Skip to main content

Advertisement

SpringerLink
Log in

Neurocognitive Impairment is Associated with Lower Health Literacy Among Persons Living with HIV Infection

  • Original Paper
  • Published:
AIDS and Behavior Aims and scope Submit manuscript

Abstract

This study sought to determine the effects of HIV-associated neurocognitive disorders (HAND) on health literacy, which encompasses the ability to access, understand, appraise, and apply health-related information. Participants included 56 HIV seropositive individuals, 24 of whom met Frascati criteria for HAND, and 24 seronegative subjects who were comparable on age, education, ethnicity, and oral word reading. Each participant was administered a brief battery of well-validated measures of health literacy, including the Expanded Numeracy Scale (ENS), Newest Vital Sign (NVS), Rapid Estimate of Adult Literacy in Medicine (REALM), and Brief Health Literacy Screen (BHLS). Results revealed significant omnibus differences on the ENS and NVS, which were driven by poorer performance in the HAND group. There were no significant differences on the REALM or the BHLS by HAND status. Among individuals with HAND, lower scores on the NVS were associated with greater severity of neurocognitive dysfunction (e.g., working memory and verbal fluency) and self-reported dependence in activities of daily living. These preliminary findings suggest that HAND hinders both fundamental (i.e., basic knowledge, such as numeracy) and critical (i.e., comprehension and application of healthcare information) health literacy capacities, and therefore may be an important factor in the prevalence of health illiteracy. Health literacy-focused intervention may play an important role in the treatment and health trajectories among persons living with HIV infection.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Institute of Medicine. Health literacy: a prescription to end confusion. Washington: National Academies Press; 2004.

    Google Scholar 

  2. Berkman ND, Sheridan SL, Donahue KE, Halpern DJ, Crotty K. Low health literacy and health outcomes: an updated systematic review. Ann Int Med. 2011;155:97–107.

    Article  PubMed  Google Scholar 

  3. Wawrzyniak AJ, Ownby RL, McCoy K, Waldrop-Valverde D. Health literacy: impact on the health of HIV-infected individuals. Curr HIV/AIDS Rep. 2013;10:295–304.

    Article  PubMed Central  PubMed  Google Scholar 

  4. Kalichman SC, Rompa D. Functional health literacy is associated with health status and health-related knowledge in people living with HIV-AIDS. J Acquir Immune Defic Syndr. 2000;25:337–44.

    Article  CAS  PubMed  Google Scholar 

  5. Hicks G, Barragan M, Franco-Paredes C, Williams MV, del Rio C. Health literacy is a predictor of HIV/AIDS knowledge. Fam Med. 2006;38:717–23.

    PubMed  Google Scholar 

  6. Barragan M, Hicks G, Williams MV, Franco-Parades C, del Rio C. Low health literacy is associated with HIV test acceptance. J Gen Intern Med. 2005;20:422–5.

    Article  PubMed Central  PubMed  Google Scholar 

  7. Kalichman SC, Rompa D, Cage M. Distinguishing between overlapping somatic symptoms of depression and HIV disease in people living with HIV-AIDS. J Nerv Mental Disord. 2000;188:662–70.

    Article  CAS  Google Scholar 

  8. Kalichman SC, Ramachandran B, Catz S. Adherence to combination antiretroviral therapies in HIV patients of low health literacy. J Gen Intern Med. 1999;14:267–73.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  9. Colbert AM, Sereika SM, Erlen JA. Functional health literacy, medication-taking self-efficacy and adherence to antiretroviral therapy. J Adv Nurs. 2013;69:295–304.

    Article  PubMed  Google Scholar 

  10. Sorensen K, Van den Broucke S, Fullam J, Doyle G, Pelikan J, Brand H, Erlen JA, (HLS-EU) Consortium Health Literacy Project European. Health literacy and public health: a systematic review and integration of definitions and models. BMC Public Health. 2012;12:80.

    Article  PubMed Central  PubMed  Google Scholar 

  11. Paasche-Orlow MK, Wolf MS. The causal pathways linking health literacy to health outcomes. Am J Health Behav. 2007;Supplement 1:S19–26.

