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Lorkiewicz SA, Webber TA, Sober J, Kiselica AM, Woods SP. Self-perceived cognitive fluctuations and their relationship to everyday functioning in older adults with and without HIV disease. Clin Neuropsychol 2024; 38:1085-1108. [PMID: 38914007 PMCID: PMC11196870 DOI: 10.1080/13854046.2023.2282728] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 11/07/2023] [Indexed: 06/26/2024]
Abstract
Objective: HIV is associated with elevated performance-based cognitive intra-individual variability (IIV) in the laboratory that can reflect difficulty regulating cognitive resources over time (i.e., cognitive fluctuations) and disrupt everyday functioning. Whether persons living with HIV (PLWH) experience appreciable cognitive fluctuations in their daily lives is unclear. This study examined the presence of cognitive fluctuations and their relationship to everyday functioning in PLWH. Methods: Participants were 145 PLWH and 61 seronegative individuals age ≥ 50 years who completed a self-report version of the Mayo Fluctuations Scale (MFS), structured psychiatric interview, medical evaluation, and well-validated measures of mood, cognitive symptoms, and activities of daily living (ADLs). A confirmatory factor analysis of the MFS yielded three factors, including a 7-item cognitive fluctuations scale. Results: Univariable analyses showed that HIV was associated with moderately higher MFS Cognitive Fluctuation subscale scores (d = 0.46), but this effect was no longer significant a multiple regression model that included medical comorbidities and affective disorders, which emerged as unique predictors. Of clinical relevance, higher MFS Cognitive Fluctuation subscale scores were independently associated with more frequent cognitive symptoms and dependence in ADLs in the full sample. Conclusions: Higher frequency of self-perceived cognitive fluctuations disrupts management of ADLs among middle-aged and older adults independent of HIV status and general cognitive symptoms. Future studies are needed to understand the full clinical significance of self-perceived cognitive fluctuations among PLWH and their impact on daily life.
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Affiliation(s)
| | - Troy A. Webber
- Michael E. DeBakey VA Medical Center, Houston, TX, USA
- Psychology Division, Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | | | - Andrew M. Kiselica
- Department of Health Psychology, University of Missouri, Colombia, MO, USA
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Sober J, Woods SP, Webber TA, Thompson Kamar JL, Beltran-Najera I, Gomez EM. Does Social Support Play a Role in the Expression and Everyday Functioning Impact of Apathy in HIV Disease? AIDS Behav 2024:10.1007/s10461-024-04424-w. [PMID: 38904928 DOI: 10.1007/s10461-024-04424-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/18/2024] [Indexed: 06/22/2024]
Abstract
Clinically notable apathy occurs in approximately one-third of persons living with HIV (PLWH). Drawing from psychological theory, this cross-sectional study examined the interplay between apathy and social support in persons with (n = 143) and without (n = 61) HIV disease. Analyses were conducted using multiple regression and mediation procedures with 95th percentile bootstrap confidence intervals. Positive HIV serostatus and lower social support were associated with more frequent apathy, independent of other mood symptoms. Social support did not moderate apathy's associations with everyday functioning among PLWH, but post hoc analyses revealed that apathy mediated the relationship between social support and everyday functioning among PLWH. Stronger social support may provide a buffer against the frequency of apathy symptoms in persons with and without HIV disease. The relationship between lower social support and poorer everyday functioning in HIV might be partly explained by apathy. Longitudinal research is needed to examine the mechanisms of these relationships.
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Affiliation(s)
- Jonathan Sober
- Michael E. DeBakey VA Medical Center, Houston, TX, USA
- Department of Neurology, Baylor College of Medicine, Houston, TX, USA
| | - Steven Paul Woods
- Department of Psychology, University of Houston, Houston, TX, USA.
