Predictors of Perception of Cognitive

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Corless Vol. / Cognitive Functioning in
JANAC et al.11, No. 3, May/June 2000 HIV/AIDS

Predictors of Perception of Cognitive
Functioning in HIV/AIDS

Inge B. Corless, RN, PhD, FAAN, Suzanne Bakken, RN, DNSc, FAAN,
Patrice K. Nicholas, RN, MPH, DNSc, William L. Holzemer, RN, PhD, FAAN, Chris A. McGibbon, PhD,
Jillian Inouye, RN, PhD, Kathleen M. Nokes, RN, PhD, FAAN, Joan G. Turner, RN, DNS, CIC,
Gail M. Powell-Cope, ARNP, PhD, Marie-Annette Brown, RN, PhD, FAAN, and
Carmen J. Portillo, RN, PhD, FAAN

   This is a descriptive, correlational study of the pre-       Key words: HIV/AIDS, cognition, functioning
dictors of perceived cognitive functioning. The conve-
nience sample of 728 nonhospitalized persons receiv-            Numerous neurological changes, characterized by a
ing health care for HIV/AIDS was recruited from seven           combination of cognitive, motor, and behavioral alter-
sites in the United States. All measures were self-             ations, occur across the spectrum of HIV disease
reported. Self-perception of cognitive functioning, the         (Selnes et al., 1990; Snider et al., 1983). Although neu-
dependent variable, was composed of three items from            rological change is widely noted in advanced HIV dis-
the Medical Outcomes Study HIV scale: thinking,                 ease, researchers have debated the evidence of cogni-
attention, and forgetfulness. Data related to age, gen-         tive decline during the asymptomatic stages (Grant,
der, ethnicity, education, injection drug use, CD4              Atkinson, Hesselinki, Kennedy, & Richman, 1987;
count, and length of time known to be HIV-positive              Grassi et al., 1997; Poutiainen, Elovaara, Raininko,
were collected on a demographic questionnaire. The              Vikki, Lahdeverta, & Iwanainen, 1996; Poutiainen,
scale from the Sign and Symptom Checklist for Persons           Irvanainan, Elovaara, Valle, Landervirta, 1988; Selnes
with HIV Disease was used to measure self-reported              et al., 1997; Wilkie et al., 1998). Villa et al. (1996)
symptoms. Data were analyzed using hierarchical                 argued that there are “subtle but significant cognitive
multiple regression analysis. Predictors of perception          abnormalities” (p. 130).
of cognitive functioning explained a total of 36.3% of
the variance. Four blocks—person variables (1.5%)               Inge B. Corless, RN, PhD, FAAN, Patrice K. Nicholas, RN,
(age, gender, education, history of injection drug use),        MPH, DNSc, and Chris A. McGibbon, PhD, are at the MGH
disease status (2.3%), symptom status (26.5%), and              Institute of Health Professions, Boston. Suzanne Bakken,
functional status (5.4%)—significantly contributed              RN, DNSc, FAAN, William L. Holzemer, RN, PhD, FAAN,
statistically to the total variance. Among those indi-          and Carmen J. Portillo, RN, PhD, FAAN, are at the Univer-
viduals who completed the questions related to depres-          sity of California, San Francisco. Jillian Inouye, RN, PhD,
                                                                is at the University of Hawaii, Manoa. Kathleen M. Nokes,
sion (n = 450), 28% of the variance in cognitive func-
                                                                RN, PhD, FAAN, is at Hunter College, New York, New York.
tioning was explained by this variable. The findings in
                                                                Joan G. Turner, RN, DNS, CIC, is at the University of Ala-
this multi-site study indicate that symptom status              bama, Birmingham. Gail M. Powell-Cope, ARNP, PhD, is at
explained the largest amount of variance in perceived           Jack Haley Veterans Hospital, Tampa, Florida.
cognitive functioning. Early identification of cognitive        Marie-Annette Brown, RN, PhD, FAAN, is at the University
impairment can result in appropriate clinical interven-         of Washington, Seattle. This research was supported by the
tions in remediable conditions and in the improvement of        nursing research program of the research and development
quality of life.                                                department of Glaxo-Wellcome, Inc.

