title: Deficits in self-awareness impact the diagnosis of asymptomatic neurocognitive impairment in HIV.
abstract: 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.
authors: School of Medicine, University of California San Francisco, San Francisco, CA 94143-1207, USA.
authors: Stephanie
authors: S
authors: Chiao
authors: Howard J
authors: HJ
authors: Rosen
authors: Krista
authors: K
authors: Nicolas
authors: Lauren A
authors: LA
authors: Wendelken
authors: Oscar
authors: O
authors: Alcantar
authors: Katherine P
authors: KP
authors: Rankin
authors: Bruce
authors: B
authors: Miller
authors: Victor
authors: V
authors: Valcour
mesh_terms: D015526:AIDS Dementia Complex / Q000175:diagnosis* / Q000503:physiopathology / Q000523:psychology; D000368:Aged; D058070:Asymptomatic Diseases / Q000523:psychology; D001364:Awareness; D016022:Case-Control Studies; D003072:Cognition Disorders / Q000175:diagnosis* / Q000209:etiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D012720:Severity of Illness Index