- , 3695 Cullen Blvd, 126 Heyne Building, Suite 239D, Houston, TX, 77004-5022, USA.
| | - Troy A Webber
- Michael E. DeBakey VA Medical Center, Houston, TX, USA
- Department of Psychology, University of Houston, Houston, TX, USA
- Psychology Division, Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Jennifer L Thompson Kamar
- Department of Psychology, University of Houston, Houston, TX, USA
- West Los Angeles VA Healthcare Center, Los Angeles, CA, USA
| | | | - Elliott M Gomez
- Department of Psychology, University of Houston, Houston, TX, USA
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3
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Gomez EM, Mustafa A, Beltran-Najera I, Ridgely NR, Thompson JL, Medina LD, Woods SP. Health literacy mediates the association between cognition and healthcare provider interactions among gay and bisexual men with HIV disease. Clin Neuropsychol 2024:1-22. [PMID: 38414159 DOI: 10.1080/13854046.2024.2319902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 02/09/2024] [Indexed: 02/29/2024]
Abstract
Introduction: Gay and bisexual men (GBM) account for the highest rates of incident infection with HIV in the U.S., and experience social, systemic barriers to accessing and engaging in healthcare services. Interacting with healthcare providers can be a complex process for some GBM with HIV disease. The current study examined the contributions of cognition and health literacy to perceived interactions with healthcare providers among GBM with HIV disease. Methods: The sample included 100 adults with HIV disease (ages 24-75) who identified as GBM. All participants completed the Dealing with Health Professionals subscale of the Beliefs Related to Medication Adherence survey, as well as the Cogstate neuropsychological battery, self-report measures of cognitive symptoms, and well-validated measures of health literacy. Results: Worse performance-based cognition and subjective cognitive symptoms were both associated with perceived difficulties dealing with healthcare providers, but these associations were fully mediated by lower health literacy. Conclusion: Health literacy may play a role in the association between poorer cognitive functioning and difficulties navigating healthcare interactions among GBM with HIV disease. Further studies are needed to determine whether cognitive approaches to enhancing the access, understanding, and use of health information in GBM with HIV disease improves healthcare interactions and outcomes.
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Affiliation(s)
- Elliott M Gomez
- Department of Psychology, University of Houston, Houston, Texas, USA
| | - Andrea Mustafa
- Department of Psychology, University of Houston, Houston, Texas, USA
| | | | - Natalie R Ridgely
- Department of Psychology, University of Houston, Houston, Texas, USA
| | | | - Luis D Medina
- Department of Psychology, University of Houston, Houston, Texas, USA
| | - Steven Paul Woods
- Department of Psychology, University of Houston, Houston, Texas, USA
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4
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Johnson R, Bhandary P R, Guddatu V, Kamath C, John S. Comparison of verbal fluency performance in Kannada-speaking adults with and without euthymic bipolar disorder type 1. APPLIED NEUROPSYCHOLOGY. ADULT 2023:1-11. [PMID: 38117696 DOI: 10.1080/23279095.2023.2289550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2023]
Abstract
Individuals with euthymic bipolar disorder (BD) type I exhibit deficits in executive functions. Although less explored in the BD population, the tasks of verbal fluency (VF) have shown great potential in understanding semantic organization. This study provides an extensive exploration across the letter and semantic VF tasks in 27 demographically matched euthymic BD-I and healthy controls (HC). The groups were compared on measures of the total number of correct words (TNCW), temporal pattern analysis, number of clusters (NC), mean cluster size (MCS), number of switches (NS), and error pattern. An overall reduction in letter fluency scores (the TNCW, number of switches, and NC) as compared to semantic fluency scores was noted for both groups, with a significantly greater decrease in the BD-1 group. The MCS and temporal pattern were relatively similar across the two groups. The influence of education with no gender difference was observed between groups with error types prevalent in both groups. The study findings call attention toward assessing the VF performance in persons with BD in terms of error production and the strategies employed (clustering-switching).