Copyright © 2000 Association of Nurses in AIDS Care
20   JANAC Vol. 11, No. 3, May/June 2000

   Neurologic problems associated with HIV disease         biologic and physiologic variables and symptom and
include central nervous system infections, neoplasms,      functional status.
vascular complications, peripheral neuropathies, and
myopathies. HIV dementia (HIVD) (also called AIDS
dementia complex, subacute encephalitis, HIV                            Conceptual Framework
encephalopathy, and HIV-1-associated cognitive and
motor complex), is often identified based on three            The conceptual framework for this study was the
main categories of symptoms: cognitive, motor, and         Wilson and Cleary (1995) model, linking clinical vari-
behavioral. The primary symptom is forgetfulness,          ables with health-related quality of life. The model
which is associated with slowed mental and motor           included five sets of variables: physiological and bio-
abilities. Loss of balance and leg weakness are early      logical factors (including disease status), symptom
motor signs. The most commonly observed behavioral         status, functional status, general health perceptions,
symptoms are apathy and social withdrawal, which are       and overall quality of life (Wilson & Cleary, 1995). In
often diagnosed as depression. Sometimes, organic          addition, selected individual and environmental vari-
psychoses, such as acute mania, may be a primary           ables are hypothesized to affect model components.
manifestation of HIV dementia (Evans & Perkins,            For this study, only the first three components and
1990; Simpson & Tagliati, 1994).                           selected individual characteristics were used. Table 1
   The early course of HIV disease may be marked by        specifies the study measures by components of the
symptoms and signs of dementia too subtle to identify.     Wilson and Cleary model and delineates the manner in
Several studies suggest that neuropsychological tests      which the measures were used in the hierarchical
are useful in providing quantitative markers of disease    regression analysis to answer the following questions:
progression (Derix, de Gans, Stam, & Portigies, 1990;
Sidtis, Ornitz, & Price, 1988; Tross et al., 1988). With     1. What are the perceptions of cognitive function-
advanced dementia, cognitive impairment becomes                 ing as reported by persons with HIV on the Medi-
more obvious with psychomotor problems and behav-               cal Outcomes Study–HIV questionnaire?
ioral abnormalities. Wilkie et al. (1998) argued that        2. Do individual characteristics, disease status,
“poor neuropsychological test performance prior to              symptom status, and functional status explain a
the development of AIDS is a proximal predictor of              significant amount of the variance in perceptions
mortality” (p. 130). Early detection is key to interven-        of cognitive functioning as reported by persons
ing in this downward trajectory. Factors in addition to         with HIV on the Medical Outcomes Study–HIV
HIV/AIDS that independently might account for dec-              questionnaire?
rements in cognition include drug abuse, apathy, and
depression (Castellon, Hinkin, Wood, & Yarema,
1998; Grassi et al., 1997). Selnes et al. (1997), how-                           Method
ever, found no significant differences in cognitive per-
formance among drug-using and non-drug-using               Design
HIV-infected persons. Their study suggested that “the
natural history of cognitive changes secondary to HIV         The study design was descriptive and correlational,
infection is similar among HIV-infected IDU’s [injec-      focusing on the predictors of perception of cognitive
tion drug users] and other risk groups” (p. 223).          functioning in HIV/AIDS.

                                                              The sample was recruited from seven sites: Bir-
   The purpose of this study was to examine the rela-      mingham, Boston, Honolulu, New York, the San Fran-
tionships between perception of cognitive functioning      cisco Bay Area of northern California, Seattle, and
and other variables. Perception of cognitive function-     Tampa. The settings included university-based AIDS
ing, the dependent variable, is viewed as influenced by    clinics, private practices, public and for-profit
                                                                             Corless et al. / Cognitive Functioning in HIV/AIDS   21

