A comparison of performance-based measures of function in HIV-associated neurocognitive disorders

Abstract

The objectives of this study are to compare the results of newer performance-based functional assessments in the study of HIV-associated neurocognitive disorders (HAND) and to correlate these functional assessments with specific levels of severity of HAND. One hundred fourteen HIV+ subjects in an existing cohort were evaluated with a medical history, neurological exam, neuropsychological test battery as well as subjective and novel objective measures of functional abilities. Self-reported measures of functional performance included the Karnofsky Performance Scale, a questionnaire for instrumental activities of daily living, and a questionnaire for physical quality of life measures. The newer objective functional performance assessments in cluded the Columbia Medication Management and the San Diego Finances tests. These newer performance-based measures of function were assessed for their ability to predict level of HAND. The two objective measures of functional performance, The Columbia Medication Management Scale and the San Diego Finances Test, were both associated with levels of severity of HAND. The Karnofsky Performance Scale and the questionnaires for role and physical quality of life were subjective measures that were also associated with specific levels of HAND. Newer measures of functional performance can be used to objectively evaluate functional impairment in HAND and validate different levels of HAND.

Self-Reported Decline in Everyday Function, Cognitive Symptoms, and Cognitive Function in People With HIV

“…There are limited data on more accurate and reliable measures of everyday performance, such as third-party observation or performance-based measures. 12,13 This has crucial implications for the interpretation of longitudinal studies in which the risk of change from ANI to MND is measured, such as the United States CHARTER cohort, 39 the Canadian OHTN Cohort, 6 and the French Aquitaine cohort. 40 For example, in the Ottawa cohort, depression was a major risk factor for change from ANI to MND.…”

“…The questionnaire has been used in large published studies of HAND. 2,12,13 Symptoms of cognitive impairment were elicited using 4 questions from the Medical Outcomes Study in HIV (MOS-HIV) 14 (see Supplemental Digital Content 2, http://links.lww. com/QAI/B55).…”

The Influence of Neurocognitive Impairment, Alcohol and other Drug (AOD) Use, and Psychosocial Factors on Antiretroviral Treatment Adherence, Service Utilization and Viral Load Among HIV-Seropositive Adults

“…MCMD in turn is subdivided into asymptomatic neurocognitive impairment (ANI) and mild neurocognitive disorder (MND). MND is accompanied by mild interference in daily functioning, whereas ANI is not (Foley et al, 2010;Gandhi et al, 2011). ANI and MND are both identified by performance scores at least one standard deviation (SD) below the mean of normative scores in at least two cognitive domains:…”

“…In contrast, HAD is characterized by marked neurocognitive dysfunction (≥ 2 standard deviations below the mean normative scores) in at least two cognitive domains. This level of cognitive impairment produces marked interference with activities of daily living Foley et al, 2010;Gandhi et al, 2011;Gisslén, Price, & Nilsson, 2011;Palacio et al, 2012).…”

“…The types of impairments exhibited by persons with these neurologic syndromes can affect functioning at work or in everyday activities (Gandhi et al, 2011). Even though HAD has become less frequent, HIV-positive individuals are still at risk for HIVassociated neurological complications.…”