Depression, not cognitive impairment is the least of the problems in their daily difficulties in life
One in five people living with HIV in a European study reported a decline in daily life as a result of cognitive problems, while most mentioned depression And not things like memory loss, problem solving difficulties, lack of concentration or reduced attention span, researchers from the CIPHER study group reportedJournal of Acquired Immune Deficiency Syndromes.
But, researchers say, people who reported these problems were also more susceptible to such conditions. Comorbidities, such as being depressed or anxious, unemployed or having difficulty meeting basic needs, should be evaluated for these problems before concluding that underlying problems may be signs of a decline in cognitive function.
Depression, anxiety and other "mental imbalances" could indicate cognitive problems
"All of our observed associations may have multiple explanations, and causality can be in any direction," the authors said. "These results imply that patients reporting symptoms of cognitive impairment, or decreased daily function, should be assessed for depression, Anxiety, concomitant medical conditions and financial difficulties. Failure to recognize these important elements of patients' experiences runs the risk of delayed diagnosis, failure to meet significant needs, unnecessary investigations, and even greater anxiety. "
Previous research has detected a high prevalence of cognitive impairment in people with HIV. In many cases, this is so mild that it has no impact on daily function.
Asymptomatic cognitive problems
A pattern used to diagnose the progression of asymptomatic neurocognitive impairment to mild is an assessment of self-reported difficulties with activities of daily living (ADLs - N). The pattern includes an evaluation of 16 separate activities. Progression is defined as a decline in two or more ADLs attributed by the individual to cognitive difficulties.
The researchers from the European CIPHER study wanted to assess the validity of this assessment and determine the factors associated with decreased ADLs and symptoms of cognitive impairment in a cohort of 448 adults recruited between 2011 and 2013.
Participants completed a series of computerized and pen-and-paper quizzes and questionnaires. Self-reported information was collected on employment, income, schooling, and substance use. The researchers also collected clinical data from the patient's notes.
Participants were overwhelmingly white majority (87%), male (84%) with mean age of 46 years. Most (89%) were taking ART, with 81% undetectable viral load, CD4 cell count mean age of 550 cells /mm3And the mean duration of ten years' HIV diagnosis.
Auto declination reported
The self-reported decline in two or more ADLs was present in 31% of people, of whom 21% attributed their decline to cognitive problems. The most commonly reported difficulties were experienced in social activities, work, housekeeping and reading or watching television programming.
Difficulty meeting basic needs
Several factors were associated with an auto-reported decline in ADLs attributed to cognitive impairment. Models adjusted for age, sex, ethnicity, education, and place of study showed a significant association between decline in ADLs and slower rate / reaction time and attention and working memory - all key measures of cognitive impairment. Other factors included difficulty meeting basic needs, unable to work or unemployment, depression, anxiety and being diagnosed as HIV-positive for at least five years.
The researchers also found that several factors were associated with self-reported symptoms of cognitive impairment. These included weaker performance on the tests used to assess cognitive impairment, including impaired reaction time / speed, attention / work memory, verbal memory, and verbal fluency. Other important factors included lower levels of schooling, comorbidities, poverty, lack of work, anxiety, depression, and ten years or more since the diagnosis of HIV.
"The relationship between cognitive impairment, low mood and functional decline is complex and multidirectional," write the researchers.
Tests used to assess ADL declines and cognitive impairment did not show levels of accuracy that would be acceptable for diagnostic purposes. The ADL assessment had a sensitivity of 40% and a specificity of 78%, with measures of cognitive impairment with sensitivity of 48% and specificity of 69%. This finding implies that only half of the true cases of cognitive impairment would be diagnosed and that almost one third of people would be incorrectly classified as having cognitive impairment.
The researchers concluded that other research groups and physicians need to be careful about using day-to-day tests and, in particular, pay attention to depression as a reason for any change.
They point out that a previous study of the same population by their group found that poor scores on cognitive impairment tests, especially those that measure the speed of recall or decision making, were associated with severe depressive symptoms.
They suggest that additional work is needed to shed light on this association, and in particular to test whether interventions to improve mood and anxiety have the effect of improving scores on cognitive tests - and people's perceptions about their memory And other cognitive functions.
Translated by Claudio Souza's original Researchers say rule out depression, anxiety, unemployment and other stresses before blaming cognitive impairment for everyday difficultiesWritten by Michael Carter on 19 June 2017
Laverick R et al.Self-reported difficulties with everyday function, cognitive symptoms and cognitive function in people with HIV. J Acquir Immune Defic Syndr, online edition. DOI: 10.1097 / QAI.0000000000001468 (2017).