Browsing by Author "Faytell, Marika P."
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Item Investigating the Interrelationships between Fatigue, Memory Impairment, and Medication Adherence among Persons Living with HIV Disease(2017-05) Faytell, Marika P.; Woods, Steven P.; Massman, Paul J.; Neighbors, Clayton; Crutchley, Rustin D.Fatigue and memory impairment are each highly prevalent in HIV disease (e.g., Heaton et al., 2011; Jong et al., 2010), and exert independent influences on adherence to antiretroviral therapy. However, the combined effects of fatigue and memory impairments on adherence, as well as possible modulating factors of these effects, remain unknown. This study adopted the Aaronson et al. (1999) model of fatigue, which predicts that fatigue depletes compensatory resources, thus leaving HIV+ individuals vulnerable to the impact of memory impairment on adherence. The first aim was to determine the best-fitting model of the relationships between fatigue, compensatory strategy use, retrospective and prospective memory, and adherence. The second aim was to assess whether changes in fatigue, strategy use, and memory were associated with changes in perceived medication management efficacy over one year. Study participants included 177 HIV+ persons who completed a semi-structured clinical interview, comprehensive neurocognitive battery, a series of questionnaires, and a physical evaluation. cART adherence was obtained behaviorally with MEMS caps and by self-report of medication management. Readministration of these assessments (except for the MEMS) was conducted with 57 participants at follow-up about one year later. Structural equation modeling revealed that adherence was most parsimoniously represented by contributions from measures of perceived medication management efficacy and MEMS. In the first aim, the data were fit best by a model comprised of direct and covarying negative effects of fatigue and strategy use on adherence, which were independent from a direct positive effect of prospective memory (controlled for retrospective memory) on adherence. In the second aim, data were fit best by a model comprised of changes in fatigue and strategy use, but not prospective memory, as significant covariates of change in perceived medication management efficacy. These data revealed dynamic interplay between fatigue, strategy use, and perceived efficacy, with separate and stable contributions of prospective memory to perceived efficacy. These and prior findings are discussed in the context of metacognitive awareness. Ultimately, enhanced understanding of these relationships provides valuable clinical information that can inform efforts to (1) improve patient-specific targeting of fatigue-related assessments and interventions; and (2) develop effective interventions for bolstering adherence in seropositive populations.Item Using Disability Rating Scale Recovery Curves to Predict PASAT Performance After Closed Head Injury(2014-12) Faytell, Marika P.; Hannay, H. Julia; Massman, Paul J.; Taylor, Pat; McCauley, Stephen R.Objective: Existing predictive models of cognitive outcome following closed head injury have been largely based on a single time-point. Using archival data, the current study sought to improve upon existing models by predicting cognitive outcome at six months post-injury from a model of the rate of recovery of global functioning over four time-points: hospital discharge, one, three and six months post-injury. Participants and Method: Data from 91 individuals with complicated mild, moderate, and severe closed head injury who had participated in CPHS approved, NIH funded research that involved the collection of global outcome data and neuropsychological testing at six months post injury were used. Disability Rating Scale (DRS) scores from discharge, one, three and six months post-injury were selected along with Paced Auditory Serial Addition Test (PASAT) scores at six months post injury. The PASAT is a task that involves multiple cognitive domains, including processing speed, sustained and divided attention, and working and immediate memory. . Growth curve analysis was used to fit individual growth curves to the DRS scores and then to produce a best-fit recovery curve model. The utility of this model for predicting PASAT scores at six months was determined. Age and severity of injury variables were then added to the model to determine their utility for predicting PASAT scores at six months. Results: Statistical analyses revealed that only the intercept of the DRS recovery curves significantly predicted PASAT performance at six months post-injury. This finding suggested that only the level of DRS score at one month post-injury, and not the trajectory of recovery, was predictive of later PASAT performance. Higher DRS scores, indicated by larger intercepts, were associated with worse PASAT performance. Age was observed to significantly moderate the relationship between the intercept of the DRS recovery curve and PASAT performance at six months post-injury. Other demographic and severity of injury variables were not observed to significantly moderate the relationship between the intercept of the DRS recovery curves and PASAT performance. Conclusion: The change of DRS scores over time was fit best by a quadratic growth curve model with random intercept, linear and curvilinear parameters. Only initial DRS scores were significant predictors of later cognitive performance. Age was the only significant moderator of the relationship between initial DRS scores and PASAT performance. Future research could utilize the current study methodology to evaluate the ability of DRS recovery curves to predict performance on less cognitively demanding neuropsychological tests.