Risky decision-making in HIV-associated neurocognitive disorders (HAND)

Individuals infected with HIV show moderate deficits in decision-making, but the ecological relevance of such deficits on everyday functioning has not previously been described. This study sought to examine the magnitude, cognitive correlates, and everyday functioning impact of risky decision-making...

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Bibliographic Details
Published in:	Clinical neuropsychologist 2013-02, Vol.27 (2), p.256-275
Main Authors:	Iudicello, Jennifer E., Woods, Steven Paul, Cattie, Jordan E., Doyle, Katie, Grant, Igor
Format:	Article
Language:	eng
Subjects:	Activities of Daily Living Adult Adult and adolescent clinical studies Anti-HIV Agents - therapeutic use Biological and medical sciences Cognition Disorders - etiology Cognition Disorders - psychology Cognitive flexibility Cognitive impairment Decision Making Everyday functioning Female HIV HIV Infections - complications HIV Infections - drug therapy HIV Infections - psychology Human viral diseases Humans Immunodeficiencies Immunodeficiencies. Immunoglobulinopathies Immunopathology Infectious diseases Male Medical sciences Medication Adherence Middle Aged Neuropsychological Tests Organic mental disorders. Neuropsychology Psychology. Psychoanalysis. Psychiatry Psychopathology. Psychiatry Risk-Taking Surveys and Questionnaires Viral diseases Viral diseases of the lymphoid tissue and the blood. Aids
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Summary:	Individuals infected with HIV show moderate deficits in decision-making, but the ecological relevance of such deficits on everyday functioning has not previously been described. This study sought to examine the magnitude, cognitive correlates, and everyday functioning impact of risky decision-making impairment in HIV-associated neurocognitive disorders (HAND). Participants included 68 HIV+ individuals with HAND, 78 HIV+ individuals without HAND, and 51 HIV− comparison participants, who were administered the Iowa Gambling Task (IGT) alongside a comprehensive neuropsychological test battery and self-report measures assessing aspects of everyday functioning. HIV+ individuals with HAND performed more poorly on the IGT relative to the other two groups, most notably during the last three trial blocks. Within the HIV+ group, IGT performance during the last three trial blocks was most strongly associated with cognitive flexibility, but was not significantly related to declines in instrumental activities of daily living (IADLs), unemployment, or medication non-adherence. While overall IGT performance across the last three trial blocks may be helpful diagnostically in identifying decision-making impairment in HAND, examination of alternate, more specific metrics (e.g., individual deck selections across trial blocks) may be more useful in delineating the role of poor decision-making in HIV-related disability, and should be examined in future research.
ISSN:	1385-4046 1744-4144