Hostname: page-component-745bb68f8f-s22k5 Total loading time: 0 Render date: 2025-01-22T07:07:07.902Z Has data issue: false hasContentIssue false
  • English
  • Français

The impact of HIV-associated neuropsychological impairment on everyday functioning

Published online by Cambridge University Press:  01 May 2004

ROBERT K. HEATON ,
THOMAS D. MARCOTTE ,
MONICA RIVERA MINDT ,
JOSEPH SADEK ,
DAVID J. MOORE ,
HEATHER BENTLEY ,
J. ALLEN MCCUTCHAN ,
CARLA REICKS  and
IGOR GRANT
ROBERT K. HEATON
Affiliation:
Department of Psychiatry, University of California at San Diego, San Diego, California VA San Diego Health Care System, San Diego, California
THOMAS D. MARCOTTE
Affiliation:
Department of Psychiatry, University of California at San Diego, San Diego, California
MONICA RIVERA MINDT
Affiliation:
Department of Psychology, Fordham University, New York, New York
JOSEPH SADEK
Affiliation:
Department of Psychiatry, University of California at San Diego, San Diego, California
DAVID J. MOORE
Affiliation:
San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California
HEATHER BENTLEY
Affiliation:
Department of Psychiatry, University of California at San Diego, San Diego, California
J. ALLEN MCCUTCHAN
Affiliation:
Department of Psychiatry, University of California at San Diego, San Diego, California
CARLA REICKS
Affiliation:
Department of Psychiatry, University of California at San Diego, San Diego, California
IGOR GRANT
Affiliation:
Department of Psychiatry, University of California at San Diego, San Diego, California VA San Diego Health Care System, San Diego, California
Get access Rights & Permissions [Opens in a new window]

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 Abstraction/Executive Function, Learning, Attention/Working 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.NOTE: Dr. Erin D. Bigler served as action editor during the course of this review. (JINS, 2004, 10, 317–331.)

Keywords

HIVActivities of daily livingEveryday functioningCognition
Type
Research Article
Information
Journal of the International Neuropsychological Society , Volume 10 , Issue 3 , May 2004 , pp. 317 - 331
Copyright
© 2004 The International Neuropsychological Society