Table 1. Summary of Study Measures by Components of Wil-              study were recruited to participate. Inclusion criteria
         son and Cleary (1995) Framework and Block in the
                                                                      were fourfold: that the individuals be at least 18 years
         Regression Analysis
                                                                      of age, receiving HIV care at their respective facilities,
Wilson and                                                            English speaking, and able to provide informed consent.
Cleary Framework/
Component/Study                   Study          Regression
Measure                          Measure          Analysis            Procedures
Individual characteristics
  Demographic              Race/ethnicity                 Block 1        The institutional review boards of the coordinating
   questionnaire                                                      site and each data collection site approved the study
Individual characteristics                                            protocol. Following completion of informed consent,
  Demographic              Age, gender, high school       Block 2     each client completed the set of study instruments.
   questionnaire            diploma, current/past
                                                                      HIV-infected individuals who met the study criteria
                            injection drug use
                                                                      were approached by either the study site coordinator or
 (disease status)                                                     researcher, their health care provider, or their case
  Demographic              Years known HIV positive,      Block 3     managers in seeking their participation. Study person-
  questionnaire             CD4 count, AIDS                           nel provided assistance if needed for completion of the
                            diagnosis, number of                      instruments (e.g., reading questions to persons with
                                                                      decreased visual acuity).
Symptom Status
  Sign and Symptom         SSC–HIV: Diarrhea,             Block 4
   Checklist–HIV            shortness of breath, fever,               Study Measures
   (SSC–HIV)                nausea/vomiting,
                            gastrointestinal                            All measures were self-reported by clients. Each
                            discomfort, fatigue,
                            psychological distress
                                                                      measure is briefly described in the following section.
  Center for               CES–D: Total depression                    Independent Variable
   Epidemiological          score
   Study–Depression                                                      Demographic questionnaire. Data related to indi-
   Scale (CES–D)
                                                                      vidual characteristics (race and ethnicity, age, gender,
  Medical Outcomes         MOS SF–36: Bodily pain                     education, intravenous drug use) and physiological/
   Study–Short Form         score                                     biological factors and disease status (CD4 count, pres-
   36 (MOS SF–36)                                                     ence of AIDS diagnosis, length of time known to be
Functional status                                                     HIV positive) were collected on a demographic
  MOS SF–36                Physical functioning,          Block 5
                            social functioning, role-
                            emotional functioning
Functional status                                                        Sign and Symptom Checklist–HIV. The Sign and
  Medical Outcomes         Cognitive functioning          Depen-      Symptom Checklist–HIV (SSC-HIV) was used to
   Study–HIV                                               dent       measure symptom status. Each symptom is rated on a
   (MOS–HIV)                                               variable   4-point scale, with values ranging from 0 (absent) to 3
                                                                      (severe). Evidence of construct and concurrent valid-
                                                                      ity, internal consistency reliability, and sensitivity to
                                                                      change over time in the study sample was reported by
hospitals, residential and day care facilities, commu-                Holzemer, Henry, et al. (1999). The initial scale
nity-based organizations, and home care.                              included 41 signs and symptoms. The following
                                                                      symptoms or symptom clusters were used as predictor
Sample                                                                variables in the analysis: diarrhea, fatigue, fever, gas-
                                                                      trointestinal discomfort, nausea and vomiting, short-
  A convenience sample (n = 728) of HIV-infected                      ness of breath, and psychological distress and
men and women who met the inclusion criteria for the                  depression.
22    JANAC Vol. 11, No. 3, May/June 2000

