Diagnosing symptomatic HIV-associated neurocognitive disorders: self-report versus performance-based assessment of everyday functioning.
- Author(s): Blackstone, K;
- Moore, DJ;
- Heaton, RK;
- Franklin, DR;
- Woods, SP;
- Clifford, DB;
- Collier, AC;
- Marra, CM;
- Gelman, BB;
- McArthur, JC;
- Morgello, S;
- Simpson, DM;
- Rivera-Mindt, M;
- Deutsch, R;
- Ellis, RJ;
- Hampton Atkinson, J;
- Grant, I;
- CNS HIV Antiretroviral Therapy Effects Research (CHARTER) Group
- et al.
Published Web Location
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3882265/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.
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