    Article  Google Scholar 

  12. Zogg JB, Woods SP, Weber E, Iudicello JE, Dawson MS, Grant I, The HIV Neurobehavioral Research Center Group. HIV-associated prospective memory impairment in the laboratory predicts failures on a semi-naturalistic measure of health care compliance. Clin Neuropsychol. 2010;24:945–62.

    Article  PubMed Central  PubMed  Google Scholar 

  13. Federman AD, Sano M, Wolf MS, Siu AL, Halm EA. Health literacy and cognitive performance in older adults. J Am Ger Soc. 2009;57:1475–80.

    Article  Google Scholar 

  14. Ellis RJ, Calero P, Stockin MD. HIV infection and the central nervous system: a primer. Neuropsychol Rev. 2009;19:144–51.

    Article  PubMed Central  PubMed  Google Scholar 

  15. Heaton RK, Clifford DB, Franklin DR Jr, Woods SP, Ake C, Vaida F, CHARTER Group. HIV-associated neurocognitive disorders persist in the era of potent antiretroviral therapy: CHARTER study. Neurology. 2010;75:2087–96.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  16. Heaton RK, Franklin DR, Ellis RJ, McCutchan JA, Letendre SL, Grant I. HIV-associated neurocognitive disorders before and during the era of combination antiretroviral therapy: differences in rates, nature, and predictors. J Neurovirol. 2011;17:3–16.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  17. Woods SP, Moore DJ, Weber E, Grant I. Cognitive neuropsychology of HIV-associated neurocognitive disorders. Neuropsychol Rev. 2009;19:152–68.

    Article  PubMed Central  PubMed  Google Scholar 

  18. Reger M, Welsh R, Razani J, Martin DJ, Boone KB. A meta-analysis of the neuropsychological sequelae of HIV infection. J Int Neuropsychol Soc. 2002;8:410–24.

    Article  PubMed  Google Scholar 

  19. Heaton RK, Marcotte TD, Mindt MR, Sadek J, Moore DJ, Bentley H, McCutchan JA, Reicks C. Grant I; HNRC Group. The impact of HIV-associated neuropsychological impairment on everyday functioning. J Int Neuropsychol Soc. 2004;10:317–31.

    PubMed  Google Scholar 

  20. van Gorp WG, Rabkin JG, Ferrando SJ, Mintz J, Ryan E, Borkowski T, McElhiney M. Neuropsychiatric predictors of return to work in HIV/AIDS. J Int Neuropsychol Soc. 2007;13:80–9.

    PubMed  Google Scholar 

  21. Tozzi V, Balestra P, Galgani S, Murri R, Bellagamba R, Narciso P, et al. Neurocognitive performance and quality of life in patients with HIV infection. AIDS Res Hum Retrovir. 2003;19:643–52.

    Article  PubMed  Google Scholar 

  22. Albert SM, Weber CM, Todak G, Polanco C, Clouse R, McElhiney M, Rabkin J, Stern Y, Marder K. An observed performance test of medication management ability in HIV: relation to neuropsychological status and medication adherence outcomes. AIDS Behav. 1999;3:121–8.

    Article  Google Scholar 

  23. Hinkin CH, Castellon SA, Durvasula RS, Hardy DJ, Lam MN, Mason KI, et al. Medication adherence among HIV+ adults: effects of cognitive dysfunction and regimen complexity. Neurology. 2002;59:1944–50.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  24. Lysaker PH, Ringer JM, Buck KD, Grant M, Olesek K, Leudtke BL, Dimaggio G. Metacognitive and social cognition deficits in patients with significant psychiatric and medical adversity: a comparison between participants with schizophrenia and a sample of participants who are HIV-positive. J Nerv Mental Dis. 2012;200:130–4.

    Article  Google Scholar 

  25. Waldrop-Valverde D, Jones DL, Gould F, Kumar M, Ownby RL. Neurocognition, health-related reading literacy, and numeracy in medication management for HIV infection. AIDS Patient Care STDs. 2010;24:477–84.

    Article  PubMed Central  PubMed  Google Scholar 

  26. Antinori A, Arendt G, Becker JT, Brew BJ, Byrd D, Cherner M, et al. Updated research nosology for HIV-associated neurocognitive disorders. Neurology. 2007;69:1789–99.