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Affiliation(s)
- Rachel Johnson
- Department of Speech and Hearing, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, India
| | | | - Vasudeva Guddatu
- Department of Data Science, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India
| | - Chinmayi Kamath
- Department of Speech and Hearing, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, India
| | - Sunila John
- Department of Speech and Hearing, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, India
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Tsiaras Y, Kitsakis N, Papadopoulou E, Karanikas E, Kourbetis D, Aretouli E. Neuropsychological Profile of Hospitalized Patients Due to COVID-19: Clinical and Inflammatory Correlates. Arch Clin Neuropsychol 2023; 38:1564-1577. [PMID: 37210601 DOI: 10.1093/arclin/acad038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/24/2023] [Indexed: 05/22/2023] Open
Abstract
OBJECTIVES In the present study, we investigated the pattern of cognitive difficulties in hospitalized patients due to COVID-19 and its relation with the clinical features of the disease. METHOD Forty hospitalized patients with COVID-19 [mean age: 46.98 years (SD = 9.30); mean years of education: 13.65 (SD = 2.07) and 40 sex-, age- and education-matched healthy controls completed a set of neuropsychological measures administered by telephone. Participants' premorbid intellectual skills and patients' anxiety and depressive symptoms were also evaluated. The association of COVID-19-related biomarkers [oxygen saturation (SpO2), C-reactive protein (CRP), D-dimer and ferritin levels] with neuropsychological performances was examined with a series of hierarchical multiple linear regression analyses, after controlling for demographic and clinical characteristics, psychological distress and premorbid intellectual skills. RESULTS Patients performed worse than healthy participants on measures of verbal memory, attention and working memory. SpO2 levels were associated with patients' performance on verbal and working memory, whereas CRP levels were associated with performance on verbal memory, abstract reasoning and verbal fluency, after controlling for demographic and clinical characteristics. Ferritin levels predicted performance on the verbal fluency test, whereas D-dimer levels did not predict any of the neuropsychological measures. CONCLUSIONS Cognitive difficulties in verbal memory, attention and working memory were noted in patients with COVID-19. Markers of hyperinflammation predicted patients' performance above and beyond demographic characteristics, duration of symptoms, length of hospitalization and psychological distress.
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Affiliation(s)
- Yiannis Tsiaras
- Psychiatric Department, 424 General Military Hospital, Thessaloniki, Greece
- School of the Social Sciences, University of Ioannina, Ioannina, Greece
| | - Nikolaos Kitsakis
- Psychiatric Department, 424 General Military Hospital, Thessaloniki, Greece
| | - Eleftheria Papadopoulou
- Cognitive Neuroscience Lab, School of Psychology, Aristotle University of Thessaloniki, Thessaloniki Greece
| | | | | | - Eleni Aretouli
- School of the Social Sciences, University of Ioannina, Ioannina, Greece
- Cognitive Neuroscience Lab, School of Psychology, Aristotle University of Thessaloniki, Thessaloniki Greece
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Mustafa AI, Woods SP, Loft S, Morgan EE. Lower prospective memory is associated with higher neurocognitive dispersion in two samples of people with HIV: A conceptual replication study. J Int Neuropsychol Soc 2023; 29:677-685. [PMID: 36750975 PMCID: PMC10801707 DOI: 10.1017/s1355617722000698] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
OBJECTIVES People living with HIV (PLWH) often experience deficits in the strategic/executive aspects of prospective memory (PM) that can interfere with instrumental activities of daily living. This study used a conceptual replication design to determine whether cognitive intraindividual variability, as measured by dispersion (IIV-dispersion), contributes to PM performance and symptoms among PLWH. METHODS Study 1 included 367 PLWH who completed a comprehensive clinical neuropsychological test battery, the Memory for Intentions Test (MIsT), and the Prospective and Retrospective Memory Questionnaire (PRMQ). Study 2 included 79 older PLWH who completed the Cogstate cognitive battery, the Cambridge Prospective Memory Test (CAMPROMPT), an experimental measure of time-based PM, and the PRMQ. In both studies, a mean-adjusted coefficient of variation was derived to measure IIV-dispersion using normative T-scores from the cognitive battery. RESULTS Higher IIV-dispersion was significantly associated with lower time-based PM performance at small-to-medium effect sizes in both studies (mean r s = -0.30). The relationship between IIV-dispersion and event-based PM performance was comparably small in magnitude in both studies (r s = -0.19, -0.20), but it was only statistically significant in Study 1. IIV-dispersion showed very small, nonsignificant relationships with self-reported PM symptoms in both samples (r s < 0.10). CONCLUSIONS Extending prior work in healthy adults, these findings suggest that variability in performance across a cognitive battery contributes to laboratory-based PM accuracy, but not perceived PM symptoms, among PLWH. Future studies might examine whether daily fluctuations in cognition or other aspects of IIV (e.g., inconsistency) play a role in PM failures in everyday life.
