Department of Psychiatry, University of California, San Diego, USA.
Arch Clin Neuropsychol. 2012 May;27(3):293-303. doi: 10.1093/arclin/acs003. Epub 2012 Feb 15.
Although HIV-associated neurocognitive disorders (HAND) are the strong predictors of everyday functioning difficulties, approximately half of all functionally impaired individuals are labeled "neurocognitively normal" according to the standard neuropsychological measures, suggesting that novel predictors of functional problems in this prevalent subgroup are needed. The present study hypothesized that increased neurocognitive intra-individual variability as indexed by dispersion would be associated with poor daily functioning among 82 persons with HIV infection who did not meet research criteria for HAND. An intra-individual standard deviation was calculated across the demographically adjusted T-scores of 13 standard neuropsychological tests to represent dispersion, and functional outcomes included self-reported declines in basic and instrumental activities of daily functioning (basic activity of daily living [BADL] and instrumental activity of daily living [IADL], respectively) and medication management. Dispersion was a significant predictor of medication adherence and dependence in both BADL and IADL, even when other known predictors of functional status (i.e., age, affective distress, and indices of disease severity) were included in the models. As a significant and unique predictor of a performance on the range of daily functioning activities, neurocognitive dispersion may be indicative of deficient cognitive control expressed as inefficient regulation of neurocognitive resources in the context of competing functional demands. As such, dispersion may have clinical utility in detecting risk for functional problems among HIV-infected individuals without HAND.
虽然 HIV 相关的神经认知障碍（HAND）是日常功能障碍的强预测因素，但根据标准神经心理学测量，大约一半的所有功能受损个体被标记为“神经认知正常”，这表明在这个普遍的亚组中，需要新的功能障碍预测因素。本研究假设，在 82 名未达到 HAND 研究标准的 HIV 感染者中，以离散度为指标的神经认知个体内变异性增加与日常功能较差有关。在经过人口统计学调整的 13 项标准神经心理学测试的 T 分数的个体内标准差来表示离散度，功能结果包括自我报告的基本和工具日常生活活动能力下降（基本日常生活活动 [BADL] 和工具日常生活活动 [IADL]）和药物管理。即使在模型中纳入了其他已知的功能状态预测因素（即年龄、情感困扰和疾病严重程度指数），离散度也是 BADL 和 IADL 中药物依从性和依赖性的显著预测因素。作为日常功能活动范围表现的重要且独特的预测因素，神经认知离散度可能表明认知控制不足，表现为在竞争性功能需求的背景下神经认知资源的调节效率低下。因此，离散度在检测无 HAND 的 HIV 感染者的功能问题风险方面可能具有临床实用性。