    Article  CAS  PubMed  Google Scholar 

  27. Wilkinson GS. Wide range achievement test administration manual. 3rd ed. Wilmington: Wide Range Inc; 1993.

    Google Scholar 

  28. Davis TC, Long SW, Jackson RH, et al. Rapid estimate of adult literacy in medicine: a shortened screening instrument. Fam Med. 1993;25:391–5.

    CAS  PubMed  Google Scholar 

  29. Chew LD, Bradley KA, Boyko E. Brief questions to identify patients with inadequate health literacy. J Fam Med. 2004;36:588–94.

    Google Scholar 

  30. Lipkus IM, Samsa G, Rimer BK. General performance on a Numeracy Scale among highly educated samples. Med Decis Mak. 2001;21:37–44.

    Article  CAS  Google Scholar 

  31. Weiss BD, Mays MZ, Martz W, Castro KM, DeWalt DA, Pignone MP, Mockbee J, Hale FA. Quick assessment of literacy in primary care: the newest vital sign. Ann Fam Med. 2005;3:514–22.

    Article  PubMed Central  PubMed  Google Scholar 

  32. World Health Organization. Composite international diagnostic interview (CIDI, Version 2.1). Geneva: World Health Organization; 1998.

    Google Scholar 

  33. Benton AL, Hamsher K, Sivan AB. Multilingual aphasia examination. Iowa City: AJA Associates; 1983.

    Google Scholar 

  34. Gladsjo JA, Schuman CC, Evans JD, Peavy GM, Miller SW, Heaton RK. Norms for letter and category fluency: demographic corrections for age, education, and ethnicity. Assessment. 1999;6:147–78.

    Article  CAS  PubMed  Google Scholar 

  35. Heaton RK, Miller SW, Taylor MJ, Grant I. Revised comprehensive norms for an expanded Halstead–Reitan battery: demographically adjusted neuropsychological norms for African American and Caucasian adults. Odessa: Psychological Assessment Resources Inc; 2004.

    Google Scholar 

  36. Reitan RM, Wolfson D. The Halstead–Reitan neuropsychological test battery: theory and clinical interpretation Tucson. AZ: Neuropsychology Press; 1993.

    Google Scholar 

  37. Heaton RK, Taylor MJ, Manly JJ. Demographic effects and use of demographically corrected norms with the WAIS-III and WMS-III. In: Tulsky DS, Heaton RK, Chelune G, Ivnik R, Bornstein RA, Prifitera A, Ledbetter M, editors. Clinical Interpretation of the WAIS-III and WMS-III. San Diego: Academic Press; 2002.

    Google Scholar 

  38. Tulsky D, Zhu J, Ledbetter MF. WAIS-III and WMS-III technical manual. San Antonio, TX: The Psychological Corporation; 1997.

    Google Scholar 

  39. Golden CJ. Stroop Color and Word Test. Chicago: Stoelting; 1998.

    Google Scholar 

  40. Diehr MC, Heaton RK, Miller W, Grant I. The Paced Auditory Serial Addition Task (PASAT): norms for age, education, and ethnicity. Assessment. 1998;5:375–87.

    Article  CAS  PubMed  Google Scholar 

  41. Gronwall DM. Paced auditory serial-addition task: a measure of recovery from concussion. Percept Motor Skills. 1977;44:367–73.

    Article  CAS  PubMed  Google Scholar 

  42. Kongs SK, Thompson LL, Iverson GL, Heaton RK. Wisconsin Card Sorting Test-64 card computerized version. Odessa: Psychological Assessment Resources; 2000.

    Google Scholar 

  43. Benedict RH, Schretlen D, Groninger L, Brandt J. Hopkins verbal learning test-revised: normative data and analysis of inter-form and test-retest reliability. Clin Neuropsychol. 1998;12:43–55.

    Article  Google Scholar 

  44. Norman MA, Moore DJ, Taylor M, et al. Demographically corrected norms for African Americans and Caucasians on the Hopkins verbal learning test-revised, brief visuospatial memory test-revised, Stroop color and word test, and Wisconsin card sorting test 64-card version. J Clin Exp Neuropsychol. 2011;33:793–804.

    Article  PubMed Central  PubMed  Google Scholar 

  45. Benedict RH. Brief visuospatial memory test—revised. Odessa: Psychological Assessment Resources; 1997.

    Google Scholar 

  46. Kløve H. Grooved pegboard. Lafayette: Lafayette Instruments; 1963.

    Google Scholar 

  47. Carey CL, Woods SP, Gonzalez R, Conover E, Marcotte TD, Grant I, et al. Predictive validity of global deficit scores for detecting neuropsychological impairment in HIV infection. J Clin Exp Neuropsychol. 2004;26:307–19.