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Affiliation(s)
- Andrea I. Mustafa
- Department of Psychology, University of Houston, 126 Heyne Building, Houston, Texas, USA, 77204
| | - Steven Paul Woods
- Department of Psychology, University of Houston, 126 Heyne Building, Houston, Texas, USA, 77204
- School of Psychological Science, University of Western Australia, Crawley, WA 6009
| | - Shayne Loft
- School of Psychological Science, University of Western Australia, Crawley, WA 6009
| | - Erin E. Morgan
- Department of Psychiatry, University of California, San Diego, San Diego, California, USA, 92103
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Márquez NG, Jamal A, Johnston R, Richter EI, Gorbach PM, Vannorsdall TD, Rubin LH, Jennings C, Landay AL, Peluso MJ, Antar AAR. Characterizing Symptoms and Identifying Biomarkers of Long COVID in People With and Without HIV: Protocol for a Remotely Conducted Prospective Observational Cohort Study. JMIR Res Protoc 2023; 12:e47079. [PMID: 37104709 PMCID: PMC10234419 DOI: 10.2196/47079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 04/26/2023] [Accepted: 04/27/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND Living with HIV is a risk factor for severe acute COVID-19, but it is unknown whether it is a risk factor for long COVID. OBJECTIVE This study aims to characterize symptoms, sequelae, and cognition formally and prospectively 12 months following SARS-CoV-2 infection in people living with HIV compared with people without HIV. People with no history of SARS-CoV-2 infection, both with and without HIV, are enrolled as controls. The study also aims to identify blood-based biomarkers or patterns of immune dysregulation associated with long COVID. METHODS This prospective observational cohort study enrolled participants into 1 of the following 4 study arms: people living with HIV who had SARS-CoV-2 infection for the first time <4 weeks before enrollment (HIV+COVID+ arm), people without HIV who had SARS-CoV-2 infection for the first time within 4 weeks of enrollment (HIV-COVID+ arm), people living with HIV who believed they never had SARS-CoV-2 infection (HIV+COVID- arm), and people without HIV who believed they never had SARS-CoV-2 infection (HIV-COVID- arm). At enrollment, participants in the COVID+ arms recalled their symptoms, mental health status, and quality of life in the month before having SARS-CoV-2 infection via a comprehensive survey administered by telephone or on the web. All participants completed the same comprehensive survey 1, 2, 4, 6, and 12 months after post-acute COVID-19 symptom onset or diagnosis, if asymptomatic, (COVID+ arms) or after enrollment (COVID- arms) on the web or by telephone. In total, 11 cognitive assessments were administered by telephone at 1 and 4 months after symptom onset (COVID+ arms) or after enrollment (COVID- arms). A mobile phlebotomist met the participants at a location of their choice for height and weight measurements, orthostatic vital signs, and a blood draw. Participants in the COVID+ arms donated blood 1 and 4 months after COVID-19, and participants in the COVID- arms donated blood once or none. Blood was then shipped overnight to the receiving study laboratory, processed, and stored. RESULTS This project was funded in early 2021, and recruitment began in June 2021. Data analyses will be completed by summer 2023. As of February 2023, a total of 387 participants were enrolled in this study, with 345 participants having completed enrollment or baseline surveys together with at least one other completed study event. The 345 participants includes 76 (22%) HIV+COVID+, 121 (35.1%) HIV-COVID+, 78 (22.6%) HIV+COVID-, and 70 (20.3%) HIV-COVID- participants. CONCLUSIONS This study will provide longitudinal data to characterize COVID-19 recovery over 12 months in people living with and without HIV. Additionally, this study will determine whether biomarkers or patterns of immune dsyregulation associate with decreased cognitive function or symptoms of long COVID. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/47079.
