pp 1-18 | Cite as

Conceptualizing and Assessing Everyday Functioning in the Context of HIV-Associated Neurocognitive Disorders

  • Victoria M. Kordovski
  • Savanna M. Tierney
  • Steven Paul WoodsEmail author
Part of the Current Topics in Behavioral Neurosciences book series


Combination antiretroviral therapy has reduced the rates of severe HIV-associated neurocognitive disorders (HAND), but the prevalence of milder forms of HAND that can affect everyday functioning remains high. As HIV-infected adults approach near-normal life expectancies, they may become increasingly susceptible to declines in everyday functioning secondary to a variety of physical and mental factors, including HAND. Although impairments in everyday functioning are a hallmark of HAND diagnoses and can adversely influence quality of life, there are no gold standard measures of this fundamentally important and complex construct. This chapter provides a brief review of the various self-report, clinician-rated, and performance-based methods by which everyday functioning is measured in the setting of HIV disease, including global activities of daily living and specific domains of medication adherence, financial management, automobile driving, and vocational functioning.


Activities of daily living Everyday functioning Functional living skills HIV Performance-based assessment Self-assessment 


  1. Ackerman ML, Crowe M, Vance DE, Wadley VG, Owsley C, Ball KK (2010) The impact of feedback on self-rated driving ability and driving self-regulation among older adults. Gerontologist 51(3):367–378Google Scholar
  2. Albert SM, Weber CM, Todak G, Polanco C, Clouse R, McElhiney M, Rabkin J, Stern Y, Marder K (1999) An observed performance test of medication management ability in HIV: relation to neuropsychological status and medication adherence outcomes. AIDS Behav 3(2):121–128Google Scholar
  3. American Psychiatric Association, DSM-5 Task Force (2013) Diagnostic and statistical manual of mental disorders: DSM-5Google Scholar
  4. American Psychiatric Association, DSM-IV-TR (2000) Diagnostic and statistical manual of mental disorders: DSM-IV-TR. 4th edn. Text revisionGoogle Scholar
  5. Antinori A, Arendt G, Becker JT, Brew BJ, Byrd DA, Cherner M, Clifford DB, Cinque P, Epstein LG, Goodkin K, Gisslen M (2007) Updated research nosology for HIV-associated neurocognitive disorders. Neurology 69(18):1789–1799Google Scholar
  6. Barclay TR, Hinkin CH, Castellon SA, Mason KI, Reinhard MJ, Marion SD, Levine AJ, Durvasula RS (2007) Age-associated predictors of medication adherence in HIV-positive adults: health beliefs, self-efficacy, and neurocognitive status. Health Psychol 26(1):40Google Scholar
  7. Beck KH, Daughters SB, Ali B (2013) Hurried driving: relationship to distress tolerance, driver anger, aggressive and risky driving in college students. Accid Anal Prev 51:51–55Google Scholar
  8. Benedict RH, Mezhir JJ, Walsh K, Hewitt RG (2000) Impact of human immunodeficiency virus type-1-associated cognitive dysfunction on activities of daily living and quality of life. Arch Clin Neuropsychol 15(6):535–544Google Scholar
  9. Blackstone Casaletto K, Weber E, Iudicello JE, Woods SP (2017) Real-world impact of HIV-associated neurocognitive impairment. In: Chiaravalloti ND, Goverover Y (eds) Changes in the brain: impact on daily life. Springer, New York, pp 211–245Google Scholar
  10. Blackstone K, Moore DJ, Heaton RK, Franklin DR, Woods SP, Clifford DB, Collier AC, Marra CM, Gelman BB, McArthur JC, Morgello S (2012) Diagnosing symptomatic HIV-associated neurocognitive disorders: self-report versus performance-based assessment of everyday functioning. J Int Neuropsychol Soc 18(1):79–88Google Scholar
