title: Depression, cognition, and self-appraisal of functional abilities in HIV: an examination of subjective appraisal versus objective performance.
abstract: Depression frequently co-occurs with HIV infection and can result in self-reported overestimates of cognitive deficits. Conversely, genuine cognitive dysfunction can lead to an under-appreciation of cognitive deficits. The degree to which depression and cognition influence self-report of capacity for instrumental activities of daily living (IADLs) requires further investigation. This study examined the effects of depression and cognitive deficits on self-appraisal of functional competence among 107 HIV-infected adults. As hypothesized, higher levels of depression were found among those who over-reported problems in medication management, driving, and cognition when compared to those who under-reported or provided accurate self-assessments. In contrast, genuine cognitive dysfunction was predictive of under-reporting of functional deficits. Together, these results suggest that over-reliance on self-reported functional status poses risk for error when diagnoses require documentation of both cognitive impairment and associated functional disability in everyday life.
authors.affiliation: Semel Institute for Neuroscience and Human Behavior, School of Medicine, University of California-Los Angeles, CA 90095, USA. athames@mednet.ucla.edu
authors.forename: April D
authors.initials: AD
authors.lastname: Thames
authors.forename: Brian W
authors.initials: BW
authors.lastname: Becker
authors.forename: Thomas D
authors.initials: TD
authors.lastname: Marcotte
authors.forename: Lindsay J
authors.initials: LJ
authors.lastname: Hines
authors.forename: Jessica M
authors.initials: JM
authors.lastname: Foley
authors.forename: Amir
authors.initials: A
authors.lastname: Ramezani
authors.forename: Elyse J
authors.initials: EJ
authors.lastname: Singer
authors.forename: Steven A
authors.initials: SA
authors.lastname: Castellon
authors.forename: Robert K
authors.initials: RK
authors.lastname: Heaton
authors.forename: Charles H
authors.initials: CH
authors.lastname: Hinkin
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D003072:Cognition Disorders / Q000175:diagnosis* / Q000209:etiology*; D003863:Depression / Q000175:diagnosis* / Q000209:etiology*; D059026:Diagnostic Self Evaluation; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000523:psychology; D006801:Humans; D007802:Language; D007858:Learning / Q000502:physiology; D008297:Male; D055118:Medication Adherence / Q000523:psychology; D008606:Mental Processes / Q000502:physiology; D008875:Middle Aged; D009483:Neuropsychological Tests; D011569:Psychiatric Status Rating Scales; D011597:Psychomotor Performance / Q000502:physiology