   Center for Epidemiological Studies–Depression              3. Did you have difficulty doing activities involving
Scale. The Center for Epidemiological Studies–                   concentration and thinking?
Depression Scale (CES-D) (Radloff, 1977) was
designed as a self-report depression scale for research        Response options for the three questions are on a
in the general population. Responses on the 20-item         6-point scale, with values ranging from all of the time
scale range from 0 (never or rarely) to 3 (mostly or all    to none of the time. The responses were summed to
the time). Total possible scores range from 0 to 60, and    generate the perception of cognitive functioning score
scores above 15 indicate the need for diagnostic evalu-     (dependent variable) for the analysis.
ation for major depression. The CES-D was used as a
measure of symptom status (predictor variable) in the       Data Analysis
                                                               All instruments were scored and scale scores calcu-
   Medical Outcomes Study–Short Form 36. The Med-           lated where appropriate. Descriptive statistics were
ical Outcomes Study–Short Form 36 (MOS-SF36) is a           performed on all variables. Nominal variables were
generic measure of selected components of quality of        dummy coded for inclusion in the analysis. A hierar-
life, including symptom status, functional status, gen-     chical multiple regression analysis with variables,
eral health perceptions, and overall quality of life        entered in five blocks (see Table 1), was performed,
(Ware & Sherbourne, 1992). Scales included physical         with perception of cognitive functioning as the
functioning, role-physical, role-emotional, body pain,      dependent variable. Only participants with data on all
social functioning, mental health, general health per-      study variables were entered into the regression
ception, energy and fatigue, and changes in health          analysis.
(Stewart, Hays, & Ware, 1988). Scores are trans-
formed on a scale of 0 to 100, with 100 meaning opti-
mum health. The reliability and validity of the                                    Results
MOS-SF36 are well established. Bodily pain was
entered into the analysis as a measure of symptom status.   Sample
Three scales (physical functioning, role-emotional,
and social functioning) from the MOS-SF36 were                 The study sample (n = 728) was 77% male, with an
used as predictor variables as measures of functional       average age of 39.4 (SD = 7.7). The ethnicity of the
status.                                                     sample was African American (39.3%), Asian and
                                                            Pacific Islander (3.7%), Latino (8.9%), Caucasian
Dependent Variable                                          (43.1)%, and Other (4.5%). Reported risk factors for
                                                            HIV infection included the following: male-male sex
   Medical Outcomes Study–HIV. The Medical Out-             (50.2%), male-female sex with bisexual male (5.2%),
comes Study–HIV scale (MOS-HIV), formerly                   male-female sex with intravenous drug user (16%),
known as the Health Status Questionnaire, was devel-        male-female sex with hemophiliac (1.1%), and
oped as an HIV-specific measure of aspects of health        male-female sex with transfusion recipient (1.1%).
status and quality of life (Wu et al., 1991). Perception    The percentage of the sample reporting current or past
of cognitive functioning, the dependent variable in this    intravenous drug use was 39.3% (see Table 2).
study, was composed of the responses to three MOS-             The descriptive statistics on the study measures are
HIV questions, which included the following:                summarized in Table 3.
                                                               The sample reported mild symptom scores, with
     1. How much of the time during the past month did      mean scores close to 1.00 (3-point scale). Highest
        you forget things that happened (e.g., where you    means were reported for symptom clusters involving
        put things, appointments)?                          psychological distress (anxiety, depression, and fear).
     2. Did you have trouble keeping attention on any       Participants reported a mean CES-D depression score
        activity for long?                                  of 21.91 (SD = 12.21) and a mean SF36 body pain
                                                                   Corless et al. / Cognitive Functioning in HIV/AIDS      23

Table 2. Sample Characteristics                             Table 3. Descriptive Statistics on Study Instruments

