Objective: The ability to work is amongst the top concerns of people living with well treated HIV. Cognitive impairment has been reported in many otherwise asymptomatic persons living with HIV and even mild impairment is associated with higher rates of occupational difficulties. There are several classification algorithms for HIV-associated neurocognitive disorder (HAND) as well as overall scoring methods available to summarize neuropsychological performance. We asked which method best explained work status and productivity.Design: Participants (N ¼ 263) drawn from a longitudinal Canadian cohort underwent neuropsychological testing.Methods : Several classification algorithms were applied to establish a HAND diagnosis and two summary measures (NPZ and Global Deficit Score) were computed. Selfreported work status and productivity was assessed at each study visit (four visits, 9 months apart). The association of work status with each diagnostic classification and summary measure was estimated using logistic regression. For those working, the value on the productivity scale was regressed within individuals over time, and the slopes were regressed on each neuropsychological outcome. Results:The application of different classification algorithms to the neuropsychological data resulted in rates of impairment that ranged from 28.5 to 78.7%. Being classified as impaired by any method was associated with a higher rate of unemployment. None of the diagnostic classifications or summary methods predicted productivity, at time of testing or over the following 36 months. Conclusion:Neuropsychological diagnostic classifications and summary scores identified participants who were more likely to be unemployed, but none explained productivity. New methods of assessing cognition are required to inform optimal workforce engagement.

Background:Apathy, defined as a lack of motivation, is common in neurodegenerative diseases. Specific scales are available for the evaluation of apathy but it lacks objective evaluation methods.Aim:To evaluate the changes in reaction time task according to the presence or absence of reward stimulation and to assess the relation between these performances and apathy scales.Methods:13 patients with Mild Cognitive Impairment, 15 patients with Alzheimer's disease and 91 elderly healthy subjects were enrolled. A computerized test using the experiment software E-prime® was designed to assess reaction times in different experimental conditions after a training trial (neutral, stimulation, stress, stimulation after stress, extinction) and relation between the performances to the test and the Apathy Inventory (AI) scores were observed.Results:Patients reaction times were significantly higher than control. Reactions times were lower in stimulation conditions and maximum during the stress condition. In the patients population, apathetic subjects (AI total score >2) had significantly higher reaction times than non apathetic subjects (p<0,05). We found significant positive correlation between AI dimensions lack of initiative and lack of interest, and reaction times in the following conditions: lack of interest and neutral condition (p<0,01), stimulation condition (p<0,05), lack of initiative and stress condition (p<0,05). Furthermore, AI total score was correlated with both stimulation and extinction conditions (p<0,05). There was no significant correlation with the emotional blunting.Conclusion:the reaction time task may be a promising tool for an objective evaluation of the initiative and interest dimensions of apathy in neurodegenerative diseases.

Background: Evidence regarding the risk of cognitive decline conferred by a low nadir CD4 cell count and increasing age in people living with HIV is mixed. The objective of this study was to assess the change in cognition over one year among older adults with well-controlled HIV infection and a history of low nadir CD4 cell count compared with the change in a matched non-HIV sample. Methods: We recruited 50 HIV+ aviremic individuals 40 years or older, on stable antiretroviral treatment and with a nadir CD4 < 200 cells/uL, and seventeen matched HIV-negative individuals. Neuropsychological testing was performed twice, one year apart; an NPZ was computed by averaging all z-scores and five existing algorithms for a diagnosis of HAND were applied. Change was defined as making a reliable change on the NPZ or a change in HAND category (impaired vs not). Results: Change in NPZ over one year was more often in the direction of an improvement, and not different between HIV+ and HIV- individuals. Among the HIV+, the proportion meeting criteria for HAND at baseline ranged from 34-80% depending on the classification algorithm. A reliable change in NPZ was demonstrated in a single HIV+ participant. In contrast, a transition between HAND category at one year was common. Conclusion: Among aviremic HIV+ older adults with a history of low nadir CD4 cell count, change in NPZ over 1 year was comparable to that seen among demographically matched HIV- individuals and did not represent a reliable change while transition across HAND category was common. Rates of HAND were very dependent on the classification algorithm applied. These findings provide some explanation for the inconsistent findings from existing studies and highlight the importance of exercising caution when pooling results in the field of neuroHIV.