Evaluating the accuracy of selfreport for the dia

Authors: Lisa C Obermeit Jessica Beltran Kaitlin B Casaletto Donald R Franklin Scott Letendre Ronald Ellis Christine FennemaNotestine Florin Vaida Ann C Collier Christina M Marra David Clifford Benjamin Gelman Ned Sacktor Susan Morgello David Simpson J Allen McCutchan Igor Grant Robert K Heaton The CNS HIV AntiRetroviral Therapy Effects Research CHARTER Group

Publish Date: 2016/08/24

Volume: 23, Issue: 1, Pages: 67-78

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Abstract

The criteria for differentiating symptomatic from asymptomatic HIVassociated neurocognitive disorder require evaluation of 1 cognitive impairment 2 daily functioning declines and 3 whether the functional declines are attributable to cognitive versus physical problems Many providers rely only on selfreport to evaluate these latter criteria However the accuracy of patientprovided information may be limited This study evaluated the validity of selfassessment for HIVassociated neurocognitive disorder HAND diagnoses by comparing objective findings with selfreport of criteria 2 and 3 above Selfreports were used to stratify 277 cognitively impaired HIV+ individuals into functionally dependent n = 159 and independent n = 118 groups followed by group comparisons of objective functional problems The dependent group was then divided into those who selfattributed their functional dependence to only cognitive n = 80 versus only physical n = 79 causes for further comparisons on objective findings The functionally dependent group was significantly worse than the independent group on all objective disability characteristics except severity of cognitive impairment while those who attributed their dependence to physical versus cognitive factors were similar on all objective physical cognitive and functioning variables Of note 28  of physical attributors showed no physical abnormalities on neuromedical examinations Results suggest that patient report is consistently associated with objective measures of functional loss in contrast patient identification of physical versus cognitive causes is poorly associated with objective criteria These findings caution against relying solely on patient selfreport to determine whether functional disability in cognitively impaired HIV+ individuals can be attributed to strictly physical causesThe CNS HIV AntiRetroviral Therapy Effects Research CHARTER https//wwwcharterresourceucsdedu is supported by awards N01 MH22005 HHSN271201000036C and HHSN271201000030C from the National Institutes of Health The CNS HIV AntiRetroviral Therapy Effects Research CHARTER group is affiliated with Johns Hopkins University the Icahn School of Medicine at Mount Sinai University of California San Diego University of Texas Galveston University of Washington Seattle and Washington University St Louis and is headquartered at the University of California San Diego and includes Director Igor Grant MD Codirectors Scott L Letendre MD Ronald J Ellis MD PhD and Thomas D Marcotte PhD Center Manager Donald Franklin Jr Neuromedical Component Ronald J Ellis MD PhD PI and J Allen McCutchan MD Laboratory and Virology Component Scott Letendre MD CoPI and Davey M Smith MD CoPI Neurobehavioral Component Robert K Heaton PhD PI J Hampton Atkinson MD and Matthew Dawson Imaging Component Christine FennemaNotestine PhD PI Michael J Taylor PhD and Rebecca Theilmann PhD Data Management Component Anthony C Gamst PhD PI and Clint Cushman Statistics Component Ian Abramson PhD PI Florin Vaida PhD and Reena Deutsch PhD Johns Hopkins University Site Ned Sacktor PI and Vincent Rogalski Icahn School of Medicine at Mount Sinai Site Susan Morgello MD CoPI David Simpson MD CoPI and Letty Mintz NP University of California San Diego Site J Allen McCutchan MD PI and Kaori Phillips BSN University of Washington Seattle Site Ann Collier MD CoPI Christina Marra MD CoPI and Sher Storey PAC University of Texas Galveston Site Benjamin