HIV-infected persons with bipolar disorder are less aware of memory deficits than HIV-infected persons without bipolar disorder

Abstract

Episodic memory deficits are common in HIV infection and bipolar disorder, but patient insight into such deficits remains unclear. Thirty-four HIV-infected individuals without bipolar disorder (HIV+/BD–) and 47 HIV+ individuals with comorbid bipolar disorder (HIV+/BD+) were administered the Hopkins Verbal Learning Test–Revised and the Brief Visuospatial Memory Test–Revised to examine objective learning/memory functioning. Subjective memory complaints were assessed via the memory subscale of the Patient's Assessment of Own Functioning Inventory. HIV+/BD+ individuals performed poorer on tests of visual learning and visual/verbal recall than did HIV+/BD– participants (ps < .05). Memory complaints only predicted verbal learning (at a trend level, p = .10) and recall (p = .03) among the HIV+/BD– individuals. Memory complaints were not associated with memory performance within the HIV+/BD+ group (ps > .10). Memory complaints were associated with depressive symptoms in both groups (ps < 0.05). These complaints were also predictive of immunosuppression, higher unemployment, and greater dependence on activities of daily living among the HIV+/BD+ individuals (ps < .05). Awareness of memory abilities was particularly poor among HIV+/BD+ individuals (i.e., objective learning/memory did not correspond to reported complaints), which has important implications for the capacity of these individuals to engage in error-monitoring and compensatory strategies in daily life. Memory complaints are associated with depressed mood regardless of group membership. Among HIV+/BD+ individuals, these complaints may also signify worse HIV disease status and problems with everyday functioning. Clinicians and researchers should be cognizant of what these complaints indicate in order to lead treatment most effectively; use of objective neurocognitive assessments may still be warranted when working with these populations.

Keywords:

• Self-report
• Infectious diseases
• Affective disorders
• Episodic memory
• Cognition

Acknowledgments

This work was supported by the National Institute of Mental Health (R03 MH078785), California HIV/AIDS Research Program IDEA Award (ID06-SD-201), T32 NIDA (National Institute on Drug Abuse) Grant DA031098, and the HIV Neurobehavioral Research Center (P30 MH062512).

Notes

The San Diego HIV Neurobehavioral Research Center (HNRC) group is affiliated with the University of California, San Diego, the Naval Hospital, San Diego, and the Veterans Affairs San Diego Healthcare System, and it includes: Director: Igor Grant; Co-Directors: J. Hampton Atkinson, Ronald J. Ellis, and J. Allen McCutchan; Center Manager: Thomas D. Marcotte; Jennifer Marquie-Beck; Melanie Sherman; Neuromedical Component: Ronald J. Ellis (P.I.), J. Allen McCutchan, Scott Letendre, Edmund Capparelli, Rachel Schrier, Terry Alexander, Debra Rosario, Shannon LeBlanc; Neurobehavioral Component: Robert K. Heaton (P.I.), Steven Paul Woods, Mariana Cherner, David J. Moore, Matthew Dawson; Neuroimaging Component: Terry Jernigan (P.I.), Christine Fennema-Notestine, Sarah L. Archibald, M.A., John Hesselink, Jacopo Annese, Michael J. Taylor; Neurobiology Component: Eliezer Masliah (P.I.), Cristian Achim, Ian Everall (Consultant); Neurovirology Component: Douglas Richman (P.I.), David M. Smith; International Component: J. Allen McCutchan (P.I.); Developmental Component: Cristian Achim (P.I.), Stuart Lipton; Participant Accrual and Retention Unit: J. Hampton Atkinson (P.I.), Rodney von Jaeger; Data Management Unit: Anthony C. Gamst (P.I.), Clint Cushman (Data Systems Manager); Statistics Unit: Ian Abramson (P.I.), Florin Vaida, Reena Deutsch, Anya Umlauf, Tanya Wolfson.