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Affiliation(s)
- Nuria Gallego Márquez
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Armaan Jamal
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Rowena Johnston
- amfAR, The Foundation for AIDS Research, New York, NY, United States
| | - E India Richter
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, CA, United States
| | - Pamina M Gorbach
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, CA, United States
| | - Tracy D Vannorsdall
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Leah H Rubin
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- Department of Molecular and Comparative Pathobiology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Cheryl Jennings
- Department of Internal Medicine, Rush University Medical College, Chicago, IL, United States
| | - Alan L Landay
- Department of Internal Medicine, Rush University Medical College, Chicago, IL, United States
| | - Michael J Peluso
- Division of HIV, Infectious Diseases, and Global Medicine, University of California, California, CA, United States
| | - Annukka A R Antar
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
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8
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Matchanova A, Woods SP, Neighbors C, Medina LD, Podell K, Beltran-Najera I, Alex C, Babicz MA, Thompson JL. Are accuracy discernment and sharing of COVID-19 misinformation associated with older age and lower neurocognitive functioning? CURRENT PSYCHOLOGY 2023:1-13. [PMID: 37359606 PMCID: PMC9991876 DOI: 10.1007/s12144-023-04464-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2023] [Indexed: 03/10/2023]
Abstract
The online proliferation of COVID-19 misinformation led to adverse health and societal consequences. This study investigated possible differences in COVID-19 headline accuracy discernment and online sharing of COVID-19 misinformation between older and younger adults, as well as the role of individual differences in global cognition, health literacy and verbal IQ. Fifty-two younger (18-35 years old) and fifty older adults (age 50 and older) completed a neurocognitive battery, health literacy and numeracy measures, and self-report questionnaires via telephone. Participants also completed a social media headline-sharing experiment (Pennycook et al., Psychological science, 31(7), 770-780, 2020) in which they were presented with true and false COVID-19 headlines about which they indicated: 1) the likelihood that they would share the story on social media; and 2) the factual accuracy of the story. A repeated measures multivariate analysis of variance controlling for gender and race/ethnicity showed no effects of age (p = .099) but a significant interaction between actual COVID-19 headline accuracy and the likelihood of sharing (p < .001), such that accuracy was more strongly related to sharing false headlines (r = -.64) versus true headlines (r = -.43). Moreover, a higher likelihood of sharing false COVID-19 headlines was associated with lower verbal IQ and numeracy skills in older adults (rs = -.51--.40) and with lower verbal IQ, numeracy, and global cognition in younger adults (rs = -.66--.60). Findings indicate that headline accuracy judgements, numeracy, and verbal IQ are important contributors to sharing COVID-19 misinformation in both older and younger adults. Future work might examine the benefits of psychoeducation for improving health and science literacy for COVID-19. Supplementary Information The online version contains supplementary material available at 10.1007/s12144-023-04464-w.