  11. Blackstone K, Iudicello JE, Morgan EE, Weber E, Moore DJ, Franklin DR, Ellis RJ, Grant I, Woods SP, TMARC Group (2013) HIV infection heightens concurrent risk of functional dependence in persons with chronic methamphetamine use. J Addict Med 7(4):255Google Scholar
  12. Burgoyne R, Renwick R (2004) Social support and quality of life over time among adults living with HIV in the HAART era. Soc Sci Med 58(7):1353–1366Google Scholar
  13. Burns SM, Young LR, Maniss S (2006) Predictors of employment and disability among people living with HIV/AIDS. Rehabil Psychol 51(2):127Google Scholar
  14. Cattie JE, Doyle K, Weber E, Grant I, Woods SP, HIV Neurobehavioral Research Program (HNRP) Group (2012) Planning deficits in HIV-associated neurocognitive disorders: component processes, cognitive correlates, and implications for everyday functioning. J Clin Exp Neuropsychol 34(9):906–918Google Scholar
  15. Centers for Disease Control and Prevention (2016) HIV surveillance report, 2015, vol 27Google Scholar
  16. Chernoff RA, Martin DJ, Schrock DA, Huy MP (2010) Neuropsychological functioning as a predictor of employment activity in a longitudinal study of HIV-infected adults contemplating workforce reentry. J Int Neuropsychol Soc 16(1):38–48Google Scholar
  17. Clark US, Cohen RA, Westbrook ML, Devlin KN, Tashima KT (2010) Facial emotion recognition impairments in individuals with HIV. J Int Neuropsychol Soc 16(6):1127–1137Google Scholar
  18. Conrad KJ, Matters MD, Luchins DJ, Hanrahan P, Quasius DL, Lutz G (2006) Development of a money mismanagement measure and cross-validation due to suspected range restriction. J Appl Meas 7(2):206Google Scholar
  19. Croft D, Jones RD (1987) The value of off-road tests in the assessment of driving potential of unlicensed disabled people. Br J Occup Ther 50(10):357–361Google Scholar
  20. Crystal S, Fleishman JA, Hays RD, Shapiro MF, Bozzette SA (2000) Physical and role functioning among persons with HIV: results from a nationally representative survey. Med Care:1210–1223Google Scholar
  21. Diehl M, Willis SL, Schaie KW (1995) Everyday problem solving in older adults: observational assessment and cognitive correlates. Psychol Aging 10(3):478Google Scholar
  22. Doyle KL, Morgan EE, Morris S, Smith DM, Little S, Iudicello JE, Blackstone K, Moore DJ, Grant I, Letendre SL, Woods SP (2013) Real-world impact of neurocognitive deficits in acute and early HIV infection. J Neurovirol 19(6):565–573Google Scholar
  23. Ettenhofer ML, Hinkin CH, Castellon SA, Durvasula R, Ullman J, Lam M, Myers H, Wright MJ, Foley J (2009) Aging, neurocognition, and medication adherence in HIV infection. Am J Geriatr Psychiatry 17(4):281–290Google Scholar
  24. Ettenhofer ML, Foley J, Castellon SA, Hinkin CH (2010) Reciprocal prediction of medication adherence and neurocognition in HIV/AIDS. Neurology 74(15):1217–1222Google Scholar
  25. Fazeli PL, Casaletto KB, Woods SP, Umlauf A, Scott JC, Moore DJ, HNRP Group (2017) Everyday multitasking abilities in older HIV+ adults: neurobehavioral correlates and the mediating role of metacognition. Arch Clin Neuropsychol 32(8):917–928Google Scholar
  26. Foley JM, Gooding AL, Thames AD, Ettenhofer ML, Kim MS, Castellon SA, Marcotte TD, Sadek JR, Heaton RK, Gorp WV, Hinkin CH (2013) Visuospatial and attentional abilities predict driving simulator performance among older HIV-infected adults. Am J Alzheimer’s Dis Other Demen 28(2):185–194Google Scholar
  27. Gandhi NS, Skolasky RL, Peters KB et al (2011) A comparison of performance-based measures of function in HIV-associated neurocognitive disorders. J Neurovirol 17(2):159–165Google Scholar
