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Publication Abstract Display
Type: Poster
Title: Neurocognitive deficits predict performance-based functional impairment in methamphetamine-dependent individuals with HIV infection.
Authors: Iudicello JE, Henry BL, Minassian A, Perry W, Marquine MJ, Morgan EE, Letendre SL, Ellis R, Woods SP, Grant I, Heaton RK, and the TMARC Group
Date: 10-16-2013
Abstract:Objective: Preliminary evidence suggests that methamphetamine (MA) dependent individuals with HIV infection (HIV+/MA+) may be at increased risk for problems with essential daily activities (e.g., medication adherence). However, these studies have relied on self-report measures, which can be highly influenced by mood and/or social desirability factors. Given the clinical and diagnostic significance of functional impairment in this high-risk population, we aimed to identify underlying neurobehavioral predictors of functional impairment in HIV+/MA+ individuals using the UCSD Performance-Based Skills Assessment (UPSA), an objective, performance-based measure designed to simulate and assess the skills required for successful completion of important real-world activities. Method: Participants included 29 HIV+/MA+ and 41 demographically comparable HIV-/MA- individuals who were administered the UPSA alongside a comprehensive neuromedical and neuropsychological evaluation. Results: Relative to controls, HIV+/MA+ individuals performed significantly worse overall (p<0.05; Cohenís d=0.71), and within the comprehension/planning and communication domains (ps<0.05; Cohenís ds=0.62 and 0.54). HIV+/MA+ individuals also demonstrated relative difficulties within the financial and medication management domains (ps<0.10; Cohenís ds=0.44 and 0.48). Within the HIV+/MA+ group, global neurocognitive impairment (NCI) was a strong independent predictor of overall functional impairment (p=0.013), even while accounting for potentially confounding characteristics (e.g., depression, HIV plasma viral load, duration of MA use). This association between NCI and overall functional impairment was driven primarily by deficits in learning, executive functions, and working memory. Conclusions: Results demonstrate significant performance-based functional difficulties in HIV+/MA+ individuals that are strongly linked to NCI. Neurocognitive rehabilitation strategies targeting learning, working memory and executive functions may be particularly helpful in the remediation of functional impairment in HIV+/MA+ individuals.

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