Prescott Maximo R, Paolillo Emily W, Rivera Saldana Carlos D, Franklin Donald, Pasipanodya Elizabeth C, Hussain Mariam A, Moore Raeanne C, Heaton Robert K, Montoya Jessica L, Moore David J
Department of Psychiatry, UC San Diego, San Diego, CA, USA.
San Diego State University/UC San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA.
J Int Neuropsychol Soc. 2025 Jul 7:1-8. doi: 10.1017/S1355617725101094.
Diagnosing HIV-Associated Neurocognitive Disorders (HAND) requires attributing neurocognitive impairment and functional decline at least partly to HIV-related brain effects. Depressive symptom severity, whether attributable to HIV or not, may influence self-reported functioning. We examined longitudinal relationships among objective global cognition, depressive symptom severity, and self-reported everyday functioning in people with HIV (PWH).
Longitudinal data from 894 PWH were collected at a university-based research center (2002-2016). Participants completed self-report measures of everyday functioning to assess both dependence in instrumental activities of daily living (IADL) and subjective cognitive difficulties at each visit, along with depressive symptom severity (BDI-II). Multilevel modeling examined within- and between-person predictors of self-reported everyday functioning outcomes.
Participants averaged 6 visits over 5 years. Multilevel regression showed a significant interaction between visit-specific global cognitive performance and mean depression symptom severity on likelihood of dependence in IADL ( = 0.04), such that within-person association between worse cognition and greater likelihood of IADL dependence was strongest among individuals with lower mean depressive symptom severity. In contrast, participants with higher mean depressive symptom severity had higher likelihoods of IADL dependence regardless of cognition. Multilevel modelling of subjective cognitive difficulties showed no significant interaction between global cognition and mean depressive symptom severity ( > 0.05).
The findings indicate a link between cognitive abilities and IADL dependence in PWH with low to moderate depressive symptoms. However, those with higher depressive symptoms severity report IADL dependence regardless of cognitive status. This is clinically significant because everyday functioning is measured through self-report rather than performance-based assessments.
诊断HIV相关神经认知障碍（HAND）需要将神经认知损害和功能下降至少部分归因于HIV对大脑的影响。抑郁症状的严重程度，无论是否归因于HIV，都可能影响自我报告的功能。我们研究了HIV感染者（PWH）的客观整体认知、抑郁症状严重程度和自我报告的日常功能之间的纵向关系。
在一个大学研究中心（2002 - 2016年）收集了894名PWH的纵向数据。参与者在每次就诊时完成自我报告的日常功能测量，以评估日常生活工具性活动（IADL）中的依赖性和主观认知困难，同时评估抑郁症状严重程度（BDI-II）。多水平模型研究了自我报告的日常功能结果的个体内和个体间预测因素。
参与者在5年中平均就诊6次。多水平回归显示，特定就诊时的整体认知表现与平均抑郁症状严重程度之间在IADL依赖性可能性方面存在显著交互作用（ = 0.04），即认知较差与IADL依赖性可能性增加之间的个体内关联在平均抑郁症状严重程度较低的个体中最强。相比之下，平均抑郁症状严重程度较高的参与者无论认知情况如何，IADL依赖性可能性都更高。主观认知困难的多水平模型显示，整体认知与平均抑郁症状严重程度之间无显著交互作用（ > 0.05）。
研究结果表明，在抑郁症状低至中度的PWH中，认知能力与IADL依赖性之间存在联系。然而，抑郁症状严重程度较高的人无论认知状态如何都报告有IADL依赖性。这在临床上具有重要意义，因为日常功能是通过自我报告而非基于表现的评估来衡量的。