  28. Gisslén M, Price RW, Nilsson S (2011) The definition of HIV-associated neurocognitive disorders: are we overestimating the real prevalence? BMC Infect Dis 11:356Google Scholar
  29. Glass TR, Sterne JA, Schneider MP, De Geest S, Nicca D, Furrer H, Günthard HF, Bernasconi E, Calmy A, Rickenbach M, Battegay M (2015) Self-reported nonadherence to antiretroviral therapy as a predictor of viral failure and mortality. AIDS 29(16):2195–2200Google Scholar
  30. Goverover Y, O’Brien AR, Moore NB, DeLuca J (2010) Actual reality: a new approach to functional assessment in persons with multiple sclerosis. Arch Phys Med Rehabil 91(2):252–260Google Scholar
  31. Günthard HF, Saag MS, Benson CA, Del Rio C, Eron JJ, Gallant JE, Hoy JF, Mugavero MJ, Sax PE, Thompson MA, Gandhi RT (2016) Antiretroviral drugs for treatment and prevention of HIV infection in adults: 2016 recommendations of the International Antiviral Society–USA panel. JAMA 316(2):191–210Google Scholar
  32. Heaton RK, Velin RA, McCutchan JA, Gulevich SJ, Atkinson JH, Wallace MR, Godfrey HP, Kirson DA, Grant I (1994) Neuropsychological impairment in human immunodeficiency virus-infection: implications for employment. Psychosom Med 56(1):8Google Scholar
  33. Heaton RK, Marcotte TD, Mindt MR, Sadek J, Moore DJ, Bentley H, McCutchan JA, Reicks C, Grant I, HNRC Group (2004) The impact of HIV-associated neuropsychological impairment on everyday functioning. J Int Neuropsychol Soc 10(3):317–331Google Scholar
  34. Heaton RK, Franklin DR, Ellis RJ, McCutchan JA, Letendre SL, LeBlanc S, Corkran SH, Duarte NA, Clifford DB, Woods SP, Collier AC (2011) HIV-associated neurocognitive disorders before and during the era of combination antiretroviral therapy: differences in rates, nature, and predictors. J Neurovirol 17(1):3–16Google Scholar
  35. Hinkin CH, Castellon SA, Durvasula RS, Hardy DJ, Lam MN, Mason KI, Thrasher D, Goetz MB, Stefaniak M (2002) Medication adherence among HIV+ adults effects of cognitive dysfunction and regimen complexity. Neurology 59(12):1944–1950Google Scholar
  36. Hinkin CH, Hardy DJ, Mason KI, Castellon SA, Durvasula RS, Lam MN, Stefaniak M (2004) Medication adherence in HIV-infected adults: effect of patient age, cognitive status, and substance abuse. AIDS 18(Suppl 1):S19Google Scholar
  37. Iudicello JE, Morgan EE, Gongvatana A, Letendre SL, Grant I, Woods SP, Translational Methamphetamine AIDS Research Center (TMARC) Group (2014) Detrimental impact of remote methamphetamine dependence on neurocognitive and everyday functioning in older but not younger HIV+ adults: evidence for a legacy effect. J Neurovirol 20(1):85–98Google Scholar
  38. Karnofsky D, Abelman WH, Craver LF, Burchenal JH (1948) The use of nitrogen mustards in the palliative tratment of cancer. Cancer 1:634–456Google Scholar
  39. Kordovski VM, Woods SP, Avci G, Verduzco M, Morgan EE (2017a) Is the newest vital sign a useful measure of health literacy in HIV disease? J Int Assoc Provid AIDS Care 16(6):595–602Google Scholar
  40. Kordovski VM, Woods SP, Verduzco M, Beltran J (2017b) The effects of aging and HIV disease on employment status and functioning. Rehabil Psychol 62(4):591Google Scholar
  41. Krentz HB, Cosman I, Lee K, Ming JM, Gill MJ (2012) Pill burden in HIV infection: 20 years of experience. Antivir Ther 17(5):833–840Google Scholar
  42. Langebeek N, Gisolf EH, Reiss P, Vervoort SC, Hafsteinsdóttir TB, Richter C, Sprangers MA, Nieuwkerk PT (2014) Predictors and correlates of adherence to combination antiretroviral therapy (ART) for chronic HIV infection: a meta-analysis. BMC Med 12(1):142Google Scholar
