Levine Andrew J, Martin Eileen, Sacktor Ned, Munro Cynthia, Becker James
*Department of Neurology, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, CA; †Department of Psychiatry, Rush University Medical Center, Chicago, IL; ‡Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD; §Departments of Psychiatry and Neurology, Johns Hopkins University School of Medicine, Baltimore, MD; and ‖Departments of Psychiatry and Neurology, University of Pittsburgh, Pittsburgh, PA.
J Acquir Immune Defic Syndr. 2017 Jun 1;75(2):203-210. doi: 10.1097/QAI.0000000000001371.
Prevalence estimates of HIV-associated neurocognitive disorders (HAND) may be inflated. Estimates are determined via cohort studies in which participants may apply suboptimal effort on neurocognitive testing, thereby inflating estimates. Additionally, fluctuating HAND severity over time may be related to inconsistent effort. To address these hypotheses, we characterized effort in the Multicenter AIDS Cohort Study.
After neurocognitive testing, 935 participants (525 HIV- and 410 HIV+) completed the visual analog effort scale (VAES), rating their effort from 0% to 100%. Those with <100% then indicated the reason(s) for suboptimal effort. K-means cluster analysis established 3 groups: high (mean = 97%), moderate (79%), and low effort (51%). Rates of HAND and other characteristics were compared between the groups. Linear regression examined the predictors of VAES score. Data from 57 participants who completed the VAES at 2 visits were analyzed to characterize the longitudinal relationship between effort and HAND severity.
Fifty-two percent of participants reported suboptimal effort (<100%), with no difference between serostatus groups. Common reasons included "tired" (43%) and "distracted" (36%). The lowest effort group had greater asymptomatic neurocognitive impairment and minor neurocognitive disorder diagnosis (25% and 33%) as compared with the moderate (23% and 15%) and the high (12% and 9%) effort groups. Predictors of suboptimal effort were self-reported memory impairment, African American race, and cocaine use. Change in effort between baseline and follow-up correlated with change in HAND severity.
Suboptimal effort seems to inflate estimated HAND prevalence and explain fluctuation of severity over time. A simple modification of study protocols to optimize effort is indicated by the results.
与人类免疫缺陷病毒（HIV）相关的神经认知障碍（HAND）的患病率估计值可能被高估。这些估计值是通过队列研究确定的，在这些研究中，参与者在神经认知测试中可能没有付出最佳努力，从而使估计值膨胀。此外，HAND严重程度随时间的波动可能与努力程度不一致有关。为了验证这些假设，我们在多中心艾滋病队列研究中对努力程度进行了特征分析。
在神经认知测试后，935名参与者（525名HIV阴性和410名HIV阳性）完成了视觉模拟努力程度量表（VAES），将他们的努力程度从0%评定到100%。那些努力程度低于100%的参与者随后指出了努力程度未达最佳的原因。K均值聚类分析确定了3组：高努力程度组（平均=97%）、中等努力程度组（79%）和低努力程度组（51%）。比较了各组之间HAND的发生率及其他特征。线性回归分析了VAES评分的预测因素。对57名在两次访视时完成VAES的参与者的数据进行分析，以描述努力程度与HAND严重程度之间的纵向关系。
52%的参与者报告努力程度未达最佳（<100%），血清学状态组之间无差异。常见原因包括“疲倦”（43%）和“分心”（36%）。与中等努力程度组（23%和15%）和高努力程度组（12%和9%）相比，低努力程度组有更多的无症状神经认知损害和轻微神经认知障碍诊断（分别为25%和33%）。努力程度未达最佳的预测因素是自我报告的记忆损害、非裔美国人种族和使用可卡因。基线和随访之间努力程度的变化与HAND严重程度的变化相关。
努力程度未达最佳似乎会使HAND患病率估计值膨胀，并解释了严重程度随时间的波动。研究结果表明，对研究方案进行简单修改以优化努力程度是可行的。
