Diagnosing symptomatic HIV-associated neurocognitive disorders: self-report versus performance-based assessment of everyday functioning

J Int Neuropsychol Soc. 2012 Jan;18(1):79-88. doi: 10.1017/S135561771100141X. Epub 2011 Nov 24.

Abstract

Three types of HIV-associated neurocognitive disorders (HAND) exist that are distinguished by presence and severity of impairment in cognitive and everyday functioning. Although well-validated neurocognitive measures exist, determining impairment in everyday functioning remains a challenge. We aim to determine whether Self-Report measures of everyday functioning are as effective in characterizing HAND as Performance-Based measures. We assessed 674 HIV-infected participants with a comprehensive neurocognitive battery; 233 met criteria for a HAND diagnosis by having at least mild neurocognitive impairment. Functional decline was measured via Self-Report and Performance-Based measures. HAND diagnoses were determined according to published criteria using three approaches to assess functional decline: (1) Self-Report measures only, (2) Performance-Based measures only, and (3) Dual-method combining Self-Report and Performance-Based measures. The Dual-method classified the most symptomatic HAND, compared to either singular method. Singular method classifications were 76% concordant with each other. Participants classified as Performance-Based functionally impaired were more likely to be unemployed and more immunosuppressed, whereas those classified as Self-Report functionally impaired had more depressive symptoms. Multimodal methods of assessing everyday functioning facilitate detection of symptomatic HAND. Singular Performance-Based classifications were associated with objective functional and disease-related factors; reliance on Self-Report classifications may be biased by depressive symptoms.

Publication types

  • Multicenter Study
  • Research Support, N.I.H., Extramural

MeSH terms

  • Activities of Daily Living*
  • Adult
  • Aged
  • Cognition Disorders / diagnosis*
  • Cognition Disorders / etiology*
  • Cognition Disorders / virology
  • Cohort Studies
  • Depression / etiology
  • Female
  • HIV Infections / complications*
  • HIV Infections / diagnosis
  • HN Protein / metabolism
  • Humans
  • Immunoenzyme Techniques
  • Lipopolysaccharide Receptors / metabolism
  • Logistic Models
  • Male
  • Middle Aged
  • Motor Activity / physiology*
  • Neuropsychological Tests
  • Psychiatric Status Rating Scales
  • Self Report*
  • Sensitivity and Specificity
  • Statistics, Nonparametric
  • Young Adult

Substances

  • HN Protein
  • Lipopolysaccharide Receptors