Variable                                 n        %         Measure/Variable                   n     M       SD Range
Gender                                                      HIV sign and symptom checklist    696    0.87    0.95    0-3
  Male                                  558      76.6         Diarrhea                        699    0.83    0.76    0-3
  Female                                166      22.8         Shortness of breath             688    0.64    0.75    0-3
  Missing                                 4       0.5         Fever                           698    0.70    0.77    0-3
Race/ethnicity                                                Nausea/vomiting                 699    0.89    0.78    0-3
  Asian/Pacific Islander                 27       3.7         Gastrointestinal discomfort     686    1.12    0.99    0-3
  Black                                 286      39.3         Fatigue                         695    1.24    0.99    0-3
  Latino                                 65       8.9         Psychological distress          695    1.24    0.99    0-3
  White                                 314      43.1
  Other                                  33       4.5       CES Depression Scale Total        450 21.91 12.21       0-54
  Missing                                 3       0.4       Medical Outcomes Study–
AIDS diagnosis                                              Short Form 36
  Yes                                   446      61.3         Bodily pain                     722   58.53   25.29    0-90
  No                                    269      37.0         Physical functioning            714   39.23   28.74   0-100
  Missing                                13       1.8         Role—physical                   716   46.18   42.30   0-100
High school diploma                                           Social functioning              724   64.42   27.77   0-100
  Yes                                   547      75.1         Role—emotional                  714   45.58   43.98   0-100
  No                                    170      23.4
  Missing                                11       1.5       NOTE: CES = Center for Epidemiological Studies.
Telephone in home
  Yes                                   592      81.3
  No                                    131      18.0
  Missing                                 5       0.7       education, history of injection drug use), disease sta-
Adequate income to meet daily needs                         tus, symptom status, and functional status—made sig-
  Yes                                   575      79.0
  Barely Possible                       403      55.4
                                                            nificant statistical contributions toward explaining the
  No                                    142       9.5       total variance. Person variables explained 1.5% (p =
  Missing                                11       1.5       .027) of the variance in cognitive functioning. Disease
                                                            status explained an additional 2.3% (p = .005). Symp-
                N       M     SD      Maximum   Minimum
                                                            tom status explained 26.5% (p < .001) of the variance.
Age            713     39.4     7.7        64     20        The block for functional status explained 5.4% (p <
CD4 count      535    322.7   244.7     1,500      1
                                                            .001) of the variance. There was no significant rela-
                                                            tionship with race and ethnicity (Block 1) and cogni-
                                                            tive functioning (p = .145).
score of 58.53 (SD = 25.29). The mean SF36 score on            Block 2 included person variables, with age, gen-
social functioning was 64.42 (SD = 27.77), indicating       der, education, and current or past injection drug use
relatively high functioning, whereas the role-physical      found to be significantly related to higher scores on
mean score was 46.18 (SD = 42.30). The physical             perception of cognitive functioning. Disease status
functioning mean score was 39.23 (SD = 28.74), and          explained an additional 2.3% of the variance in per-
the role-emotional mean score was 45.58 (SD =               ception of cognitive functioning scores. This variance
43.98), indicating a wide variability in these scores.      was accounted for by the variables of years known
Nearly 40% of the sample (n = 286) indicated a history      HIV-positive, CD4 counts, AIDS diagnosis, and
of injection drug use.                                      co-morbidities. Symptom status rendered a statisti-
                                                            cally significant contribution to the explanation of the
Regression Analyses                                         total variance (26.5%), primarily accounted for by
                                                            depression. Depression had a negative Beta weight
  Predictors of perception of cognitive functioning         (–0.158), indicating that lower scores on depression
explained a total of 36.3% of the variance (see Table 4).   were associated with higher cognitive functioning
Four blocks—person variables (age, gender,                  scores.
24   JANAC Vol. 11, No. 3, May/June 2000

Table 4. Predictors of Cognitive Functioning                                      Discussion
