Laverick Rosanna, Haddow Lewis, Daskalopoulou Marina, Lampe Fiona, Gilson Richard, Speakman Andrew, Antinori Andrea, Bruun Tina, Vassilenko Anna, Collins Simon, Rodger Alison
*Research Department of Infection and Population Health, University College London, London, United Kingdom; †National Institute for Infectious Diseases, Lazzaro Spallanzani, Rome, Italy; ‡Department of Infectious Diseases, University of Copenhagen, Copenhagen, Denmark; §Belarusian State Medical University, Minsk, Belarus; and ∥HIV i-Base, London, United Kingdom.
J Acquir Immune Defic Syndr. 2017 Nov 1;76(3):e74-e83. doi: 10.1097/QAI.0000000000001468.
We determined factors associated with self-reported decline in activities of daily living (ADLs) and symptoms of cognitive impairment in HIV positive adults in 5 European clinics.
HIV+ adults underwent computerized and pen-and-paper neuropsychological tests and questionnaires of cognitive symptoms and ADLs. We considered cognitive function in 5 domains, psychosocial factors, and clinical parameters as potentially associated with symptoms. Separate regression analyses were used to determine factors associated with a decline in ADL (defined as self-reported decline affecting ≥2 ADLs and attributed to cognitive difficulties) and self-reported frequency of symptoms of cognitive impairment. We also estimated the diagnostic accuracy of both questionnaires as tests for cognitive impairment.
Four hundred forty-eight patients completed the assessments [mean age 45.8 years, 84% male, 87% white, median CD4 count 550 cells/mm, median time since HIV diagnosis 9.9 years, 81% virologically suppressed (HIV-1 plasma RNA <50 copies/mL)]. Ninety-six (21.4%) reported decline in ADLs and attributed this to cognitive difficulties. Self-reported decline in ADLs and increased symptoms of cognitive impairment were both associated with worse performance on some cognitive tests. There were also strong associations with financial difficulties, depressive and anxiety symptoms, unemployment, and longer time since HIV diagnosis. Both questionnaires performed poorly as diagnostic tests for cognitive impairment.
Patients' own assessments of everyday function and symptoms were associated with objectively measured cognitive function. However, there were strong associations with other psychosocial issues including mood and anxiety disorders and socioeconomic hardship. This should be considered when assessing HIV-associated cognitive impairment in clinical care or research studies.
我们确定了欧洲5家诊所中与HIV阳性成年人自我报告的日常生活活动（ADL）能力下降及认知障碍症状相关的因素。
HIV阳性成年人接受了计算机化和纸笔形式的神经心理学测试以及认知症状和ADL问卷。我们将5个领域的认知功能、心理社会因素和临床参数视为可能与症状相关的因素。采用单独的回归分析来确定与ADL下降（定义为自我报告的下降影响≥2项ADL且归因于认知困难）和自我报告的认知障碍症状频率相关的因素。我们还估计了这两份问卷作为认知障碍测试的诊断准确性。
448名患者完成了评估[平均年龄45.8岁，84%为男性，87%为白人，CD4计数中位数为550个细胞/mm，自HIV诊断以来的时间中位数为9.9年，81%病毒学抑制（HIV-1血浆RNA<50拷贝/mL）]。96名（21.4%）报告ADL能力下降并将其归因于认知困难。自我报告的ADL能力下降和认知障碍症状增加均与某些认知测试中的较差表现相关。还与经济困难、抑郁和焦虑症状、失业以及自HIV诊断以来的较长时间密切相关。两份问卷作为认知障碍诊断测试的表现均较差。
患者对日常功能和症状的自我评估与客观测量的认知功能相关。然而，与包括情绪和焦虑障碍以及社会经济困难在内的其他心理社会问题密切相关。在临床护理或研究中评估HIV相关认知障碍时应考虑这一点。
