Actual versus Self-reported Cognitive Dysfunction in HIV-1 Infection: Memory-Metamemory Dissociations

Abstract

The relationship between subjective awareness and objective neuropsychological status in HIV-1 infection remains unclear. Forty-six HIV-1 seropositive males were administered a battery of neuropsychological measures assessing episodic memory, metacognition, and depression. Results of ANOVA revealed a dissociation between subjects' self-complaint of neuropsychological impairment and objective performance, with subjects who denied cognitive impairment performing worse on memory testing. Three subgroups were identified: A group whose self-reported cognitive impairment exceeded deficits demonstrated on memory testing (37% of subjects); a group who denied impairment but evidenced deficits on memory testing (26% of subjects); and a group whose self-appraisal was consistent with performance (37% of subjects). These data suggest that self-report of cognitive dysfunction among HIV-1 infected subjects is frequently at variance with objective neuropsychological testing and that diminished awareness of decline among medically symptomatic HIV-1 infected subjects can be identified.

Theoretically derived CVLT subtypes in HIV-1 infection: Internal and external validation

“…This suggests that self-reported difficulties of cognitive inefficiency should not be interpreted in isolation (BeasonHazen et al, 1994;Hinkin et al, 1996;Mapou et al, 1993;Rourke et al, 1999aRourke et al, , 1999b. Gauging the individual's level of accuracy (e.g., based on subjective0objective discrepancy) may be a more fruitful approach than relying exclusively on subjective complaints (Rourke et al, 1999a(Rourke et al, , 1999b.…”

“…For instance, individuals with HIV-1 infection may be classified as neuropsychologically "normal" or as having "subsyndromic" or mild neuropsychological impairment (Grant et al, 1999). The "Atypical" subtype was deemed to be analogous to an "over-reporters" subgroup (individuals whose subjective complaints are elevated in the context of normal neuropsychological test performance) reported in memory-metamemory research (Hinkin et al, 1996;Rourke et al, 1999a). The "Frontal-striatal" descriptor was chosen to reflect more extensive involvement of systems connecting frontal and subcortical regions of the brain (Cummings 1993a;Delis et al, 1995).…”

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

“…30 Each cognitive test was converted to an age-, sex-, and education-standardized Z-score using normative mean values and SD. Normative data for the computerized tests were provided by Cogstate from Europe, United States of America, South East Asia, and Australia/New Zealand, frequencymatched for age (18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42)(43)(44)(45)(46)(47)(48)(49)(50), and 51+ years; minimum cell size n = 145), sex (157 female, 377 male), and education (university/further education, n = 243, or secondary school, n = 291). The normative population excluded individuals with clinical or functional impediments to test performance, and subsets of these data had been used previously to measure cognitive function in HIV+ adults.…”

Cognitive complaints, depression, medical symptoms, and their association with neuropsychological functioning in HIV infection: A structural equation model analysis.

“…Results of these studies suggest that there may be multiple sources of variance contributing to neuropsychological symptoms in HIV infection. Moreover, subgroups of individuals who are HIV positive may vary in the accuracy of their self-reported cognitive complaints (Hinkin et al, 1996;Rourke et al, 1999b).…”