Date of Award
HIV-Associated Neurocognitive Disorders, Performance Validity Tests
Human immunodeficiency virus (HIV) associated neurocognitive disorders (HAND) affect 50% of individuals with HIV. HAND is characterized by cognitive and functional impairment and is diagnosed through neuropsychological assessment. The use of performance validity tests (PVT) is recommended to determine the credibility of cognitive profiles during neuropsychological testing. However, little is known about the utility of PVTs within an HIV+ population. The objective of the present study was to compare the base rate of failure on embedded validity indicators (EVIs) between individuals diagnosed with HAND, neurocognitively normal individuals with HIV, undergraduate controls, and undergraduates asked to feign cognitive impairment. The relationship between EVI failure and neurocognitive performance, as well as self-reported depressive symptoms, was also explored. Cumulative EVI failure produced good classification accuracy within the student sample, reaffirming their utility in detecting invalid performance. As predicted, individuals with more severe HAND diagnoses (i.e., HIV-associated dementia and mild cognitive impairment) failed more EVIs than neurocognitively normal individuals. Further, as neurocognitive test performance decreased, cumulative EVI failures increased. Although directionality of this finding could not be determined (i.e., do low scores reflect non-credible responding or are EVI failures false positives in individuals with genuine impairment?), monitoring performance validity might help explain the well-known fluctuation in cognitive performance over time in the HAND population. There was no relationship between the number of EVIs failed and self-reported depressive symptoms or severity, ruling out a commonly discussed confounding variable in PVT research.
Hurtubise, Jessica, "Improving Diagnostic Accuracy in HIV-Associated Neurocognitive Disorders" (2018). Electronic Theses and Dissertations. 7527.