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Affiliation(s)
- Anastasia Matchanova
- Department of Psychology, University of Houston, 3695 Cullen Blvd, 126 Heyne Bldg (Ste. 239d), Houston, TX 77004 USA
| | - Steven Paul Woods
- Department of Psychology, University of Houston, 3695 Cullen Blvd, 126 Heyne Bldg (Ste. 239d), Houston, TX 77004 USA
| | - Clayton Neighbors
- Department of Psychology, University of Houston, 3695 Cullen Blvd, 126 Heyne Bldg (Ste. 239d), Houston, TX 77004 USA
| | - Luis D. Medina
- Department of Psychology, University of Houston, 3695 Cullen Blvd, 126 Heyne Bldg (Ste. 239d), Houston, TX 77004 USA
| | - Kenneth Podell
- Department of Neurology, Methodist Hospital, Houston, TX USA
| | - Ilex Beltran-Najera
- Department of Psychology, University of Houston, 3695 Cullen Blvd, 126 Heyne Bldg (Ste. 239d), Houston, TX 77004 USA
| | | | - Michelle A. Babicz
- Mental Health and Behavioral Science Service, James A. Haley Veterans’ Hospital, Tampa, FL USA
| | - Jennifer L. Thompson
- Department of Psychology, University of Houston, 3695 Cullen Blvd, 126 Heyne Bldg (Ste. 239d), Houston, TX 77004 USA
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Kohli M, Fisher A, Sun-Suslow N, Heaton A, Dawson MS, Marquie J, Franklin DR, Marquine M, Iudicello JE, Heaton RK, Moore DJ. Concurrent validity and reliability of at-home teleneuropsychological evaluations among people with and without HIV. J Int Neuropsychol Soc 2023; 29:193-204. [PMID: 36510855 PMCID: PMC10205080 DOI: 10.1017/s1355617722000777] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To determine the reliability of teleneuropsychological (TNP) compared to in-person assessments (IPA) in people with HIV (PWH) and without HIV (HIV-). METHODS Participants included 80 PWH (Mage = 58.7, SDage = 11.0) and 23 HIV- (Mage = 61.9, SDage = 16.7). Participants completed two comprehensive neuropsychological IPA before one TNP during the COVID-19 pandemic (March-December 2020). The neuropsychological tests included: Hopkins Verbal Learning Test-Revised (HVLT-R Total and Delayed Recall), Controlled Oral Word Association Test (COWAT; FAS-English or PMR-Spanish), Animal Fluency, Action (Verb) Fluency, Wechsler Adult Intelligence Scale 3rd Edition (WAIS-III) Symbol Search and Letter Number Sequencing, Stroop Color and Word Test, Paced Auditory Serial Addition Test (Channel 1), and Boston Naming Test. Total raw scores and sub-scores were used in analyses. In the total sample and by HIV status, test-retest reliability and performance-level differences were evaluated between the two consecutive IPA (i.e., IPA1 and IPA2), and mean in-person scores (IPA-M), and TNP. RESULTS There were statistically significant test-retest correlations between IPA1 and IPA2 (r or ρ = .603-.883, ps < .001), and between IPA-M and TNP (r or ρ = .622-.958, ps < .001). In the total sample, significantly lower test-retest scores were found between IPA-M and TNP on the COWAT (PMR), Stroop Color and Word Test, WAIS-III Letter Number Sequencing, and HVLT-R Total Recall (ps < .05). Results were similar in PWH only. CONCLUSIONS This study demonstrates reliability of TNP in PWH and HIV-. TNP assessments are a promising way to improve access to traditional neuropsychological services and maintain ongoing clinical research studies during the COVID-19 pandemic.