Predictor                 Final Beta    R2     R2∆   p∆         Concerns about cognitive functioning in HIV dis-
Block 1: Race/ethnicity                0.015 0.015   .145    ease have arisen with the observation of decreased per-
  Black                                                      formance across the spectrum of HIV disease. Poorer
                                                             cognitive functioning is found with neurological com-
  White                                                      plications associated with HIV, including crypto-
Block 2: Person                        0.021 0.015   .027    sporidiosis, toxoplasmosis, and lymphoma. A direct
  Age                                                        effect on neurological and cognitive functioning as a
  Gender                                                     result of HIV infection has also been suspected. In
  High school diploma
  Current/past injection                                     addition to these physical causes, symptoms including
   drug use                                                  depression, apathy, and fatigue have also been impli-
Block 3: Disease status                0.044 0.023   .005    cated in changes in cognitive functioning (Corless
  Years known HIV+            0.030                  .447    et al., 1998). The findings in this multisite study indi-
  CD4 count                  –0.002                  .967
  AIDS diagnosis              0.020                  .657
                                                             cate that symptom status explained the largest amount
  Comorbidities               0.002                  .956    of the variance in perception of cognitive functioning.
Block 4: Symptom status                0.309 0.265 < .001       The relationship between cognitive functioning and
  Diarrhea                   –0.009                  .843    depression in HIV disease requires further study. The
  Fatigue                     0.015                  .810    linkage between these variables and the causal mecha-
  Fever                      –0.035                  .515
  Gastrointestinal           –0.073                  .201    nisms requires further investigation across the spec-
  Nausea/vomiting             0.013                  .800    trum of HIV disease. Furthermore, the impact of inten-
  Shortness of breath        –0.063                  .212    sive medication therapies and their potential side
  Pain                       –0.081                  .116    effects, as well as the relationship with depression and
  Psychological distress     –0.101                  .073
  Depression                 –0.158                  .009
                                                             neurological functioning, should be further examined.
Block 5: Functional status             0.363 0.054 < .001    In addition, the mechanism underlying the relation-
  Physical functioning       –0.172                  .001    ship between symptom status and cognitive function-
  Social functioning          0.125                  .023    ing requires explication.
  Emotional role                                                Functional status also was found to be significantly
   functioning                0.183                  .001
                                                             related to cognitive functioning, with physical, social,
                                                             and role-emotional performance contributing to the
                                                             variance in cognitive functioning. The link between
                                                             physical, social, and emotional variables and cognitive
   Functional status, including the variables of physi-      functioning requires further study to determine the
cal, social, and role-emotional functioning, accounted       pathway between progression of disease and cogni-
for a total of 5.4% of the additional variance in percep-    tion. Impairments in cognition have been associated
tion of cognitive functioning. Physical functioning had      with decreased adherence to medication, advice and
a negative Beta weight (–0.172). Lower scores on             instructions, and maintenance of health care provider
physical functioning were related to higher scores on        appointments (Ware & Sherbourne, 1992). Factors
perception of cognitive functioning (e.g., less forget-      found by researchers to be associated with decrements
ful, less trouble maintaining attention, less difficulty     in cognition include the following: neurological, psy-
with activities). This indicates that declines in physical   chiatric, and psychological factors (Stewart, Hayes, &
functioning were not associated with declines in self-       Ware, 1998), and apathy (Castellon et al., 1998). In
perception of cognitive functioning. Higher scores on        turn, cognitive impairment, or “mental slowing,” was
social functioning and role-emotional functioning            related by some investigators (Bouwman et al., 1998;
were associated with higher perception of cognitive          Villa et al., 1996) to more rapid disease progression
functioning scores.                                          and even to death (Wilkie et al., 1998).
                                                                    Corless et al. / Cognitive Functioning in HIV/AIDS      25

