Executive Function Deficits in HIV-Associated Neurocognitive Decline

People with HIV infection are living longer as a result of advances in combination
antiretroviral therapy. This increase in lifespan has been coupled with an increase
in the prevalence of HIV associated neurocognitive decline (HAND). A central
feature of this presentation is the impairment of executive functioning, and the
aim of this study was to explore whether there is general impairment of this
domain or whether there is an executive function profile (of deficits versus
relatively preserved aspects of function) in people with HAND.
Sixteen participants with HAND (mean age = 49.25 years, range 23 to 72 years)
were recruited from an inpatient HIV-rehabilitation unit, and completed cognitive
and executive function batteries.
The executive function profile obtained at group level suggested impairments in
working memory, verbal initiation, verbal inhibition, rule induction, and processing
speed abilities. In contrast letter fluency and visuo-spatial switching scores were
less affected.
Case series analyses indicated that cognitive and executive functioning varied
widely within the participant sample. However verbal initiation and inhibition were
impaired in all profiles, indicating these impairments are prominent in the early
stages of disease.
The findings of this study indicate that it may be beneficial for clinicians to use
executive function batteries when assessing for HAND, since a thorough
assessment of this multi-faceted cognitive domain can support more informed
clinical decision-making. Further, the study suggests which tests may be clinically
useful in detecting executive function deficits in HAND.