Diagnosing Symptomatic HIV-Associated Neurocognitive Disorders: Self-Report Versus Performance-Based Assessment of Everyday Functioning

Abstract

Background HIV-associated neurocognitive disorders (HAND) include both “asymptomatic” and “symptomatic” neurocognitive impairment. Asymptomatic diagnoses indicate HAND without demonstrable functional impairment. The present study compares three approaches to assess functional decline: 1) self-report measures only (SR); 2) performance-based measures only (PB); and 3) combining SR and PB measures (SR+PB). Methods We assessed 674 HIV-infected research volunteers with a comprehensive neurocognitive battery; 233 met criteria for a HAND diagnosis by having at least mild neurocognitive impairment. Functional decline was measured via SR and PB measures. HAND diagnoses in these 233 cognitively impaired individuals were determined according to published criteria, which allow for both SR and PB methods in establishing functional decline. Results The dual-method diagnosed the most symptomatic (53%; 124/233) HAND conditions, compared to either singular method, which were only 59% concordant. Participants classified as functionally-impaired via PB were more likely to be unemployed, more immunosuppressed, and had more hepatitis-C co-infection, whereas those classified via singular SR were more depressed. Conclusions Multimodal methods of assessing everyday functioning facilitate detection of symptomatic HAND. PB-based classification was associated with objective functional status (i.e., employment) and important disease-related factors, whereas the typical SR singular classifications may be biased by depressed mood.

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