  43. Laverick R, Haddow L, Daskalopoulou M, Lampe F, Gilson R, Speakman A, Antinori A, Bruun T, Vassilenko A, Collins S, Rodger A (2017) Self-reported decline in everyday function, cognitive symptoms, and cognitive function in people with HIV. J Acquir Immune Defic Syndr 76(3):e74–e83Google Scholar
  44. Lawton MP, Brody EM (1969) Assessment of older people: self-maintaining and instrumental activities of daily living. The Gerontologist 9(3_Part_1):179–186Google Scholar
  45. Lima VD, Geller J, Bangsberg DR, Patterson TL, Daniel M, Kerr T (2007) The effect of adherence on the association between depressive symptoms and mortality among HIV-infected individuals first initiating HAART. AIDS 21(9):1175–1183Google Scholar
  46. Loeb PA (1996) Independent living scales. The Psychological Corporation, San AntonioGoogle Scholar
  47. Malaspina L, Woods SP, Moore DJ, Depp C, Letendre SL, Jeste D, Grant I, HIV Neurobehavioral Research Programs (HNRP) Group (2011) Successful cognitive aging in persons living with HIV infection. J Neurovirol 17(1):110–119Google Scholar
  48. Marcotte TD, Heaton RK, Wolfson T, Taylor MJ, Alhassoon O, Arfaa K, Grant I (1999) The impact of HIV-related neuropsychological dysfunction on driving behavior. J Int Neuropsychol Soc 5(07):579–592Google Scholar
  49. Marcotte TD, Wolfson T, Rosenthal TJ, Heaton RK, Gonzalez R, Ellis RJ, Grant I (2004) A multimodal assessment of driving performance in HIV infection. Neurology 63(8):1417–1422Google Scholar
  50. Marcotte TD, Lazzaretto D, Cobb Scott J, Roberts E, Woods SP, Letendre S, The HNRC Group (2006) Visual attention deficits are associated with driving accidents in cognitively-impaired HIV-infected individuals. J Clin Exp Neuropsychol 28(1):13–28Google Scholar
  51. Marottoli RA, de Leon CFM, Glass TA, Williams CS, Cooney LM Jr, Berkman LF (2000) Consequences of driving cessation: decreased out-of-home activity levels. J Gerontol B Psychol Sci Soc Sci 55(6):S334–S340Google Scholar
  52. Marson DC, Sawrie SM, Snyder S, McInturff B, Stalvey T, Boothe A, Aldridge T, Chatterjee A, Harrell LE (2000) Assessing financial capacity in patients with Alzheimer disease: a conceptual model and prototype instrument. Arch Neurol 57(6):877–884Google Scholar
  53. McDonnell J, Haddow L, Daskalopoulou M, Lampe F, Speakman A, Gilson R et al (2014) Minimal cognitive impairment in UK HIV-positive men who have sex with men: effect of case definitions and comparison with the general population and HIV-negative men. J Acquir Immune Defic Syndr 67(2):120–127Google Scholar
  54. Moore DJ, Palmer BW, Patterson TL, Jeste DV (2007) A review of performance-based measures of functional living skills. J Psychiatr Res 41(1–2):97–118Google Scholar
  55. Morgan EE, Iudicello JE, Weber E, Duarte NA, Riggs PK, Delano-Wood L, Ellis R, Grant I, Woods SP, HIV Neurobehavioral Research Program (HNRP) Group (2012) Synergistic effects of HIV infection and older age on daily functioning. J Acquir Immune Defic Syndr 61(3):341Google Scholar
  56. Norman W, Shallice T (1986) Attention to action. In: Davidson RJ, Schwartz GE, Shapiro D (eds) Consciousness and self regulation: advances in research and theory. Plenum, New York, pp 1–18Google Scholar
  57. Obermeit LC, Morgan EE, Casaletto KB, Grant I, Woods SP, HIV Neurobehavioral Research Program (HNRP) Group (2015) Antiretroviral non-adherence is associated with a retrieval profile of deficits in verbal episodic memory. Clin Neuropsychol 29(2):197–213Google Scholar
  58. Obermeit LC, Beltran J, Casaletto KB, Franklin DR, Letendre S, Ellis R, Fennema-Notestine C, Vaida F, Collier AC, Marra CM, Clifford D (2017) Evaluating the accuracy of self-report for the diagnosis of HIV-associated neurocognitive disorder (HAND): defining “symptomatic” versus “asymptomatic” HAND. J Neurovirol 23(1):67–78Google Scholar
