models were used for these data to accommodate for within subject correlations that naturally occur in longitudinal studies. The mixed effect linear models on global and domain neurocognitive scores in the overall sample included terms for [1] HIV status; [2] PA group (i.e., ''No PA'', ''consistent PA'', and ''inconsistent PA''); [3] time; [4] the twoway interactions between PA group and time, HIV status and time, and HIV status and PA group; [5] the three-way interaction among HIV status, PA and time; and [6] adjustments for demographic characteristics (age at baseline, education, gender, ethnicity) and significant covariates. To create a more parsimonious model, non-significant interaction terms were subsequently removed.…”

“…Although the most severe form of HIV-associated neurocognitive disorders (HAND), HIV-associated dementia (HAD), is on the decline, there is evidence that the milder forms of HAND have increased in prevalence [3]. Even mild NCI can lead to problems with everyday functioning, including medication adherence, driving, and financial management [4][5][6][7]. Moreover, HIV infection and aging may have additive or synergistic negative effects on the central nervous system (CNS), leading to increased rates of NCI among older HIV-infected cohorts [8,9].…”

Adaptive working memory training improved brain function in human immunodeficiency virus–seropositive patients

“…Therefore, WM is necessary for concentration, maintaining awareness, and is crucial for learning, executive function, and ultimately for all daily life activities. WM deficits can result in HAND and may lead to unemployment and dependence in activities of daily living,10 self‐reported cognitive complaints,11 and poorer medication adherence 12…”