    Article  PubMed  Google Scholar 

  48. Cysique LA, Franklin D Jr, Abramson I, Ellis RJ, Letendre S, Collier A, et al. Normative data and validation of a regression based summary score for assessing meaningful neuropsychological change. J Clin Exp Neuropsychol. 2011;33:505–22.

    Article  PubMed Central  PubMed  Google Scholar 

  49. Collie A, Maruff P, Darby DG, McStephen M. The effects of practice on the cognitive test performance of neurologically normal individuals assessed at brief test-retest intervals. J Int Neuropsychol Soc. 2003;9:419–28.

    PubMed  Google Scholar 

  50. Lawton MP, Brody EM. Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist. 1969;9:179–86.

    Article  CAS  PubMed  Google Scholar 

  51. Chelune GJ, Heaton RK, Lehman RAW. Neuropsychological and personality correlates of patients’ complaints of disability. In: Tarter RE, Goldstein G, editors. Advances in clinical neuropsychology, vol. 3. New York: Plenum Press; 1986. p. 95–126.

    Chapter  Google Scholar 

  52. Woods SP, Rippeth JD, Frol AB, Levy JK, Soukup VM, Hinkin CH, et al. Interrater reliability of clinical ratings and neurocognitive diagnoses in HIV. J Clin Exp Neuropsychol. 2004;26:759–78.

    Article  PubMed  Google Scholar 

  53. Blackstone K, Moore DJ, Heaton RK, Franklin DR Jr, Woods SP, Clifford DB, Collier AC, Marra CM, Gelman BB, McArthur JC, Morgello S, Simpson DM, Rivera-Mindt M, Deutsch R, Ellis RJ, Hampton Atkinson J, Grant I; CNS HIV Antiretroviral Therapy Effects Research (CHARTER) Group. Diagnosing symptomatic HIV-associated neurocognitive disorders: self-report versus performance-based assessment of everyday functioning. J Int Neuropsychol Soc. 2012; 18:79–88.

  54. Johnstone B, Wilhelm KL. The longitudinal stability of the WRAT-R Reading subtest: is it an appropriate estimate of premorbid intelligence. J Int Neuropsychol Soc. 1996;2:282–5.

    Article  CAS  PubMed  Google Scholar 

  55. Bogdanova Y, Neargarder S, Cronin-Golomb A. Mapping mental number line in physical space: vertical and horizontal visual number line orientation in asymptomatic individuals with HIV. Neuropsychologia. 2008;46:2914–23.

    Article  PubMed Central  PubMed  Google Scholar 

  56. Rotzer S, Loenneker T, Kucian K, Martin E, Klaver P, von Aster M. Dysfunctional neural network of spatial working memory contributes to developmental dyscalculia. Neuropsychologia. 2009;47:2859–65.

    Article  CAS  PubMed  Google Scholar 

  57. Bechara A, Martin EM. Impaired decision-making related to working memory deficits in individuals with substance addictions. Neuropsychology. 2004;18:152–62.

    Article  PubMed  Google Scholar 

  58. Blackstone K, Iudicello JE, Morgan EE, Weber E, Moore DJ, Franklin DR, et al. Human immunodeficiency virus infection heightens concurrent risk of functional dependence in persons with long-term methamphetamine use. J Addict Med. 2014;7:255–63.

    Article  Google Scholar 

  59. Woods SP, Moran LM, Carey CL, Dawson MS, Iudicello JE, Gibson S, Grant I, Atkinson JH. Prospective memory in HIV infection: is “remembering to remember” a unique predictor of self-reported medication management? Arch Clin Neuropsychol. 2008;23:257–70.

    Article  PubMed Central  PubMed  Google Scholar 

  60. Martin EM, DeHaan S, Vassileva J, Gonzalez R, Weller J, Bechara A. Decision making among HIV + drug using men who have sex with men: a preliminary report from the Chicago Multicenter AIDS Cohort Study. J Clin Exp Neuropsychol. 2013;35:573–83.