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

Albert, S.M., Marder, K.M., Dooneief, G., Bell, K., Sano, M., Todak, G., & Stern, Y. (1995). Neuropsychologic impairment in early HIV infection: A risk factor for work disability. Archives of Neurology, 52, 525–530.Google Scholar
Albert, S.M., Weber, C.M., Todak, G., Polanco, C., Clouse, R., McElhiney, M., Rabkin, J., & Marder, K. (1999). An observed performance test of medication management ability in HIV: Relation to neuropsychological status and medication outcomes. AIDS and Behavior, 3, 121–128.Google Scholar
American Academy of Neurology AIDS Task Force. (1991). Nomenclature and research case definitions for neurologic manifestations of human immunodeficiency virus-type 1 (HIV-1) infection. Neurology, 41, 778–785.Google Scholar
Baldessarini, R.J., Finklestein, S., & Arana, G.W. (1983). The predictive power of diagnostic tests and the effect of prevalence of illness. Archives of General Psychiatry, 40, 569–573.Google Scholar
Beck, A.T. (1987). The Beck Depression Inventory. San Antonio, TX: Psychological Corporation.
Benedict, R.H.B, Mezhir, J.J., Walsh, K., & Hewitt, R.G. (2000). Impact of human immunodeficiency virus Type-1-associated cognitive dysfunction on activities of daily living and quality of life. Archives of Clinical Neuropsychology, 15, 529–534.Google Scholar
Bornstein, R.A., Nasrallah, H.A., Para, M.F., Whitacre, C.C., Rosenberger, P., Fass, R.J., & Rice, R. (1992). Neuropsychological performance in asymptomatic HIV infection. Journal of Neuropsychiatry and Clinical Neurosciences, 4, 336–394.Google Scholar
Butters, N., Grant, I., Haxby, J., Judd, L.L., Martin, A., McClelland, J., Pequegnat, W., Schacter, D., & Stover, E. (1990). Assessment of AIDS-related cognitive changes: Recommendations of the NIMH Workshop on Neuropsychological Assessment Approaches. Journal of Clinical and Experimental Neuropsychology, 12, 963–978.Google Scholar
Chelune, G.J., Heaton, R.K., & Lehman, R.A.W. (1986). Neuropsychological and personality correlates of patients' complaints of disability. In R.E.T. Gerald Goldstein (Ed.), Advances in clinical neuropsychology, Vol. 3 (pp. 95–126). New York: Plenum Press.
Centers for Disease Control. (1992). 1993 revised classification system for HIV infection and expanded surveillance case definition for AIDS among adolescents and adults. Morbidity and Mortality Weekly Report, 41, 1–19.Google Scholar
Diehr, M.C., Heaton, R.K., Miller, W., & Grant, I. (1998). The Paced Auditory Serial Addition Task (PASAT): Norms for age, education, and ethnicity. Assessment, 5, 375–387.Google Scholar
Gladsjo, J.A., Schuman, C.C., Evans, J.D., Peavy, G.M., Miller, S.W., & Heaton, R.K. (1999). Norms for letter and category fluency: Demographic corrections for age, education, and ethnicity. Assessment, 6, 147–178.Google Scholar
Grant, I., Atkinson, J.H., Hesselink, J.R., Kennedy, C.J., Richman, D.D., Spector, S.A., & McCutchan, J.A. (1987). Evidence for early central nervous system involvement in the acquired immunodeficiency syndrome (AIDS) and other human immunodeficiency virus (HIV) infections. Annals of Internal Medicine, 107, 828–836.Google Scholar
Heaton, R.K. (1992). Comprehensive norms for an expanded Halstead-Reitan Battery: A supplement for the WAIS–R. Odessa, FL: Psychological Assessment Resources, Inc.
Heaton, R.K., Grant, I., Anthony, W.Z., & Lehman, R.A.W. (1981). A comparison of clinical and automated interpretation of the Halstead-Reitan battery. Journal of Clinical Neuropsychology, 3, 121–141.Google Scholar
Heaton, R.K., Grant, I., Butters, N., White, D.A., Kirson, D., Atkinson, J.H., McCutchan, J.A., Taylor, M.J., Kelly, M.D., Ellis, R.J., Wolfson, T., Velin, R., Marcotte, T.D., Hesselink, J.R., Jernigan, T.L., Chandler, J., Wallace, M., Abramson, I., & the HNRC Group. (1995). The HNRC 500—Neuropsychology of HIV infection at different disease stages. Journal of the International Neuropsychological Society, 1, 231–251.Google Scholar
Heaton, R.K., Grant, I., & Matthews, C.G. (1991). Comprehensive norms for an Expanded Halstead-Reitan Battery: Demographic corrections, research findings, and clinical applications. Odessa, FL: Psychological Assessment Resources.
Heaton, R.K., Kirson, D., Velin, R.A., Grant, I., & the HNRC Group. (1994a). The utility of clinical ratings for detecting cognitive change in HIV infection. In I. Grant & A. Martin (Eds.), Neuropsychology of HIV infection (pp. 188–206). New York: Oxford University Press.
Heaton, R.K., Marcotte, T.D., White, D.A., Ross, D., Meredith, K., Taylor, M.J., Kaplan, R., & Grant, I. (1996). Nature and vocational significance of neuropsychological impairment associated with HIV infection. Clinical Neuropsychologist, 10, 1–14.Google Scholar
Heaton, R.K. & Pendleton, M.G. (1981). Use of neuropsychological tests to predict adult patients' everyday functioning. Journal of Consulting and Clinical Psychology, 49, 807–821.Google Scholar