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Affiliation(s)
- Maulika Kohli
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
- HIV Neurobehavioral Research Program, University of California San Diego, San Diego, CA, USA
| | - Arin Fisher
- HIV Neurobehavioral Research Program, University of California San Diego, San Diego, CA, USA
| | - Ni Sun-Suslow
- HIV Neurobehavioral Research Program, University of California San Diego, San Diego, CA, USA
| | - Anne Heaton
- HIV Neurobehavioral Research Program, University of California San Diego, San Diego, CA, USA
| | - Matthew S Dawson
- HIV Neurobehavioral Research Program, University of California San Diego, San Diego, CA, USA
| | - Jennifer Marquie
- HIV Neurobehavioral Research Program, University of California San Diego, San Diego, CA, USA
| | - Donald R Franklin
- HIV Neurobehavioral Research Program, University of California San Diego, San Diego, CA, USA
| | - Maria Marquine
- HIV Neurobehavioral Research Program, University of California San Diego, San Diego, CA, USA
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Jennifer E Iudicello
- HIV Neurobehavioral Research Program, University of California San Diego, San Diego, CA, USA
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Robert K Heaton
- HIV Neurobehavioral Research Program, University of California San Diego, San Diego, CA, USA
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - David J Moore
- HIV Neurobehavioral Research Program, University of California San Diego, San Diego, CA, USA
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
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10
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Thompson JL, Matchanova A, Beltran-Najera I, Ridgely NC, Mustafa A, Babicz MA, Hasbun R, Giordano TP, Woods SP. Preliminary Validity of a Telephone-Based Neuropsychological Battery in a Consecutive Series of Persons with HIV Disease Referred for Clinical Evaluation. ARCHIVES OF CLINICAL NEUROPSYCHOLOGY : THE OFFICIAL JOURNAL OF THE NATIONAL ACADEMY OF NEUROPSYCHOLOGISTS 2022; 38:570-585. [PMID: 36566509 DOI: 10.1093/arclin/acac104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/24/2022] [Indexed: 12/26/2022]
Abstract
OBJECTIVE The COVID-19 pandemic necessitated use of remote assessments by clinical neuropsychologists. Telehealth was particularly important for vulnerable groups, including persons living with HIV (PLWH); however, limited internet access can be a serious barrier to care. This study examined the preliminary validity of a telephone-based neuropsychological assessment in a clinical sample of PLWH. METHOD A consecutive series of 59 PLWH were assessed via telephone at an HIV clinic in the southern U.S. between April 2020 and July 2022. The battery included auditory-verbal neuropsychological tests of memory, attention, and executive functions, and questionnaires assessing self-reported mood and activities of daily living (ADL). RESULTS Study measures demonstrated acceptable internal consistency. PLWH demonstrated worse neuropsychological performance compared with expectations derived from the normal curve and an HIV-seronegative adult sample (N = 44). PLWH assessed via telephone demonstrated similar impairment rates to that of a consecutive series of PLWH (N = 41) assessed in-person immediately prior to the pandemic. Higher telephone-based global neuropsychological scores were related to younger age, more education, better fund of knowledge, White race/ethnicity, fewer medical conditions, and fewer depression symptoms. Global neuropsychological impairment was strongly and independently associated with greater dependence in ADL domains, particularly for instrumental activities. CONCLUSIONS Although telephone-based approaches to neuropsychological assessment are not ideal, these data provide support for the feasibility, internal consistency, and preliminary validity of this method in a consecutive clinical series of PLWH. The direct comparability of telephone-based and in-person neuropsychological assessments remains to be determined by prospective, counterbalanced study designs examining both PLWH and seronegative individuals.
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Affiliation(s)
| | | | | | | | - Andrea Mustafa
- Department of Psychology, University of Houston, Houston, TX, USA
| | - Michelle A Babicz
- Department of Psychology, University of Houston, Houston, TX, USA.,Mental Health and Behavioral Science Service, James A. Haley Veterans' Hospital, Tampa, FL, USA
| | - Rodrigo Hasbun
- Department of Medicine, University of Texas Health Science Center, Houston, TX, USA
| | - Thomas P Giordano
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA.,Center for Innovation in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA
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11
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Assessment of Neurocognitive Functions, Olfaction, Taste, Mental, and Psychosocial Health in COVID-19 in Adults: Recommendations for Harmonization of Research and Implications for Clinical Practice. J Int Neuropsychol Soc 2022; 28:642-660. [PMID: 34365990 PMCID: PMC8825876 DOI: 10.1017/s1355617721000862] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To propose a set of internationally harmonized procedures and methods for assessing neurocognitive functions, smell, taste, mental, and psychosocial health, and other factors in adults formally diagnosed with COVID-19 (confirmed as SARS-CoV-2 + WHO definition). METHODS We formed an international and cross-disciplinary NeuroCOVID Neuropsychology Taskforce in April 2020. Seven criteria were used to guide the selection of the recommendations' methods and procedures: (i) Relevance to all COVID-19 illness stages and longitudinal study design; (ii) Standard, cross-culturally valid or widely available instruments; (iii) Coverage of both direct and indirect causes of COVID-19-associated neurological and psychiatric symptoms; (iv) Control of factors specifically pertinent to COVID-19 that may affect neuropsychological performance; (v) Flexibility of administration (telehealth, computerized, remote/online, face to face); (vi) Harmonization for facilitating international research; (vii) Ease of translation to clinical practice. RESULTS The three proposed levels of harmonization include a screening strategy with telehealth option, a medium-size computerized assessment with an online/remote option, and a comprehensive evaluation with flexible administration. The context in which each harmonization level might be used is described. Issues of assessment timelines, guidance for home/remote assessment to support data fidelity and telehealth considerations, cross-cultural adequacy, norms, and impairment definitions are also described. CONCLUSIONS The proposed recommendations provide rationale and methodological guidance for neuropsychological research studies and clinical assessment in adults with COVID-19. We expect that the use of the recommendations will facilitate data harmonization and global research. Research implementing the recommendations will be crucial to determine their acceptability, usability, and validity.
