The impact of HIV-associated neuropsychological impairment on everyday functioning
The impact of HIV-associated neuropsychological impairment on everyday functioning
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DOI：
10.1017/s1355617704102130
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发表时间：
2004-05-01
影响因子：
2.6
通讯作者：
Grant, I
中科院分区：
文献类型：
--
作者：
Heaton, RK;Marcotte, TD;Grant, I
HIV - 1感染可能与从轻微到严重的神经心理学（NP）缺陷相关。本研究的目的是评估267名HIV感染参与者中与HIV相关的NP损伤的功能，即“现实世界”影响。所有参与者都接受了全面的NP、神经医学和标准化功能评估，包括购物、烹饪、财务管理、药物管理和职业能力的实验室测试。与NP正常的参与者相比，NP受损者在所有日常功能的实验室测试中表现明显更差。多变量分析显示，抽象/执行功能、学习、注意力/工作记忆和语言能力这些NP能力领域对功能测试组的失败具有最强且最一致的预测能力。NP损伤和功能测试组的损伤都与认知困难的主观体验、失业以及日常生活活动中依赖性增加显著相关；同时考虑抑郁情绪和疾病进展的生物学指标的多变量预测模型显示，功能测试组的损伤和抑郁是“现实世界”功能的所有三个指标的唯一独特预测因素。目前的结果增加了关于与HIV相关的NP损伤临床意义的越来越多的证据。基于实验室的客观功能测试，比如这里所使用的，可能会在未来旨在了解中枢神经系统疾病及其治疗对生活质量影响的研究中补充NP测试。最后，有必要进行更多研究来探究抑郁对HIV感染者日常功能水平的明显独立影响。
HIV-1 infection can be associated with neuropsychological (NP) deficits ranging from subtle to severe. The purpose of this study was to evaluate the functional, or "real-world" impact of HIV-associated NP impairment in a group of 267 HIV-infected participants. All participants received comprehensive NP, neuromedical, and standardized functional evaluations that included laboratory measures of shopping, cooking, financial management, medication management and vocational abilities. Compared to NP-normal participants, those with NP impairment performed significantly worse on all laboratory measures of everyday functioning. Multivariate analyses revealed that the NP ability domains of Abstraction/Executive Function, Learning, Attention/Working Memory and Verbal abilities most strongly and consistently predicted failures on the functional battery. Both NP impairment and impairment on the functional battery were significantly associated with subjective experiences of cognitive difficulties, as well as unemployment and increased dependence in activities of daily living; multivariate prediction models that also considered depressed mood and biological measures of disease progression revealed that impairment on the functional battery and depression were the only unique predictors of all three indicators of "real-world" functioning. The current results add to growing evidence concerning the clinical significance of HIV-associated NP impairment. Objective, laboratory based functional measures, such as those used here, may compliment NP testing in future studies directed at understanding the impact on life quality of central nervous system disorders and their treatments. Finally, there is a need for additional research investigating the apparently independent effect of depression on level of everyday functioning in HIV infected persons.