Heaton, R.K., Velin, R.A., McCutchan, J.A., Gulevich, S.J., Atkinson, J.H., Wallace, M.R., Godfrey, H., Kirson, D., Grant, I., & the HNRC Group. (1994b). Neuropsychological impairment in human immunodeficiency virus-infection: Implications for employment. Psychosomatic Medicine, 56, 8–17.Google Scholar
Hinkin, C.H., Castellon, S.A., Durvasula, R.S., Hardy, D.J., Lam, M.N., Mason, K.I., Thrasher, D., Goetz, M.B., & Stefaniak, M. (2002). Medication adherence among HIV+ adults: Effects of cognitive dysfunction and regimen complexity. Neurology, 59, 1944–1950.Google Scholar
Hinkin, C.H., Hardy, D.J., Mason, K.I., Castellon, S.A., Durvasula, R.S., Lam, M.N., & Stefaniak, M. (2004). Medication adherence in HIV-infected adults: Effect of patient age, cognitive status, and substance abuse. AIDS, 18(S1), S19–S25Google Scholar
Jernigan, T.L., Archibald, S., Hesselink, J.R., Atkinson, J.H., Velin, R.A., McCutchan, J.A., Chandler, J., Grant, I., & the HNRC Group. (1993). Magnetic resonance imaging morphometric analysis of cerebral volume loss in human immunodeficiency virus infection. Archives of Neurology, 50, 250–255.Google Scholar
Lawton, M.P. & Brody, E.M. (1969). Assessment of older people: Self-maintaining and instrumental activities of daily living. Gerontologist, 9, 179–186.Google Scholar
Lowenstein, D.A., Duara, R., Rubert, M.P., & Arguelles, T. (1995). Neuropsychological test performance and prediction of functional capacities among Spanish-speakers and English-speaking patients with dementia. Archives of Clinical Neuropsychology, 10, 75–88.Google Scholar
Lowenstein, D.A. & Bates, B.C. (1992). Manual for administration and scoring the Direct Assessment of Functional Status scale for older adults (DAFS). Miami Beach, FL: Mount Sinai Medical Center.
Mapou, R.L., Law, W.A., Martin, A., Kampen, D., Salazar, A.M., & Rundell, J.R. (1993). Neuropsychological performance, mood, and complaints of cognitive and motor difficulties in individuals infected with the human immunodeficiency virus. Journal of Neuropsychiatry and Clinical Neurosciences, 5, 86–93.Google Scholar
Marcotte, T.D., Heaton, R.K., Wolfson, T., Taylor, M.J., Alhassoon, O., Arfaa, K., Grant, I., & the HNRC Group. (1999). The impact of HIV-related neuropsychological dysfunction on driving behavior. Journal of the International Neuropsychological Society, 7, 579–592.Google Scholar
Salthouse, T.A. (1990). Influence of experience on age differences in cognitive functioning. Human Factors, 32, 551–569.Google Scholar
Salthouse, T.A. (1994). Age-related differences in basic cognitive processes: Implications for work. Experimental Aging Research, 20, 249–255.Google Scholar
Schiffito, G., Kieburtz, K., McDermott, M.P., McArthur, J., Marder, K., Sacktor, N., Palumbo, D., Selnes, O., Stern, Y., Epstein, L., & Albert, S. (2001). Clinical trials in HIV-associated cognitive impairment: Cognitive and functional outcomes. Neurology, 56, 415–418.Google Scholar
Stern, Y., Marder, K., Bell, K., Chen, J., Dooneief, G., Goldstein, S., Mindry, D., Richards, M., Sano, M., Williams, J., Gorman, J., Ehrhardt, A., & Mayeux, R. (1991). Multidisciplinary assessment of homosexual men with and without human immunodeficiency virus infection. III. Neurologic and neuropsychological findings. Archives of Neurology, 48, 131–138.Google Scholar
Stout, J.C., Ellis, R.J., Jernigan, T.L., Archibald, S.L., Abramson, I., Wolfson, T., McCutchan, J.A., Wallace, M.R., Atkinson, J.H., Grant, I., & the HNRC Group. (1998). Progressive cerebral volume loss in human immunodeficiency virus infection: A longitudinal volumetric magnetic resonance imaging study. Archives of Neurology, 55, 161–168.Google Scholar
Temkin, N.R., Heaton, R.K., Grant, I., & Dikmen, S.S. (1999). Detecting significant change in neuropsychological test performance: A comparison of four models. Journal of the International Neuropsychological Society, 5, 357–369.Google Scholar
U.S.Department of Labor. (1991a). Dictionary of occupational titles (4th ed.). Washington, DC: U.S. Government Printing Office.
U.S.Department of Labor. (1991b). Revised handbook for analyzing jobs. Washington, DC: U.S. Government Printing Office.
Valpar International Corporation. (1986). Microcomputer Evaluation and Screening Assessment (MESA) Short Form 2. Tucson, AZ: Author.
Valpar International Corporation. (1992). Computerized Assessment (COMPASS). Tucson, AZ: Author.
Woods, S.P., Weinborn, M., & Lovejoy, D.W. (2003). Are classification accuracy statistics underused in neuropsychological research? Journal of Clinical and Experimental Neuropsychology, 25, 431–439.Google Scholar
Zweig, M.H. & Campbell, G. (1993). Receiver-operating characteristic (ROC) plots: A fundamental evaluation tool in clinical medicine. Clinical Chemistry, 39, 561–577.Google Scholar