Functional consequences of HIV-associated neuropsychological impairment

Abstract

This review focuses on the "real world" implications of infection with HIV/AIDS from a neuropsychological perspective. Relevant literature is reviewed which examines the relationships between HIV-associated neuropsychological impairment and employment, driving, medication adherence, mood, fatigue, and interpersonal functioning. Specifically, the relative contributions of medical, cognitive, psychosocial, and psychiatric issues on whether someone with HIV/AIDS will be able to return to work, adhere to a complicated medication regimen, or safely drive a vehicle will be discussed. Methodological issues that arise in the context of measuring medication adherence or driving capacity are also explored. Finally, the impact of HIV/AIDS on mood state, fatigue, and interpersonal relationships are addressed, with particular emphasis on how these variables interact with cognition and independent functioning. The purpose of this review is to integrate neuropsychological findings with their real world correlates of functional behavior in the HIV/AIDS population.

Fig. 1

CVLT Baseline Predicts Finding Employment. Note: Adapted from van Gorp, W., Rabkin, J.G., Ferrando, S.J., Mintz, J., Ryan, E., Borkowski,T., & Mcelhiney, M. (2007). Neuropsychiatric predictors of return to work in HIV/AIDS. Journal of the International Neuropsychological Society, 13, 80-89 (reprinted with permission)

Fig. 2

Cognition and Medication Adherence among Younger and Older HIV+ Adults. Note: Mem. = Memory; Attent. = Attention; Exec. = Executive; Qual. = Qualitative self-report; 30-Day = 30-Day Self-Report; 1-Day = 1-Day Self-Report. Standardized values shown. Adapted from Ettenhofer, M. L., Hinkin, C. H., Castellon, S. A., Durvasula, R., Ullman, J., Lam, M., Myers, H., Wright, M. J., & Foley, J. (in press). Aging, neurocognition, and medication adherence in HIV infection. American Journal of Geriatric Psychiatry

Fig. 3

Accidents per Million Miles in Past Year for HIV+ Groups Stratified by Neuropsychological Impairment and Risk Level*. Note: Adapted from Marcotte, T.D., Lazzaretto, D., Scott, J.C., Roberts, E., Woods, S.P., Letendre, S., & the HNRC Group. (2006). Visual attention deficits are associated with driving accidents in cognitively-impaired HIV-infected individuals. Journal of Clinical and Experimental Neuropsychology, 28, 13–28. *Risk Level: Classified based upon Useful Field of View (UFOV) task performance. NP: Neuropsychologically