Diagnosing symptomatic HIV-associated neurocognitive disorders: self-report versus performance-based assessment of everyday functioning.
Diagnosing symptomatic HIV-associated neurocognitive disorders: self-report versus performance-based assessment of everyday functioning.
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DOI：
10.1017/s135561771100141x
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发表时间：
2012-01
影响因子：
2.6
通讯作者：
Grant, I.
中科院分区：
文献类型：
--
作者：
Blackstone, K.;Moore, D. J.;Heaton, R. K.;Franklin, D. R., Jr.;Woods, S. P.;Clifford, D. B.;Collier, A. C.;Marra, C. M.;Gelman, B. B.;McArthur, J. C.;Morgello, S.;Simpson, D. M.;Rivera-Mindt, M.;Deutsch, R.;Ellis, R. J.;Atkinson, J. Hampton;Grant, I.
关键词：
HIV相关的神经认知障碍（HAND）包括“无症状”和“有症状”的神经认知损害。无症状诊断表明手无明显的功能障碍。本研究比较了三种评估功能下降的方法：1）仅自我报告测量（SR）; 2）仅基于性能的测量（PB）; 3）结合SR和PB测量（SR+PB）。我们对674名HIV感染的研究志愿者进行了全面的神经认知测试，其中233名至少有轻度神经认知障碍，符合HAND诊断标准。通过SR和PB测量来测量功能下降。这233名认知功能障碍者的HAND诊断是根据已发表的标准确定的，该标准允许SR和PB方法建立功能下降。双重方法诊断最有症状的（53%; 124/233）手的条件相比，单一的方法，只有59%的一致性。通过PB分类为功能受损的参与者更有可能失业，更多的免疫抑制，并有更多的丙型肝炎合并感染，而通过单一SR分类的参与者更抑郁。评估日常功能的多模式方法有助于检测症状性HAND。基于PB的分类与客观功能状态相关（即，就业）和重要的疾病相关因素，而典型的SR单一分类可能会受到抑郁情绪的影响。
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). 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. 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. 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.