School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA.
Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA.
Neuropsychol Rev. 2022 Dec;32(4):855-876. doi: 10.1007/s11065-021-09528-x. Epub 2021 Nov 26.
Nearly 30-50% of people living with HIV experience HIV-Associated Neurocognitive Disorder (HAND). HAND indicates performance at least one standard deviation below the normative mean on any two cognitive domains. This method for diagnosing or classifying cognitive impairment has utility, however, cognitive intraindividual variability provides a different way to understand cognitive impairment. Cognitive intraindividual variability refers to the scatter in cognitive performance within repeated measures of the same cognitive test (i.e., inconsistency) or across different cognitive tests (i.e., dispersion). Cognitive intraindividual variability is associated with cognitive impairment and cognitive decline in various clinical populations. This integrative review of 13 articles examined two types of cognitive intraindividual variability in people living with HIV, inconsistency and dispersion. Cognitive intraindividual variability appears to be a promising approach to detect subtle cognitive impairments that are not captured by traditional mean-based neuropsychological testing. Greater intraindividual variability in people living with HIV has been associated with: 1) poorer cognitive performance and cognitive decline, 2) cortical atrophy, both gray and white matter volume, 3) poorer everyday functioning (i.e., driving simulation performance), specifically medication adherence, and 4) even mortality. This inspires future directions for research. First, greater cognitive intraindividual variability may reflect a greater task demand on executive control to harness and regulate cognitive control over time. By improving executive functioning through cognitive training, it may reduce cognitive intraindividual variability which could slow down cognitive decline. Second, cognitive intraindividual variability may be reconsidered in prior cognitive intervention studies in which only mean-based cognitive outcomes were used. It is possible that such cognitive interventions may actually improve cognitive intraindividual variability, which could have clinical relevance.
大约有 30-50%的艾滋病毒感染者会出现与艾滋病毒相关的认知障碍（HAND）。HAND 表示在任何两个认知领域中的表现至少低于正常平均值一个标准差。这种用于诊断或分类认知障碍的方法具有实用性，但是认知个体内变异性提供了理解认知障碍的另一种方式。认知个体内变异性是指在同一认知测试的重复测量（即不一致）或不同认知测试（即分散）中认知表现的分散程度。认知个体内变异性与各种临床人群中的认知障碍和认知衰退有关。这篇对 13 篇文章的综合综述检查了 HIV 感染者的两种认知个体内变异性，即不一致性和分散性。认知个体内变异性似乎是一种很有前途的方法，可以检测传统基于平均值的神经心理学测试无法捕捉到的细微认知障碍。HIV 感染者的个体内变异性越大，与以下因素有关：1）认知表现和认知衰退越差，2）皮质萎缩，包括灰质和白质体积，3）日常功能（即驾驶模拟性能）越差，特别是药物依从性，以及 4）甚至死亡率。这为未来的研究提供了方向。首先，更大的认知个体内变异性可能反映了执行控制的更高任务需求，以随着时间的推移利用和调节认知控制。通过认知训练改善执行功能，可能会降低认知个体内变异性，从而减缓认知衰退。其次，在仅使用基于平均值的认知结果的先前认知干预研究中，可以重新考虑认知个体内变异性。这些认知干预实际上可能会改善认知个体内变异性，这可能具有临床意义。
