Department of Psychology, Temple University, Weiss Hall, 1701 North 13th Street, Philadelphia, PA, 19122, USA.
Neuropsychol Rev. 2017 Jun;27(2):101-123. doi: 10.1007/s11065-017-9348-2. Epub 2017 May 24.
Despite longstanding acknowledgement of the heterogeneity of HIV-associated neurocognitive disorders (HAND), existing HAND diagnostic methods classify according to the degree of impairment, without regard to the pattern of neuropsychological strengths and weaknesses. Research in mild cognitive impairment (MCI) has demonstrated that classifying individuals into subtypes by both their level and pattern of impairment, using either conventional or statistical methods, has etiologic and prognostic utility. Methods for characterizing the heterogeneity of MCI provide a framework that can be applied to other disorders and may be useful in clarifying some of the current challenges in the study of HAND. A small number of studies have applied these methods to examine the heterogeneity of neurocognitive function among individuals with HIV. Most have supported the existence of multiple subtypes of neurocognitive impairment, with some evidence for distinct clinicodemographic features of these subtypes, but a number of gaps exist. Following a review of diagnostic methods and challenges in the study of HAND, we summarize the literature regarding conventional and empirical subtypes of MCI and HAND and identify directions for future research regarding neurocognitive heterogeneity in HIV infection.
尽管人们早就认识到与 HIV 相关的神经认知障碍 (HAND) 的异质性,但现有的 HAND 诊断方法是根据损害程度进行分类的,而不考虑神经心理的强弱模式。轻度认知障碍 (MCI) 的研究表明,使用传统或统计方法,根据个体的损害程度和模式将其分类为亚型,具有病因学和预后效用。描述 MCI 异质性的方法为其他疾病的研究提供了一个框架,并且可能有助于澄清 HAND 研究中当前面临的一些挑战。少数研究应用这些方法来检查 HIV 感染者神经认知功能的异质性。大多数研究支持存在多种神经认知障碍亚型,这些亚型在临床和人口统计学特征上存在一些差异,但仍存在一些空白。在回顾 HAND 的诊断方法和研究挑战后,我们总结了关于 MCI 和 HAND 的传统和经验亚型的文献,并确定了 HIV 感染神经认知异质性的未来研究方向。