  59. Owsley C, Sloane M, McGwin D Jr, Ball K (2002) Timed instrumental activities of daily living tasks: relationship to cognitive function and everyday performance assessments in older adults. Gerontology 48(4):254–265Google Scholar
  60. Patton DE, Woods SP, Franklin D Jr, Cattie JE, Heaton RK, Collier AC et al (2012) Relationship of medication management test-revised (MMT-R) performance to neuropsychological functioning and antiretroviral adherence in adults with HIV. AIDS Behav 16(8):2286–2296Google Scholar
  61. Perno CF, Cozzi-Lepri A, Balotta C, Bertoli A, Violin M, Monno L, Zauli T, Montroni M, Ippolito G, d’Arminio-Monforte A (2002) Low prevalence of primary mutations associated with drug resistance in antiviral-naive patients at therapy initiation. AIDS 16(4):619–624Google Scholar
  62. Rabkin JG, McElhiney M, Ferrando SJ, Van Gorp W, Lin SH (2004) Predictors of employment of men with HIV/AIDS: a longitudinal study. Psychosom Med 66(1):72–78Google Scholar
  63. Rebok GW, Bylsma FW, Keyl PM, Brandt J, Folstein SE (1995) Automobile driving in Huntington’s disease. Mov Disord 10(6):778–787Google Scholar
  64. Rosenberg L, Nygård L, Kottorp A (2009) Everyday technology use questionnaire: psychometric evaluation of a new assessment of competence in technology use. Occup Part Health 29(2):52–62Google Scholar
  65. Rosenthal TJ, Parseghian Z, Allen RW, Stein AC (1995) STISIM: the low-cost driving simulator. Version 8:1985–1996Google Scholar
  66. Samson A, Lavigne RM, MacPherson P (2009) Self-fulfillment despite barriers: volunteer work of people living with HIV. AIDS Care 21(11):1425–1431Google Scholar
  67. Saykin AJ, Janssen RS, Sprehn GC, Kaplan JE, Spira TJ, O’Connor B (1991) Longitudinal evaluation of neuropsychological function in homosexual men with HIV infection: 18-month follow-up. J Neuropsychiatry Clin Neurosci 3(2):286Google Scholar
  68. Sevigny JJ, Albert SM, McDermott MP, Schifitto G, McArthur JC, Sacktor N, Conant K, Selnes OA, Stern Y, McClernon DR, Palumbo D (2007) An evaluation of neurocognitive status and markers of immune activation as predictors of time to death in advanced HIV infection. Arch Neurol 64(1):97–102Google Scholar
  69. Sheppard DP, Woods SP, Verduzco M, HIV Neurobehavioral Research Center (HNRC) Group (2018) Construct validity of the UCSD performance-based skills assessment-brief version (UPSA-B) in HIV disease. Appl Neuropsychol Adult 25(6):543–554Google Scholar
  70. Sikkes SA, Knol DL, Pijnenburg YA, De Lange-de Klerk ES, Uitdehaag BM, Scheltens P (2013) Validation of the Amsterdam IADL Questionnaire©, a new tool to measure instrumental activities of daily living in dementia. Neuroepidemiology 41(1):35–41Google Scholar
  71. Simoni JM, Frick PA, Huang B (2006) A longitudinal evaluation of a social support model of medication adherence among HIV-positive men and women on antiretroviral therapy. Health Psychol 25(1):74Google Scholar
  72. Stein AC, Allen RW, Parseghian Z (1992) The use of lowcost driving simulation to detect impaired drivers. Paper presented at the IMAGE VI conference, Scottsdale, AZGoogle Scholar
  73. Thaler NS, Sayegh P, Arentoft A, Thames AD, Castellon SA, Hinkin CH (2015) Increased neurocognitive intra-individual variability is associated with declines in medication adherence in HIV-infected adults. Neuropsychology 29(6):919Google Scholar
  74. Thames AD, Kim MS, Becker BW, Foley JM, Hines LJ, Singer EJ, Heaton RK, Castellon SA, Hinkin CH (2011) Medication and finance management among HIV-infected adults: the impact of age and cognition. J Clin Exp Neuropsychol 33(2):200–209Google Scholar
