Predicting occupational outcomes from neuropsychological test performance in older people with HIV

Abstract

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.

Multimodal neuroimaging markers of variation in cognitive ability in older HIV+ men

“…The B-CAM was developed using item-response theory as a measure of this latent construct. This battery has been validated against real world function (work status) and its concordance with multiple existing methods of operationalizing the Frascati classification of HAND has been reported [8]. Fifty-three participants included here also took part in another BHN sub-study that administered standard neuropsychological testing, covering six domains, at least two tests per domain [25], allowing HAND classification.…”

“…Executive function, attention, and processing speed are commonly affected in those with cognitive impairment [4,5]. While typically mild in people taking combined antiretroviral therapy (cART), impairment can nonetheless limit occupational function, quality of life, and medication adherence [6][7][8][9], as well as the costs of medical care [10]. The causes and underlying neural mechanisms of cognitive impairment remain unclear.…”

Using HIV neuropsychological classification methods to predict employment status

“…From the Brouillette et al [4] study, several research implications also emerged. First, misclassification of cognitive impairment can result in different conclusions in studies.…”

“…As we watch the aging of the HIV population, considering these findings within the parameters of successful aging is warranted. Brouillette et al [4] addressed two very important aspects of successful aging with HIV – cognitive efficiency and productivity. This topic will grow in importance for two reasons.…”

“…Intersecting with this is the complicated work histories of PWH, with only 30% of PWH working full or part-time [2,3]. It is from this context, the study by Brouillette et al [4] presented in this issue of AIDS generates such interest. First, they compared different neuropsychological classification methods to estimate the prevalence of impairment in the same sample of PWH.…”