Gelman MD PhD PI and Eleanor Head RN BSN and Washington University St Louis Site David Clifford MD PI Muhammad AlLozi MD and Mengesha Teshome MD The views expressed in this article are those of the authors and do not reflect the official policy or position of the US GovernmentMs Obermeit is funded by a National Institute on Drug Abuse training grant DA031098 Ms Casaletto is funded by a National Institute of Health grant F31DA035708 Mr Franklin receives support from National Institute of Health grants HHSN271201000030C and HHSN271201000036C Dr Letendre receives support from National Institute of Health grants HHSN271201000036C R01MH58076 R01MH92225 P50DA26306 and P30MH62512 and has received support for research projects from Abbott Merck Tibotec and GlaxoSmithKline has consulted for Gilead Sciences GlaxoSmithKline Merck and Tibotec and has received lecture honoraria from Abbott and BoehringerIngelheim Dr Ellis received National Institute of Health grants R01MH058076 U01MH83506 P30MH62512 R01MH83552 P50DA26306 R01MH095621 2U01NS32228 and HHSN271201000036C and consultant fees from NeurogesX Dr FennemaNotestine has received research support from National Institute of Health grants R01NS080655 R21DA037667 R01DA039775 R01AG048650 R03MH103995 and R01MH107345 R01 AG022381 P30 MH062512 and P50 DA026306 R01MH084796 and HHSN271201000036C Dr Vaida receives research support from National Institute of Health grants P30 MH62512 P50 DA26306 R01 MH083552 R01 AI47033 U01 AI74521 R01 MH085608 HHSN271201000030C and HHSN271201000036C and Precision Photonics Corporation grant AI068543 and has served on a data safety and management board for Ardea Biosciences Inc Dr Collier is supported by National Institute of Health grants MH22005 MH107345 AI069481 AI068636 AI120176 AI111806 NS082120 AI057005 DA037979 AI27757 and AI27767 had past research support from BristolMyers Squibb Merck Company and Roche Molecular Systems and is a member of a Data Safety and Monitoring Board for Mercksponsored studies Dr Marra receives research support from National Institute of Health grants R01NS082120 R01NS34235 and R01MH107345 and receives royalties from Lippincott Williams and Wilkins and from UptoDate Dr Clifford is supported by National Institute of Health and Alzheimer Association grants NS077384 AI69495 NR012907 NR014449 NR012657 and UL1 TR000448 receives research support from Lilly and Roche and has provided scientific advisory or consulting to Amgen Biogen Inhibikase Genzyme/Sanofi Takeda/Millennium Roche/Genentech Novartis GSK BMS Pfizer Quintiles and Drinker Biddle Reath PML Consortium Scientific Advisory Board Dr Gelman receives support for National Institute of Health grants R01MH101017 R01MH107345 R01MH104134 R01NS072005 R01NS079166 R01DA036165 R56HL129881 and U24MH10093001 Dr Sacktor receives support from National Institute of Health grants U01AI035042 RO1AG034852 HHSN271201000036C RO1NS081196 RO1AG042165 P30MH075673 and RO1MH099733 Dr Morgello receives support from National Institute of Health grants U24MH100931 R25MH080663 RO1MH107345 R21NR015009 R21DK105917 and RO1DA037611 Dr Simpson receives research support from National Institute of Health grants U01MH083501 HHSN271201000027C and UL1TR000067 and provided consultancy to GlaxoSmithKline and Gilead Dr McCutchan receives support from National Institute of Health grants P30MH62512 U01MH83506 U01AI69432 HHSN271201000036C K30 RR22681 R01MH58076 and U13MH81676 and National Institute of Health/Centers for Disease Control and Prevention CDC grant U2G PS00623 and authors chapters on HIV for the Merck Manual Dr Grant receives support from National Institute of Health grants P30MH62512 P50DA26306 R01MH107345 2RF1AG15301 R21DA036608 and R01MH094159 Dr Heaton receives ongoing research support from National Institute of Health grants R01MH92225 P50DA26306 P30MH62512 R01MH60720 R01MH58076 R01MH78737 U01MH83506 R01MH83552 R01MH80150 and HHSN271201000036C

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