Marie-Josée Brouillette1, Lisa Koski, Laurence Forcellino, Joséphine Gasparri, Bruce J Brew, Lesley K Fellows, Nancy E Mayo, Lucette A Cysique. 1. Department of Psychiatry, McGill University, Montreal, Canada Chronic Viral Illness Service, McGill University Health Centre (MUHC), Montreal, Canada Infectious Diseases and Immunity in Global Health Program, MUHC-RI, Montreal, Canada Canadian Institutes of Health Research Canadian HIV Trials Network, Vancouver, BC, Canada Department of Psychology, McGill University, Montreal, Canada Clinique NeuroÉvolution Bachelor of Behavioral Neuroscience, Concordia University, Montreal, CANADA Departments of Neurology and HIV Medicine, St Vincent's Hospital and Peter Duncan Neurosciences Unit, Sydney, Australia Faculty of Medicine, University of Notre Dame, and Faculty of Medicine, University of New South Wales, Sydney, Australia Department of Neurology and Neurosurgery, McGill University, Montreal, Canada Montreal Neurological Hospital and Institute, McGill University, Montreal, Canada Department of Medicine, School of Physical and Occupational Therapy, McGill University, Montreal, Canada Division of Clinical Epidemiology, McGill University Health Centre (MUHC), Center for Outcomes Research and Evaluation, Montreal, Canada Division of Geriatrics, McGill University Health Centre (MUHC), Montreal, Canada School of Psychology, University of New South Wales, Australia.
Abstract
OBJECTIVE: The ability to work is amongst the top concerns of people living with welltreated HIV. Cognitive impairment has been reported in many otherwise asymptomatic persons living with HIV and even mild impairment is associated with higher rates of occupational difficulties. There are several classification algorithms for HIV-Associated Neurocognitive Disorder (HAND) as well as overall scoring methods available to summarize neuropsychological performance. We asked which method best explained work status and productivity. DESIGN: Participants (N = 263) drawn from a longitudinal Canadian cohort underwent neuropsychological testing. Methods: Several classification algorithms were applied to establish a HAND diagnosis and two summary measures (NPZ and GDS) were computed. Self-reported work status and productivity was assessed at each study visit (4 visits, 9 months apart). The association of work status with each diagnostic classification and summary measure was estimated using logistic regression. For those working, the value on the productivity scale was regressed within individuals over time, and the slopes were regressed on each neuropsychological outcome. Results: The application of different classification algorithms to the neuropsychological data resulted in rates of impairment that ranged from 28.5% to 78.7%. Being classified as impaired by any method was associated with a higher rate of unemployment. None of the diagnostic classifications or summary methods predicted productivity, at time of testing or over the following 36 months. CONCLUSION: Neuropsychological diagnostic classifications and summary scores identified participants who were more likely to be unemployed, but none explained productivity. New methods of assessing cognition are required to inform optimal workforce engagement.
OBJECTIVE: The ability to work is amongst the top concerns of people living with welltreated HIV. Cognitive impairment has been reported in many otherwise asymptomatic persons living with HIV and even mild impairment is associated with higher rates of occupational difficulties. There are several classification algorithms for HIV-Associated Neurocognitive Disorder (HAND) as well as overall scoring methods available to summarize neuropsychological performance. We asked which method best explained work status and productivity. DESIGN:Participants (N = 263) drawn from a longitudinal Canadian cohort underwent neuropsychological testing. Methods: Several classification algorithms were applied to establish a HAND diagnosis and two summary measures (NPZ and GDS) were computed. Self-reported work status and productivity was assessed at each study visit (4 visits, 9 months apart). The association of work status with each diagnostic classification and summary measure was estimated using logistic regression. For those working, the value on the productivity scale was regressed within individuals over time, and the slopes were regressed on each neuropsychological outcome. Results: The application of different classification algorithms to the neuropsychological data resulted in rates of impairment that ranged from 28.5% to 78.7%. Being classified as impaired by any method was associated with a higher rate of unemployment. None of the diagnostic classifications or summary methods predicted productivity, at time of testing or over the following 36 months. CONCLUSION: Neuropsychological diagnostic classifications and summary scores identified participants who were more likely to be unemployed, but none explained productivity. New methods of assessing cognition are required to inform optimal workforce engagement.