Deficits in Self-Awareness Impact the Diagnosis of Asymptomatic Neurocognitive Impairment in HIV
Deficits in Self-Awareness Impact the Diagnosis of Asymptomatic Neurocognitive Impairment in HIV
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DOI：
10.1089/aid.2012.0229
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发表时间：
2013-06-01
影响因子：
1.5
通讯作者：
Valcour, Victor
中科院分区：
文献类型：
--
作者：
Chiao, Stephanie;Rosen, Howard J.;Valcour, Victor
最近一项针对艾滋病病毒感染者的全国性调查指出，近四分之三的认知障碍人士被归类为无症状神经认知障碍 (ANI)，缺乏日常功能受损的记录。 ANI 的临床影响和长期后果尚不清楚，这种无症状诊断的重要性引起了临床护理环境的担忧，因为临床护理环境中经常存在相互竞争的优先事项。在这项研究中，我们对 60 岁以上的 HIV+ 受试者样本进行了日常功能的结构化测试，并要求受试者相对于同龄人对自己的表现进行评分。我们证明，患有神经心理学测试障碍的个体通常缺乏对功能表现缺陷的自我意识。具体来说，ANI 受试者对功能表现的评价与 HIV 阴性对照受试者相似，尽管在客观功能测量方面存在明显缺陷。这些发现对于使用功能自我报告来诊断 HIV 相关神经认知障碍 (HAND) 具有重要意义，可能低估了症状损害。
A recent national survey of HIV+ adults noted that nearly three-quarters of cognitively impaired individuals are categorized as having asymptomatic neurocognitive impairment (ANI), lacking documented compromise of everyday function. The clinical impact and long-term consequences of ANI are unknown and the importance of this asymptomatic diagnosis has raised concerns in clinical care settings where competing priorities often exist. In this study, we conducted structured tests of everyday functioning in a sample of HIV+ subjects over 60 years of age and asked subjects to rate their performance relative to peers. We demonstrate that individuals with neuropsychological testing impairment often lack self-awareness of functional performance deficits. Specifically, ANI subjects rated functional performance similar to that of HIV-negative control subjects, despite noted deficits in objective measures of function. These findings have important implications for use of self-report of function in the diagnosis of HIV-associated neurocognitive disorders (HAND), likely underestimating symptomatic impairment.