Diagnosing symptomatic HIV-associated cognitive disorders: Self-report versus performance-based assessment everyday functioning.

Type: Published Abstract
Title: Diagnosing symptomatic HIV-associated cognitive disorders: Self-report versus performance-based assessment everyday functioning.
Authors: Blackstone K, Moore DJ, 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, Atkinson JH, Hetaon RK, Grant I
Year: 2011
Publication: 6th IAS Conference on HIV Pathogenesis, Treatment and Prevention, July 17-20, Rome, Italy
Volume: Issue: Pages:
Abstract:Background: HIV-associated neurocognitive disorders (HAND) include asymptomatic neurocognitive impairment (ANI) or symptomatic neurocognitive impairment (mild neurocognitive disorder(MND) or HIV-associated dementia (HAD)). ANI diagnoses indicate neurocognitive impairment attributable to HIV-infection without functional decline whereas diagnoses of MND/HAD indicate that HIV-associated cognitive impairment interferes with functional capabilities. Our study compares three methods for determining functional decline: 1) self-report measures only(SR); 2) performance-based measures only(PB; performance in mock settings of "real life" activities); and 3) dual self-report plus performance-based measures(SR+PB). Methods: We assessed 674 HIV+ participants via a comprehensive neurocognitive battery. 233 were classified as having HIV-associated cognitive impairment according to the Frascati criteria (mean age=44.2yrs; 79% male; mean education=12.8yrs; Antinori et al., 2007). Functional decline was measured via self-report (Patient's Assessment of Own Functioning and Instrumental Activities of Daily Living) and performance-based measures (Medication Management Test-Revised and vocational functioning via the Valpar work samples/COMPASS program). HAND diagnoses for the cognitively impaired were determined according to Frascati criteria utilizing three methods of functional decline: SR only, PB only, and SR+PB. Results: The dual-method diagnosed the fewest ANI (47%) and the most symptomatic (53%) diagnoses compared to either singular method (p's< .006). Comparing the sensitivities of the singular to the dual-method, PB detected more MND than SR (32% vs. 19%; p=.009) whereas SR detected more HAD than PB (6% vs. 1%; p< .001). Singular diagnoses were 59% concordant. Discrepant singular-method diagnoses showed overreporters (more severe HAND diagnosis via SR) had more years of education, depressive symptoms, Caucasians, and employed participants, and less Hepatitis C comorbidity than underreporters (more severe HAND diagnosis via PB; p's< .006). Conclusions: Multimodal methods of daily functioning facilitate detection of symptomatic HAND; utilizing either SR or PB measures alone may underestimate the prevalence of HIV-associated functional declines. Development of novel, portable, and clinically useful functional measures may aid in further facilitating accurate HAND diagnoses.