  75. Thames AD, Arentoft A, Rivera-Mindt M, Hinkin CH (2013) Functional disability in medication management and driving among individuals with HIV: a 1-year follow-up study. J Clin Exp Neuropsychol 35(1):49–45Google Scholar
  76. Tu W, Nyandiko WM, Liu H, Slaven JE, Scanlon ML, Ayaya SO, Vreeman RC (2017) Pharmacokinetics-based adherence measures for antiretroviral therapy in HIV-infected Kenyan children. J Int AIDS Soc 20(1):21157Google Scholar
  77. Twamley EW, Narvaez JM, Sadek JR, Jeste DV, Grant I, Heaton RK (2006) Work-related abilities in schizophrenia and HIV infection. J Nerv Ment Dis 194(4):268–274Google Scholar
  78. van Gorp WG, Satz P, Hinkin C, Selnes O, Miller EN, McArthur J, Cohen B, Paz D (1991) Metacognition in HIV-1 seropositive asymptomatic individuals: self-ratings versus objective neuropsychological performance. J Clin Exp Neuropsychol 13(5):812–819Google Scholar
  79. van Gorp WG, Baerwald JP, Ferrando SJ, McElhiney MC, Rabkin JG (1999) The relationship between employment and neuropsychological impairment in HIV infection. J Int Neuropsychol Soc 5(6):534–539Google Scholar
  80. van Gorp WG, Rabkin JG, Ferrando SJ, Mintz J, Ryan E, Borkowski T, Mcelhiney M (2007) Neuropsychiatric predictors of return to work in HIV/AIDS. J Int Neuropsychol Soc 13(1):80–89Google Scholar
  81. Vance DE, Roenker DL, Cissell GM, Edwards JD, Wadley VG, Ball KK (2006) Predictors of driving exposure and avoidance in a field study of older drivers from the state of Maryland. Accid Anal Prev 38(4):823–831Google Scholar
  82. Vance DE, Fazeli PL, Ball DA, Slater LZ, Ross LA (2014) Cognitive functioning and driving simulator performance in middle-aged and older adults with HIV. J Assoc Nurses AIDS Care 25(2):e11–e26Google Scholar
  83. Weber E, Blackstone K, Iudicello JE, Morgan EE, Grant I, Moore DJ, Woods SP, Translational Methamphetamine AIDS Research Center (TMARC) Group (2012) Neurocognitive deficits are associated with unemployment in chronic methamphetamine users. Drug Alcohol Depend 125(1–2):146–153Google Scholar
  84. Wilson EAH, Park D (2008) Prospective memory and health behaviors: context trumps cognition. In: Kliegel M, McDaniel MA, Einstein GO (eds) Prospective memory: cognitive, neuroscience, developmental, and applied perspectives. Erlbaum, Mahwah, NJ, pp 391–410Google Scholar
  85. Woods SP, Rippeth JD, Frol AB, Levy JK, Ryan E, Soukup VM, Hinkin CH, Lazzaretto D, Cherner M, Marcotte TD, Gelman BB (2004) Interrater reliability of clinical ratings and neurocognitive diagnoses in HIV. J Clin Exp Neuropsychol 26(6):759–778Google Scholar
  86. Woods SP, Iudicello JE, Moran LM, Carey CL, Dawson MS, Grant I (2008) HIV-associated prospective memory impairment increases risk of dependence in everyday functioning. Neuropsychology 22(1):110Google Scholar
  87. Woods SP, Dawson MS, Weber E, Gibson S, Grant I, Atkinson JH (2009) Timing is everything: antiretroviral nonadherence is associated with impairment in time-based prospective memory. J Int Neuropsychol Soc 15(1):42–52Google Scholar
  88. Woods SP, Weber E, Weisz BM, Twamley EW, Grant I (2011) Prospective memory deficits are associated with unemployment in persons living with HIV infection. Rehabil Psychol 56(1):77Google Scholar
  89. Woods SP, Iudicello JE, Morgan EE, Verduzco M, Smith TV, Cushman C, HIV Neurobehavioral Research Program (HNRP) Group (2017) Household everyday functioning in the internet age: online shopping and banking skills are affected in HIV-associated neurocognitive disorders. J Int Neuropsychol Soc 23(7):605–615Google Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Victoria M. Kordovski
    • 1
  • Savanna M. Tierney
    • 1
  • Steven Paul Woods
    • 1
    Email author
  1. 1.University of HoustonHoustonUSA

Personalised recommendations