Clinical utility of the UCSD Performance-Based Skills Assessment—Brief (UPSA-B) in adults living with HIV: Associations with neuropsychological impairment and patient-reported everyday functioning difficulties

Abstract

ObjectiveRequiring only 10–15 minutes to complete, the UCSD Performance-Based Skills Assessment (UPSA-B) has high clinical utility as a brief measure of functional capacity. This study aimed to validate the UPSA-B in adults living with HIV/AIDS (HIV+), and identify whether the UPSA-B can be used as an indicator of functional dependence in this population.MethodOne hundred and three HIV+ adults and 91 HIV- adults completed a comprehensive neuropsychological and neuromedical battery, including a self-report measure of functional status (IADL Dependence vs. IADL Independence), an objective measure of functional capacity (UPSA-B), and a self-report measure of mood states including a subscale related to cognitive difficulties (Profile of Mood States [POMS]-Confusion/Bewilderment subscale).ResultsHIV+ participants had significantly lower UPSA-B scores than their HIV- counterparts (p = 0.02), although this fell to a trend (p = 0.08) when including covariates. Among the HIV+ group, higher UPSA-B scores were related to better neuropsychological ability, but unrelated to self-reported functional independence. Conversely, UPSA-B scores were unrelated to participant-reported cognitive difficulties on the POMS Confusion/Bewilderment subscale. An ROC curve was generated to determine the optimal UPSA-B value for discriminating between normal neuropsychological functioning versus neuropsychological impairment, with results indicating an optimal cutoff of 79. The UPSA-B identified HIV+ persons with cognitive impairment with 70.9% accuracy.ConclusionsThe UPSA-B was able to differentiate neuropsychological impairment from no impairment among HIV+ participants and holds promise as a clinical screening tool in this population. However, indicators of functional disability among adults living with HIV is still not well understood and is likely multifactorial in nature. These data highlight the complex interplay between objective functional capacity, neurocognitive ability, subjective cognitive symptoms, and functional dependence.

Depression and aging with HIV: Associations with health-related quality of life and positive psychological factors

“…One hundred twenty-two PLWH and 94 HIV-individuals from the Multi-Dimensional Successful Aging Among HIV-Infected Adults study conducted at the University of California, San Diego (UCSD) HIV Neurobehavioral Research Program and the UCSD Stein Institute for Research on Aging participated in this study (Moore et al, 2017b(Moore et al, , 2018b. The study was approved by the UCSD Institutional Review Board, and all participants provided written informed consent after the study was explained to them by a trained staff member.…”

Metabolic Syndrome and Neurocognitive Deficits in HIV Infection

“…Further details on this study have been published previously. 29,30 Briefly, the inclusion criteria were being between the ages of 35 and 65 years, English-speaking, and capable of providing informed consent. We attempted to recruit an equivalent number of persons in each of three 10-year age cohorts (35-45, 46-54, and 56-65).…”

Association of HIV serostatus and metabolic syndrome with neurobehavioral disturbances

“…Participants selfreported demographic characteristics (age, sex, race/ethnicity, and years of formal education) and completed a comprehensive neuropsychiatric and neuromedical evaluation in individual sessions conducted by trained study staff. Methodological details of this study have been previously published (Moore et al 2018;Moore et al 2017c;Rooney et al 2019).…”

“…Participants included 215 adults (117 PLWH, 98 HIVuninfected) enrolled in the baseline visit of the Multi-Dimensional Successful Aging among HIV-Infected Adults study conducted at the University of California San Diego (UCSD) HIV Neurobehavioral Research Program and the UCSD Sam and Rose Stein Institute for Research on Aging from 2013 to 2015 (Moore et al 2018;Moore et al 2017c;Rooney et al 2019). Inclusion criteria included being between the ages of 36-65 years old, being fluent in English, and having the ability to provide informed consent.…”