Factors contributing to impaired self-awareness of cognitive functioning in an HIV positive and at-risk population

Abstract

Purpose: To examine the association between self-awareness of cognitive impairment and age, selected mood disorders, and type and severity of cognitive impairment in a sample of individuals with HIV/AIDS and at risk for HIV. Method: 75 subjects, 52 HIV+ and 23 at risk for HIV completed a psychosocial interview, the Patient’s Assessment of Own Functioning (PAOF) questionnaire, and a battery of neuropsychological tests. Based upon the differences between their clinical impairment and self-reported impairment, subjects were classified as being “Underestimators”, “Good Awareness”, or “Impaired Awareness” with regard to self-awareness. Results: Those with more severe cognitive impairment were less aware than those with normal or borderline cognitive impairment. A one-way ANOVA suggested that the Impaired Awareness group differed significantly from the Underestimators on the Rey Figure Immediate and Delayed Recall tasks, and from both the Underestimators and Good Awarenesss groups on the Digit Symbol Substitution Task. There were significant differences among all awareness groups on the test of Simple Reaction Time. Furthermore there is some suggestion that age may contribute to impaired self-awareness. The role of HIV in self-awareness remains unclear, as both, individuals with HIV and at risk, demonstrated impaired self-awareness. Conclusions: Overall, impaired awareness was associated with poorer test performance, suggesting a relationship between awareness and sustained complex attention and visual spatial processing. This research has implications for understanding factors contributing to poor awareness among individuals with cognitive impairment.

Implications for Rehabilitation

• Impaired self-awareness is associated with poor rehabilitation outcomes in populations with cognitive impairment.

• Individuals with and at risk for HIV/AIDS demonstrate cognitive impairments often associated with impaired self-awareness.

• Individuals with or at risk for HIV/AIDS have a critical need that could be addressed by rehabilitation professionals with expertise in assessing and treating impairments in self-awareness.

Keywords::

• self-awareness
• HIV
• cognitive impairment

Declaration of Interest: The Allegheny County Psychological Survey Study is supported by the National Institutes of Health (AG21431). This paper was submitted in partial fulfillment of a Master’s of Science in Health and Rehabilitation Science at the University of Pittsburgh.