   The precise advent of cognitive impairment is a          cannot be overstated; and assessment of social and role
matter of debate. Villa et al. (1996) found a prevalence    functioning may give the health care provider a clue as
of 28.2% related to cognitive abnormalities in 78           to the cognitive health status of the client.
asymptomatic HIV-seropositive individuals for which            Future research should examine subjective and
no cause other than their infection was established.        objective measures of cognitive functioning and other
   Other researchers (Poutiainen et al., 1988, 1996;        neurological manifestations of HIV disease, because
Selnes et al., 1990, 1997) have found no cognitive          individuals living with this disease may perceive
decline in asymptomatic HIV-infected individuals.           impairment in cognitive functioning prior to clinical
For those individuals with lower scores on social and       observation of impairment. Studies should be under-
role-emotional functioning, perceptions of cognitive        taken to examine the onset and trajectory of neurologi-
functioning scores were lower. Measures of role and         cal changes as well as the impact of HAART therapy
social factors may be more sensitive indicators than        on cognitive functioning.
physical functioning in the perception of decline in           Clinicians can help move the field forward by shar-
cognitive functioning.                                      ing their knowledge and observations regarding cogni-
   In this study, our relatively healthy cohort (M CD4 =    tive function in HIV-positive persons with their
323) experienced substantial cognitive impairment,          research colleagues. By using the findings from this
perhaps as a later manifestation of disease than as a       study, clinicians with a heightened awareness will be
decline in physical functioning. A small subset of          sensitive to potential impairments of cognitive func-
these research participants are past or present injection   tioning in their clients. Early identification of cogni-
drug users. The role of injection drug use on cognitive     tive impairment can result in appropriate clinical inter-
functioning in HIV-infected persons remains unclear.        ventions in remediable conditions and the improve-
Grassi et al. (1997) found a negative effect, whereas       ment of quality of life.
Selnes et al. (1998) found no effect.
   The impact of antiretrovirals on cognitive disorders                              References
has been positive. In a study of 154 HIV-infected indi-
viduals randomized to receive zidovudine or no              Bouwman, F. H., Skolasky, R. L., Hes, D., Selnes, O. A., Glass,
antiretrovirals, those receiving zidovudine, regardless        J. D., Nance-Sproson, T. E., Royal, W., Dal Pan, G. J., &
                                                               McArthur, J. C. (1998). Variable progression of HIV-associ-
of disease stage, displayed no progression in their
                                                               ated dementia. Neurology, 50, 1814-1820.
dementia, in contrast with those not receiving an active    Castellon, S. A., Hinkin, C. H., Wood, S., & Yarema, K. T. (1998).
drug (Lopez, Wess, Sanchez, Dew, & Becker, 1998).              Apathy, depression and cognitive performance in HIV-1 infec-
Other medicinal approaches to the reduction of                 tion. Journal of Neuropsychiatry and Clinical Neuroscience,
HIV-related cognitive impairment included the use of           10(3), 320-329.
OPC-14117 (Dana Consortium, 1997), deprenyl and             Corless, I. B., Holzemer, W., Turner, J., Nokes, K., Brown, M. A.,
                                                               Powell-Cope, S., & Inouye, J. (1998). Cognition and HIV
thioctic acid (Dana Consortium, 1998), and the use of          adherence. In XII World Aids Conference (Conference Record
Peptide T (Heseltine et al., 1998). OPC-14117 and              No. 32387.P.599). Geneva, Switzerland.
deprenyl had a positive impact on cognitive impair-         Dana Consortium on the Therapy of HIV Dementia and Related
ment, but the results require further research.                Cognitive Disorders (1997). Safety and tolerability of the anti-
   This study did not examine the relationship                 oxidant OPC-14117 in HIV-associated cognitive impairment.
                                                               Neurology, 49, 142-146.
between various medications and cognitive impair-           Dana Consortium on the Therapy of HIV Dementia and Related
ment, as persons who may be experiencing cognitive             Cognitive Disorders (1998). A randomized, double-blind, pla-
problems might or might not be reliably identifying            cebo-controlled trial of deprenyl and thioctic acid in human
their own impairment.                                          immunodeficiency virus–associated cognitive impairment.
   Recommendations based on the results of this study          Neurology, 50, 645-651.
                                                            Derix, M. M., de Gans, J., Stam, J., & Portigies, P. (1990). Mental
are threefold: The use of a self-report, patient-based
                                                               changes in patients with AIDS. Clinical Neurology and Neuro-
assessment of perception of cognitive functioning may          surgery, 92, 215-222.
be useful for longitudinal assessment; the importance       Evans, D. L., & Perkins, D. O. (1990). The clinical psychiatry of
of clinician assessment of cognitive functioning               AIDS. Current Opinion in Psychiatry, 3, 96-102.
26   JANAC Vol. 11, No. 3, May/June 2000