    Article  PubMed Central  PubMed  Google Scholar 

  61. Iudicello JE, Kellogg EJ, Weber E, Smith C, Grant I, Drane DL, Woods SP. HIV Neurobehavioral Research Program (HNRP) Group. Semantic cueing improves category verbal fluency in persons living with HIV infection. J Neuropsychiatry Clin Neurosci. 2012;24:183–90.

    Article  PubMed Central  PubMed  Google Scholar 

Download references

Acknowledgments

The authors declare that they have no conflict of interest. The study was supported by NIH Grants R01MH073419, R21MH098607, T32DA031098, L30DA034362, L30DA032120, U24MH100928, F31DA035708, P30MH062512, and P50DA026306.

Author information

Authors and Affiliations

  1. Department of Psychiatry (8231), University of California, San Diego, 220 Dickinson St., Suite B, San Diego, CA, 92103, USA

    Erin E. Morgan, Jennifer E. Iudicello, Igor Grant & Steven Paul Woods

  2. SDSU/UCSD Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA

    Jordan E. Cattie & Kaitlin Blackstone

Authors
  1. Erin E. Morgan
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jennifer E. Iudicello
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jordan E. Cattie
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Kaitlin Blackstone
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Igor Grant
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Steven Paul Woods
    View author publications

    You can also search for this author in PubMed Google Scholar

Consortia

The HIV Neurobehavioral Research Program (HNRP) Group

Corresponding author

Correspondence to Steven Paul Woods.

Additional information

The HIV Neurobehavioral Research Program (HNRP) Group members are listed in the Appendix.

Appendix

Appendix

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: Robert K. Heaton, Ph.D., Co-Director: Igor Grant, M.D.; Associate Directors: J. Hampton Atkinson, M.D., Ronald J. Ellis, M.D., Ph.D., and Scott Letendre, M.D.; Center Manager: Thomas D. Marcotte, Ph.D.; Jennifer Marquie-Beck, M.P.H.; Melanie Sherman; Neuromedical Component: Ronald J. Ellis, M.D., Ph.D. (P.I.), Scott Letendre, M.D., J. Allen McCutchan, M.D., Brookie Best, Pharm.D., Rachel Schrier, Ph.D., Terry Alexander, R.N., Debra Rosario, M.P.H.; Neurobehavioral Component: Robert K. Heaton, Ph.D. (P.I.), J. Hampton Atkinson, M.D., Steven Paul Woods, Psy.D., Thomas D. Marcotte, Ph.D., Mariana Cherner, Ph.D., David J. Moore, Ph.D., Matthew Dawson; Neuroimaging Component: Christine Fennema-Notestine, Ph.D. (P.I.), Terry Jernigan, Ph.D., Monte S. Buchsbaum, M.D., John Hesselink, M.D., Sarah L. Archibald, M.A., Gregory Brown, Ph.D., Richard Buxton, Ph.D., Anders Dale, Ph.D., Thomas Liu, Ph.D.; Neurobiology.

Component: Eliezer Masliah, M.D. (P.I.), Cristian Achim, M.D., Ph.D., Ian Everall, FRCPsych., FRCPath., Ph.D.; Neurovirology Component: David M. Smith, M.D. (P.I.), Douglas Richman, M.D.; International Component: J. Allen McCutchan, M.D., (P.I.), Mariana Cherner, Ph.D.; Developmental Component: Cristian Achim, M.D., Ph.D.; (P.I.), Stuart Lipton, M.D., Ph.D.; Participant Accrual and Retention Unit: J. Hampton Atkinson, M.D. (P.I.), Jennifer Marquie-Beck, M.P.H.; Data Management and Information Systems Unit: Anthony C. Gamst, Ph.D. (P.I.), Clint Cushman; Statistics Unit: Ian Abramson, Ph.D. (P.I.), Florin Vaida, Ph.D. (Co-PI), Reena Deutsch, Ph.D., Anya Umlauf, M.S.

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, nor the United States Government.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Morgan, E.E., Iudicello, J.E., Cattie, J.E. et al. Neurocognitive Impairment is Associated with Lower Health Literacy Among Persons Living with HIV Infection. AIDS Behav 19, 166–177 (2015). https://doi.org/10.1007/s10461-014-0851-7

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10461-014-0851-7

Keywords

Search

Navigation