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Vannorsdall TD, Brigham E, Fawzy A, Raju S, Gorgone A, Pletnikova A, Lyketsos CG, Parker AM, Oh ES. Cognitive Dysfunction, Psychiatric Distress, and Functional Decline After COVID-19. J Acad Consult Liaison Psychiatry 2022; 63:133-143. [PMID: 34793996 PMCID: PMC8591857 DOI: 10.1016/j.jaclp.2021.10.006] [Citation(s) in RCA: 39] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 10/25/2021] [Accepted: 10/30/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND There is a limited understanding of the cognitive and psychiatric sequelae of COVID-19 during the post-acute phase, particularly among racially and ethnically diverse patients. OBJECTIVE We sought to prospectively characterize cognition, mental health symptoms, and functioning approximately four months after an initial diagnosis of COVID-19 in a racially and ethnically diverse group of patients. METHODS Approximately four months after COVID-19 diagnosis, patients in the Johns Hopkins Post-Acute COVID-19 Team Pulmonary Clinic underwent a clinical telephone-based assessment of cognition, depression, anxiety, trauma, and function. RESULTS Most Johns Hopkins Post-Acute COVID-19 Team patients assessed were women (59%) and members of racial/ethnic minority groups (65%). Of 82 patients, 67% demonstrated ≥1 abnormally low cognitive score. Patients requiring intensive care unit (ICU) stays displayed greater breadth and severity of impairment than those requiring less intensive treatment. Processing speed (35%), verbal fluency (26%-32%), learning (27%), and memory (27%) were most commonly impaired. Among all patients, 35% had moderate symptoms of depression (23%), anxiety (15%), or functional decline (15%); 25% of ICU patients reported trauma-related distress. Neuropsychiatric symptoms and functional decline did not differ by post-ICU versus non-ICU status and were unrelated to global cognitive composite scores. CONCLUSIONS At approximately 4 months after acute illness, cognitive dysfunction, emotional distress, and functional decline were common among a diverse clinical sample of COVID-19 survivors varying in acute illness severity. Patients requiring ICU stays demonstrated greater breadth and severity of cognitive impairment than those requiring less intensive treatment. Findings help extend our understanding of the nature, severity, and potential duration of neuropsychiatric morbidity after COVID-19 and point to the need for longitudinal assessment of cognitive and mental health outcomes among COVID-19 survivors of different demographic backgrounds and illness characteristics.
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Affiliation(s)
- Tracy D Vannorsdall
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD.
| | - Emily Brigham
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Ashraf Fawzy
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Sarath Raju
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Alesandra Gorgone
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Alexandra Pletnikova
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Constantine G Lyketsos
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD; Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Ann M Parker
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD; Outcomes After Critical Illness and Surgery (OACIS) Research Group, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Esther S Oh
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD; Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD; Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD; Johns Hopkins University School of Nursing, Baltimore, MD
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