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Review
. 2022 Dec;32(4):855-876.
doi: 10.1007/s11065-021-09528-x. Epub 2021 Nov 26.

Cognitive Intra-individual Variability in HIV: an Integrative Review

David E Vance  1 , Victor A Del Bene  2 , Jennifer Sandson Frank  3 , Rebecca Billings  4 , Kristen Triebel  2 , Alison Buchholz  5 , Leah H Rubin  6 , Steven Paul Woods  7 , Wei Li  8 , Pariya L Fazeli  3
Affiliations
Review

Cognitive Intra-individual Variability in HIV: an Integrative Review

David E Vance et al. Neuropsychol Rev. 2022 Dec.

Abstract

Nearly 30-50% of people living with HIV experience HIV-Associated Neurocognitive Disorder (HAND). HAND indicates performance at least one standard deviation below the normative mean on any two cognitive domains. This method for diagnosing or classifying cognitive impairment has utility, however, cognitive intraindividual variability provides a different way to understand cognitive impairment. Cognitive intraindividual variability refers to the scatter in cognitive performance within repeated measures of the same cognitive test (i.e., inconsistency) or across different cognitive tests (i.e., dispersion). Cognitive intraindividual variability is associated with cognitive impairment and cognitive decline in various clinical populations. This integrative review of 13 articles examined two types of cognitive intraindividual variability in people living with HIV, inconsistency and dispersion. Cognitive intraindividual variability appears to be a promising approach to detect subtle cognitive impairments that are not captured by traditional mean-based neuropsychological testing. Greater intraindividual variability in people living with HIV has been associated with: 1) poorer cognitive performance and cognitive decline, 2) cortical atrophy, both gray and white matter volume, 3) poorer everyday functioning (i.e., driving simulation performance), specifically medication adherence, and 4) even mortality. This inspires future directions for research. First, greater cognitive intraindividual variability may reflect a greater task demand on executive control to harness and regulate cognitive control over time. By improving executive functioning through cognitive training, it may reduce cognitive intraindividual variability which could slow down cognitive decline. Second, cognitive intraindividual variability may be reconsidered in prior cognitive intervention studies in which only mean-based cognitive outcomes were used. It is possible that such cognitive interventions may actually improve cognitive intraindividual variability, which could have clinical relevance.

Keywords: Cognition; Dispersion; Executive dysfunction; HIV/AIDS; Inconsistency; Intra-individual variability.

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Conflict of interest statement

Disclosures

The authors report no real or perceived vested interest that relate to this article that could be construed as a conflict of interest.

Figures

Figure 1
Figure 1
PRISMA Diagram Demonstrating Screening Method for Literature Search (Adapted from Moher et al., 2009)
See this image and copyright information in PMC

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