New Study Of HIV−Associated Neurocognitive Disorders (HAND) Uses An Innovative Approach To Functional Assessments For Activities Of Daily Living And Correlates To Cogstate Test Performance 

November 23, 2017

JINSNavigating the Internet to get daily shopping and banking tasks done has become a necessary skill for just about all of us. Searching for products, comparing pricing, entering credit card and shipping information across multiple websites can sometimes be challenging even for experienced users. But for those persons who also struggle with cognitive dysfunction from different health conditions, getting those necessary activities accomplished can be confusing.

A new study, published in the Journal of the International Neuropsychological Society, looked specifically at HIV patients who also suffered from HIV-associated neurocognitive disorders (HAND), which may affect these instrumental activities of daily living (IADL).

Affecting one third to one half of HIV patients, HAND is a progressive complication that can cause cognitive, motor and behavioral difficulties. The spectrum ranges from asymptomatic neurocognitive impairment (ANI), found only by neurocognitive testing, to mild neurocognitive disorder (MND), which includes mild functional impairment, to HIV-associated dementia (HAD), which involves moderate to severe dysfunction in daily life.

While HAND has been studied extensively for limitations in the physical world, the difficulties of online transactions has been examined only recently. HIV patients must increasingly manage their health care using the internet for research gathering, appointment scheduling, medication ordering and social networking support. In addition, as their mobility is reduced, more of their financial transactions must also be handled online.

Those HIV patients with neurocognitive deficits may struggle to complete these internet-based daily living activities. To better understand their challenges, specifically with online shopping and banking, a research group recruited 134 participants divided into three primary cohorts; HIV-, HIV+ without HAND and HIV+ with HAND.

Two web-based tests were used to assess Internet skills; the Simulated Market Task (S-MarT), and the Web-based Evaluation of Banking Skills (WEBS). The S-MarT website is designed to mimic popular e-commerce sites, like, with product pages, search boxes, pricing information and a shopping cart. Participants were given a shopping list of eight items (cold medicine, a dress shirt, etc.) that they had to locate, add to the shopping cart and purchase (with a simulated credit card) within a certain budget and timeframe (40 min). With over 60 web pages and 325 individual items, not to mention pop-up messages, the website is complex enough to simulate a real online shopping experience.

Similarly, the WEBS website was modeled on a major bank’s website and included full functionality to login, check balances, transfer money and add reminders. The study participants were asked to complete five tasks on the site within 20 minutes, including a money transfer, setup of an automatic bill pay, pay off a credit card, check balances and review a list of account transactions looking for an obvious error.

To measure the participants’ neurocognitive correlates to the shopping and banking tasks, pencil and paper tests and/or computerized tests from Cogstate were used across seven domains including motor skills, processing speed, attention/working memory, learning, memory, verbal fluency and executive functions.

“Findings from the current study suggest that persons with HAND struggle to perform fundamental Internet-based tasks, which may have detrimental downstream effects on their day to day household management,” reported the researchers. “Specifically, HAND status was independently associated with poorer scores on Internet-based tasks of shopping and financial management that required participants to independently navigate Web sites to perform typical transactions, such as purchase goods and pay household bills.”

In fact, the participants with HAND were about 10 to 14 times more likely to fail S-MarT tasks as compared to the two groups without HAND, who showed very little difficulty with online shopping. Those with HAND were not necessarily slower completing the tasks or made more errors on the site, they often just did not buy everything that was on the list, which was prominently displayed in front of them.

Also, the shopping and banking skills were strongly correlated with higher-order cognitive functions, including executive function, but not attention or processing speed.

“This is a completely innovative approach to understanding functional disability,” commented Paul Maruff, PhD, Chief Scientific Officer for Cogstate. “It shows that even subtle impairment in cognition can limit individuals ability to operate in modern environments.”

Going forward, the researchers recommend further research into website designs that make these activities easier for those customers with cognitive deficits:

“Such research efforts may be conducted with an eye toward the development and validation of Internet navigation training and compensatory rehabilitation strategies that are maximally effective for persons with neurocognitive disorders. Findings may also inform the creation, deployment, and local testing of Web designs that consider the potential pitfalls experienced by persons with neurocognitive disorders.”

Questions or comments?  Please contact Rachel Colite

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