Abstract
Prospective memory (PM) impairment is common and limits daily function among individuals with HIV. We investigated PM and the relationships between PM, clinical characteristics, and cognitive test performance among older adults with HIV. Time-based PM tasks are problematic in this population potentially due to their memory and executive function demands. Thus, OT practitioners should implement compensatory strategies based on event-based PM to increase participation in meaningful activities.
Primary Author and Speaker: Yves Carlo Pinpin
The purpose of this study was to investigate prospective memory (PM) impairment and examine relationships between PM performance, clinical characteristics, and neuropsychological test performance among older adults with Human Immunodeficiency Virus (HIV). PM consists of creating a representation of a future action, temporarily storing that representation, retrieving it at a point in the future, and executing the action. PM impairment occurs in 30%-50% people with HIV and limits the ability to manage antiretroviral medications used to prevent disease progression. To develop or administer interventions that mitigate such negative functional consequences, it is important for occupational therapists to understand the nature of PM impairment in this population. PM falls into two main types: time-based (TB), where the passage of a time period or a particular time serves as the memory trigger, and event-based (EB) where an environmental cue serves as the trigger. It is commonly believed that TB PM is more dependent on the cortical pathways affected by HIV; however, research on PM in people with HIV is limited by reliance on a single outcome measure (the Memory for Intentions Screening Test). To enhance our understanding of PM impairment among people with HIV, we used the computerized Virtual Week (VW) test, an assessment designed to simulate daily PM tasks (e.g. taking medication, buying goods from a store) that require different underlying cognitive processes. This study reports cross-sectional analysis of baseline data from a larger randomized controlled trial examining the effect of exercise on cognition in older adults with HIV. 35 older adults with HIV (age: M = 56, SD = 5.9) completed a neuropsychological testing battery and the VW. Neuropsychological tests included the Hopkins Verbal Learning Test (HVLT), Brief Visuospatial Memory Test-Revised (BVMT-R), Trails A and B, Digit Symbol, Letter Number Sequencing (LNS), F-A-S, and Digit Span Forward/Backward. The VW consisted of 16 PM tasks across 2 virtual days. PM tasks were divided into eight TB tasks and eight TB tasks, each of which had four repeated tasks (the same each day) and four non-repeated tasks (differed each day). Repeated measures ANOVAs compared PM accuracy (% correct) across the four VW task types (i.e. repeated TB, non-repeated TB, repeated EB, non-repeated EB), and Pearson correlations explored relationships between PM performance, neuropsychological test scores, demographics, and clinical characteristics. A p value < 0.05 was considered significant. EB PM (M = 47%, SD = 28%) was better than TB PM (M = 29%, SD = 24%) (p = 0.001) regardless of task repetition. Multiple neuropsychological tests of memory and executive function (i.e. HVLT, BVMT-R, Trails B-A [measure of task switching], Digit Symbol, LNS, and F-A-S) related to time-based PM (r > 0.34, p < 0.05). There were no relationships with EB PM, demographic or clinical characteristics. We found that TB PM is particularly problematic for people with HIV, potentially due to its memory and executive function demands. These findings suggest that occupational therapists should focus on providing EB, or environmental, PM cues for people with HIV as a compensatory strategy. This may improve the performance of important daily PM tasks like medication adherence and enhance overall health and well-being. Practitioners should also consider the impact of decreased executive function and memory on daily activities among older adults with HIV.
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