Grant, I., Atkinson, J.H.M, Hesselinki, J. R., Kennedy, C. J., &           Selnes, O. A., Galai, N., McArthur, J. C., Cohn S., Royall III, W.,
   Richman, D. D. (1987). Evidence for early central nervous syn-             Esposito, D., & Vlahov, D. (1997). HIV infection and cognition
   drome (AIDS) and other human immunodeficiency virus                        in intravenous drug users: Long-term follow-up. Neurology,
   (HIV) infections. Annals of Internal Medicine, 107, 828-836.               48, 223-230.
Grassi, M. P., Perin, C., Clerici, F., Zochetti, C., Borella, M.,          Selnes, O. A., Miller, E., McArthur, J., Gordon, B., Munoz, A.,
   Cargnel, A., & Mangoni, A. (1997). Effects of HIV                          Sheridan, K., Foz, R., Saah, A. J., & the Multicenter AIDS
   seropositivity and drug abuse on cognitive function. European              Cohort Study (1990). HIV-1 Infection: No evidence of cogni-
   Neurology, 37, 48-52.                                                      tive decline during the asymptomatic stages. Neurology, 40,
Heseltine, P.N.R., Gordkin, K., Atkinson, J. H., Vitiello, B.,                204-208.
   Rochon, J., Heaton, R. K., Eaton, E. M., Wilkie, F. L., Sobel, E.,      Sidtis, J. J., Ornitz, A. H., & Price, R. W. (1988). Neuropsycho-
   Brown, S. J., Feaster, D., Schneider, L., Goldschmidts, W. L., &           logical and neurological characterization of the AIDS dementia
   Stover, E. S. (1998). Randomized, double-blind placebo-                    complex. Journal of Clinical Experimental Neuropsychology,
   controlled trial of Peptide T for HIV-associated cognitive                 10, 76.
   impairment. Archives of Neurology, 55, 41-51.                           Simpson, D. M., & Tagliati, M. (1994). Neurologic manifestations
Holzemer, W. L., Corless, I. B., Nokes, K. M., Turner, J. G.,                 of HIV infection. Annals of Internal Medicine, 121(10), 769-
   Brown, M. A., Powell-Cope, G. M., Inouye, J., Henry, S. B.,                785.
   Nicholas, P. K., & Portillo, C. J. (1999). Predictors of self-          Snider, W. D., Simpson, D. M., Nielsen, S., Gold, J. W., Metroba,
   reported adherence in persons living with HIV disease. AIDS                C. D., & Posner, J. B. (1983). Neurological complications of
   Patient Care, 13(3), 185-197.                                              acquired immune deficiency syndrome: Analysis of 50
Holzemer, W. L., Henry, S. B., Nokes, K. M., Corless, I. B., Brown,           patients. Annals of Neurology, 14, 403-418.
   M. A., Powell-Cope, G. M., Turner, J. G., & Inouye, J. (1999).          Stewart, A. L., Hays, R. D., & Ware, J. E., Jr. (1988). The MOS
   Validation of the Sign & Symptom Check-List for Persons with               short-form general health survey: Reliability and validity in a
   HIV Disease (SSC-HIV). Journal of Advanced Nursing, 30(5),                 patient population. Medical Care, 26, 724-735.
   1041-1049.                                                              Tross, S., Price, R. W., Navia, B. A., Thaler, H. T., Gold, J., Hirsch,
Lopez, O. L., Wess, J., Sanchez J., Dew, M. A., & Becker, J. T.               D. A., & Sidtis, J. J. (1988). Neuropsychological characteriza-
   (1998). Neurobehavioral correlates of perceived mental and                 tion of the AIDS dementia complex: A preliminary report.
   motor slowness in HIV infection and AIDS. Journal of                       AIDS, 2, 81-88.
   Neuropsychiatry and Clinical Neuroscience, 10, 343-350.                 Villa, G., Solida, A., Moro, E., Tavalozza, M., Antinori, A.,
Poutiainen, E., Elovaara, I., Raininko, R., Vilki, J., Lahdevirta, J., &      DeLuca, A., Murri, R., & Tamburrini, E., (1996). Cognitive
   Iivanainen, M. (1996). Cognitive decline in patients with symp-            impairment in asymptomatic stages of HIV infection. Euro-
   tomatic HIV-1 infection. No decline in asymptomatic infec-                 pean Neurology, 36, 125-133.
   tion. Acta Neurologica Scandinavia, 93, 421-427.                        Ware, J., & Sherbourne, C. (1992). The MOS-36 Short-Form
Poutiainen, E., Iivanainen, M., Elovaara, I., Valle, S. L., &                 Health Survey (SF-36). Medical Care, 30, 473-483.
   Lahdevirta, J. (1988). Cognitive changes as early signs of HIV          Wilkie, F. L., Goodkin, K., Eisdorfer, C., Fesster, D., Morgan, R.,
   infection. Acta Neurologica Scandinavia, 78, 49-52.                        Fletcher, M. A., Blaney, N., Baum, M., & Szapocanik, J.
Radloff, L. S. (1977). The CES-D scale: A self-report depression              (1998). Mild cognitive impairment and risk of mortality in
   scale for research in the general population. Applied Psycho-              HIV-1 infection. Journal of Neuropsychiatry, 10(2), 125-132.
   logical Measures, 1, 385-411.                                           Wilson, I. B., & Cleary, P. D. (1995). Linking clinical variables
Selnes, O. A., Galai, N., Bacellar, M. A., Miller, E. N., Becker,             with health-related quality of life: A conceptual model of
   J. T., Wesch, J., Van Gorp, W., & McArthur, J. C. (1998). Cog-             patient outcomes. Journal of the American Medical Associa-
   nitive performance after progression to AIDS: A longitudinal               tion, 273, 59-65.
   study from the Multicenter AIDS Cohort Study. Neurology, 45,            Wu, A. W., Rubin, H. R., Matthews, W. C., Ware, Jr., J. E., Byrck,
   267-275.                                                                   L. T., Hardy, W. D, Bazzette, S. A., Spector, S. A., & Richman,
                                                                              R. D. (1991). A health status questionnaire using 30 items from
                                                                              the Medical Outcomes Study: Preliminary validation in per-
                                                                              sons with early HIV infection. Medical Care, 291, 786-798.

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