title: Evaluating the accuracy of self-report for the diagnosis of HIV-associated neurocognitive disorder (HAND): defining "symptomatic" versus "asymptomatic" HAND.
abstract: The criteria for differentiating symptomatic from asymptomatic HIV-associated neurocognitive disorder require evaluation of (1) cognitive impairment, (2) daily functioning declines, and (3) whether the functional declines are attributable to cognitive versus physical problems. Many providers rely only on self-report to evaluate these latter criteria. However, the accuracy of patient-provided information may be limited. This study evaluated the validity of self-assessment for HIV-associated neurocognitive disorder (HAND) diagnoses by comparing objective findings with self-report of criteria 2 and 3 above. Self-reports were used to stratify 277 cognitively impaired HIV+ individuals into functionally dependent (n = 159) and independent (n = 118) groups, followed by group comparisons of objective functional problems. The dependent group was then divided into those who self-attributed their functional dependence to only cognitive (n = 80) versus only physical (n = 79) causes, for further comparisons on objective findings. The functionally dependent group was significantly worse than the independent group on all objective disability characteristics except severity of cognitive impairment, while those who attributed their dependence to physical (versus cognitive) factors were similar on all objective physical, cognitive, and functioning variables. Of note, 28 % of physical attributors showed no physical abnormalities on neuromedical examinations. Results suggest that patient report is consistently associated with objective measures of functional loss; in contrast, patient identification of physical versus cognitive causes is poorly associated with objective criteria. These findings caution against relying solely on patient self-report to determine whether functional disability in cognitively impaired HIV+ individuals can be attributed to strictly physical causes.
authors.affiliation: Department of Psychiatry, University of California, San Diego, 9500 Gilman Drive, La Jolla, San Diego, CA, 92093, USA.|SDSU/UCSD Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA.
authors.forename: Lisa C
authors.initials: LC
authors.lastname: Obermeit
authors.affiliation: Department of Psychiatry, University of California, San Diego, 9500 Gilman Drive, La Jolla, San Diego, CA, 92093, USA.
authors.forename: Jessica
authors.initials: J
authors.lastname: Beltran
authors.affiliation: SDSU/UCSD Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA.
authors.forename: Kaitlin B
authors.initials: KB
authors.lastname: Casaletto
authors.affiliation: Department of Psychiatry, University of California, San Diego, 9500 Gilman Drive, La Jolla, San Diego, CA, 92093, USA.
authors.forename: Donald R
authors.initials: DR
authors.lastname: Franklin
authors.affiliation: Department of Psychiatry, University of California, San Diego, 9500 Gilman Drive, La Jolla, San Diego, CA, 92093, USA.|Department of Medicine, University of California, San Diego, 9500 Gilman Drive, La Jolla, San Diego, CA, 92093, USA.
authors.forename: Scott
authors.initials: S
authors.lastname: Letendre
authors.affiliation: Department of Psychiatry, University of California, San Diego, 9500 Gilman Drive, La Jolla, San Diego, CA, 92093, USA.|Department of Neurosciences, University of California, San Diego, 9500 Gilman Drive, La Jolla, San Diego, CA, 92093, USA.
authors.forename: Ronald
authors.initials: R
authors.lastname: Ellis
authors.affiliation: Department of Psychiatry, University of California, San Diego, 9500 Gilman Drive, La Jolla, San Diego, CA, 92093, USA.
authors.forename: Christine
authors.initials: C
authors.lastname: Fennema-Notestine
authors.affiliation: Department of Family Medicine & Public Health, University of California, San Diego, 9500 Gilman Drive, La Jolla, San Diego, CA, 92093, USA.
authors.forename: Florin
authors.initials: F
authors.lastname: Vaida
authors.affiliation: Department of Medicine, Harborview Medical Center, University of Washington, 325 9th Avenue, Seattle, WA, 98104, USA.
authors.forename: Ann C
authors.initials: AC
authors.lastname: Collier
authors.affiliation: Department of Neurology, University of Washington, Seattle, WA, USA.
authors.forename: Christina M
authors.initials: CM
authors.lastname: Marra
authors.affiliation: Department of Neurology, Washington University in St. Louis, 660 South Euclid Avenue, Saint Louis, MO, 63110, USA.
authors.forename: David
authors.initials: D
authors.lastname: Clifford
authors.affiliation: Department of Pathology, University of Texas Medical Branch, 3.118 Keiler Building, 301 University Boulevard, Galveston, TX, 77555-0609, USA.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Gelman
authors.affiliation: Department of Neurology, Johns Hopkins University, 600 North Wolfe Street, Sheikh Zayed Tower, Baltimore, MD, 21287, USA.
authors.forename: Ned
authors.initials: N
authors.lastname: Sacktor
authors.affiliation: Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY, 21287, USA.
authors.forename: Susan
authors.initials: S
authors.lastname: Morgello
authors.affiliation: Department of Neurology, Icahn School of Medicine at Mount Sinai, 1428 Madison Avenue, New York, NY, 21287, USA.
authors.forename: David
authors.initials: D
authors.lastname: Simpson
authors.affiliation: Department of Medicine, University of California, San Diego, 9500 Gilman Drive, La Jolla, San Diego, CA, 92093, USA.
authors.forename: J Allen
authors.initials: JA
authors.lastname: McCutchan
authors.affiliation: Department of Psychiatry, University of California, San Diego, 9500 Gilman Drive, La Jolla, San Diego, CA, 92093, USA.
authors.forename: Igor
authors.initials: I
authors.lastname: Grant
authors.affiliation: Department of Psychiatry, University of California, San Diego, 9500 Gilman Drive, La Jolla, San Diego, CA, 92093, USA. rheaton@ucsd.edu.
authors.forename: Robert K
authors.initials: RK
authors.lastname: Heaton
mesh_terms: D000203:Activities of Daily Living / Q000523:psychology*; D000328:Adult; D058070:Asymptomatic Diseases; D003071:Cognition / Q000502:physiology; D060825:Cognitive Dysfunction / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology; D006233:Persons with Disabilities / Q000523:psychology*; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales; D057566:Self Report; D012720:Severity of Illness Index
keywords: AIDS; Activities of daily living; Cognitive disorders; Etiology; Self-assessment