HIV-1 infection can be associated with neuropsychological (NP)
deficits ranging from subtle to severe. The purpose of this study was
to evaluate the functional, or “real-world” impact of
HIV-associated NP impairment in a group of 267 HIV-infected
participants. All participants received comprehensive NP, neuromedical,
and standardized functional evaluations that included laboratory
measures of shopping, cooking, financial management, medication
management and vocational abilities. Compared to NP-normal
participants, those with NP impairment performed significantly worse on
all laboratory measures of everyday functioning. Multivariate analyses
revealed that the NP ability domains of Abstraction/Executive
Function, Learning, Attention/Working Memory and Verbal abilities
most strongly and consistently predicted failures on the functional
battery. Both NP impairment and impairment on the functional battery
were significantly associated with subjective experiences of cognitive
difficulties, as well as unemployment and increased dependence in
activities of daily living; multivariate prediction models that also
considered depressed mood and biological measures of disease
progression revealed that impairment on the functional battery and
depression were the only unique predictors of all three indicators of
“real-world” functioning. The current results add to
growing evidence concerning the clinical significance of HIV-associated
NP impairment. Objective, laboratory based functional measures, such as
those used here, may compliment NP testing in future studies directed
at understanding the impact on life quality of central nervous system
disorders and their treatments. Finally, there is a need for additional
research investigating the apparently independent effect of depression
on level of everyday functioning in HIV infected persons.NOTE: Dr. Erin D. Bigler served as action editor during the
course of this review. (JINS, 2004, 10,
317–331.)