TY - JOUR
T1 - Predictors and Impact of Self-Reported Suboptimal Effort on Estimates of Prevalence of HIV-Associated Neurocognitive Disorders
AU - Levine, Andrew J.
AU - Martin, Eileen
AU - Sacktor, Ned
AU - Munro, Cynthia
AU - Becker, James
N1 - Publisher Copyright:
© 2017 Wolters Kluwer Health, Inc. All rights reserved.
PY - 2017/6/1
Y1 - 2017/6/1
N2 - Background: Prevalence estimates of HIV-associated neurocognitive disorders (HAND) may be inflated. Estimates are determined via cohort studies in which participants may apply suboptimal effort on neurocognitive testing, thereby inflating estimates. Additionally, fluctuating HAND severity over time may be related to inconsistent effort. To address these hypotheses, we characterized effort in the Multicenter AIDS Cohort Study. Methods: After neurocognitive testing, 935 participants (525 HIV- and 410 HIV+) completed the visual analog effort scale (VAES), rating their effort from 0% to 100%. Those with <100% then indicated the reason(s) for suboptimal effort. K-means cluster analysis established 3 groups: high (mean = 97%), moderate (79%), and low effort (51%). Rates of HAND and other characteristics were compared between the groups. Linear regression examined the predictors of VAES score. Data from 57 participants who completed the VAES at 2 visits were analyzed to characterize the longitudinal relationship between effort and HAND severity. Results: Fifty-two percent of participants reported suboptimal effort (<100%), with no difference between serostatus groups. Common reasons included "tired" (43%) and "distracted" (36%). The lowest effort group had greater asymptomatic neurocognitive impairment and minor neurocognitive disorder diagnosis (25% and 33%) as compared with the moderate (23% and 15%) and the high (12% and 9%) effort groups. Predictors of suboptimal effort were self-reported memory impairment, African American race, and cocaine use. Change in effort between baseline and follow-up correlated with change in HAND severity. Conclusions: Suboptimal effort seems to inflate estimated HAND prevalence and explain fluctuation of severity over time. A simple modification of study protocols to optimize effort is indicated by the results.
AB - Background: Prevalence estimates of HIV-associated neurocognitive disorders (HAND) may be inflated. Estimates are determined via cohort studies in which participants may apply suboptimal effort on neurocognitive testing, thereby inflating estimates. Additionally, fluctuating HAND severity over time may be related to inconsistent effort. To address these hypotheses, we characterized effort in the Multicenter AIDS Cohort Study. Methods: After neurocognitive testing, 935 participants (525 HIV- and 410 HIV+) completed the visual analog effort scale (VAES), rating their effort from 0% to 100%. Those with <100% then indicated the reason(s) for suboptimal effort. K-means cluster analysis established 3 groups: high (mean = 97%), moderate (79%), and low effort (51%). Rates of HAND and other characteristics were compared between the groups. Linear regression examined the predictors of VAES score. Data from 57 participants who completed the VAES at 2 visits were analyzed to characterize the longitudinal relationship between effort and HAND severity. Results: Fifty-two percent of participants reported suboptimal effort (<100%), with no difference between serostatus groups. Common reasons included "tired" (43%) and "distracted" (36%). The lowest effort group had greater asymptomatic neurocognitive impairment and minor neurocognitive disorder diagnosis (25% and 33%) as compared with the moderate (23% and 15%) and the high (12% and 9%) effort groups. Predictors of suboptimal effort were self-reported memory impairment, African American race, and cocaine use. Change in effort between baseline and follow-up correlated with change in HAND severity. Conclusions: Suboptimal effort seems to inflate estimated HAND prevalence and explain fluctuation of severity over time. A simple modification of study protocols to optimize effort is indicated by the results.
KW - HIV-associated neurocognitive disorders
KW - neuropsychology of HIV
KW - prevalence
KW - suboptimal effort
KW - visual analog scale
UR - http://www.scopus.com/inward/record.url?scp=85015914092&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85015914092&partnerID=8YFLogxK
U2 - 10.1097/QAI.0000000000001371
DO - 10.1097/QAI.0000000000001371
M3 - Article
C2 - 28328547
AN - SCOPUS:85015914092
SN - 1525-4135
VL - 75
SP - 203
EP - 210
JO - Journal of Acquired Immune Deficiency Syndromes
JF - Journal of Acquired Immune Deficiency Syndromes
IS - 2
ER -