Planning deficits in HIV-associated neurocognitive disorders: Component processes, cognitive correlates, and implications for everyday functioning

Abstract

Executive dysfunction remains among the most prevalent cognitive domains impaired in persons with HIV-associated neurocognitive disorders (HAND). However, little is known specifically about the cognitive architecture or everyday functioning implications of planning, which is an aspect of executive functions involving the identification, organization, and completion of sequential behaviours toward the accomplishment of a goal. The current study examined these issues using the Tower of London^DX in 53 individuals with HAND, 109 HIV-infected persons without HAND, and 82 seronegative participants. The HAND+ group performed significantly more poorly than HIV-infected individuals without HAND on number of correct moves, total moves, execution time, time violations, and rule violations. Within the HIV+ group as a whole, greater total move scores and rule violations were most strongly associated with executive dysfunction. Of clinical relevance, elevated total moves and rule violations were significant, independent predictors of self-reported declines in instrumental activities of daily living and unemployment status in HIV. These results suggest that planning accuracy, efficiency, and rule-bound control are impaired in HAND and may meaningfully affect more cognitively complex aspects of everyday living.

Keywords:

• Planned behaviour
• Executive functioning
• Employment status
• Activities of daily living
• Higher order processes

Acknowledgments

This study was supported by R01-MH073419, P30-MH62512, and T32-DA031098. 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 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, 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. The views expressed in this article are those of the authors and do not reflect the official policy or position of the Department of the Navy, Department of Defense, or United States Government.