Dokument: Die Selbsteinschätzung HIV-positiver Patienten hinsichtlich neurokognitiver Beeinträchtigungen in Korrelation zu den Ergebnissen neuropsychologischer Tests
| Titel: | Die Selbsteinschätzung HIV-positiver Patienten hinsichtlich neurokognitiver Beeinträchtigungen in Korrelation zu den Ergebnissen neuropsychologischer Tests | |||||||
| URL für Lesezeichen: | https://docserv.uni-duesseldorf.de/servlets/DocumentServlet?id=46880 | |||||||
| URN (NBN): | urn:nbn:de:hbz:061-20180910-105146-5 | |||||||
| Kollektion: | Dissertationen | |||||||
| Sprache: | Deutsch | |||||||
| Dokumententyp: | Wissenschaftliche Abschlussarbeiten » Dissertation | |||||||
| Medientyp: | Text | |||||||
| Autor: | Gruber, Raphael [Autor] | |||||||
| Dateien: |
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| Beitragende: | Prof. Dr. Arendt, Gabriele [Gutachter] PD Dr. Neuen-Jacob, Eva [Gutachter] | |||||||
| Stichwörter: | HIV | |||||||
| Dewey Dezimal-Klassifikation: | 600 Technik, Medizin, angewandte Wissenschaften » 610 Medizin und Gesundheit | |||||||
| Beschreibungen: | Ziel dieser Arbeit war es, die Wertigkeit der Selbsteinschätzung von HIV-Patienten hinsichtlich neurokognitiver Beeinträchtigungen zu untersuchen. Für diese Studie wurden aus über 4500 Patienten, die an einer seit 1987 etablierten Kohortenstudie der neurologischen HIV-Ambulanz des Uniklinikums Düsseldorf unter Leitung von Frau Prof. Dr. G. Arendt teilnahmen, insgesamt 791 Patienten eingeschlossen. Grundvoraussetzung war eine HIV-Erkrankung, eine Dokumentation über self-reported deficits (SRDs) und die Teilnahme an einer neuropsychologischen Testbatterie. Die Patienten wurden anhand der objektiven neuropsychologischen Testergebnisse und der Frascati-Kriterien in zwei Kategorien eingeteilt: keine Defizite (NO-Defs) und pathologische Testergebnisse (YES-Defs). Zusätzlich wurden die Patienten anhand von SRDs unterteilt: Selbstbericht über Defizite positiv (YES-SRDs) und keine selbstberichteten Defizite (NO-SRDs). So konnten insgesamt vier Gruppen gebildet und untersucht werden: NO-Defs-NO-SRDs (adäquat gut), YES-Defs-YES-SRDs (adäquat schlecht), NO-Defs-YES-SRDs (Overreporter) und YES-Defs-NO-SRDs (Underreporter). Die Ergebnisauswertung zeigte, dass man mit Hilfe von SRDs weder neurokognitive Beeinträchtigungen sicher genug feststellen noch ausschließen kann. In nur 56,8% der Fälle stimmten die Angaben von SRDs mit den neuropsychologischen Testergebnissen überein. Zusätzlich wurde untersucht, ob gewisse Einflussfaktoren die Selbsteinschätzung der Patienten signifikant beeinflussen. Nur zwei Einflussfaktoren konnten ermittelt werden, die einen signifikanten Einfluss auf die korrekte Selbsteinschätzung der Patienten ausübten; nämlich die Erkrankungsdauer und das Vorhandensein von Depressionen. Je länger Patienten erkrankt waren, desto schlechter gelang deren Selbsteinschätzung und desto häufiger waren Testresultate pathologisch. Je depressiver Patienten waren, desto eingeschränkter war ihre Selbsteinschätzung, und damit waren sie umso häufiger Over- oder Underreporter.
Somit bleibt zusammenfassend festzuhalten, dass self-reported deficits als alleinige Screening-Methode für neurokognitive Defizite bei HIV-positiven Patienten nicht ausreichen. Patienten müssen zusätzlich zu SRDs immer auch neuropsychologisch untersucht werden. Welche Gründe für die insgesamt schlechte Metakognition bei HIV-Patienten verantwortlich sind, konnte in dieser Studie nicht geklärt werden.The objective of this study was to analyze the validity of HIV-patients’ self-assessment with regards to neurocognitive impairments. For this study, a total of 791 out of 4500 patients were included, who participated in a since 1987 established cohort study of the neurological HIV-ambulance of the University Clinical Center Düsseldorf under the direction of Prof. Dr. G. Arendt. The basic prerequisite was a HIV disease, a documentation on self-reported deficits (SRDs) and the participation in a neuropsychological test battery. The patients were divided into two categories on the basis of objective neuropsychological test according to the Frascati-criteria: no deficits (NO-Defs) and pathological test results (YES-Defs). In addition, the patients were divided on the basis of SRDs: self-report on deficits positive (YES-SRDs) and no self-reported deficits (NO-SRDs). As a result of these prerequisites, four groups were formed in total: NO-Defs-NO-SRDs (adequately good), YES-Defs-YES-SRDs (adequately bad), NO-Defs-YES-SRDs (Overreporter) and YES-Defs-NO-SRDs (Underreporter). The evaluation of the results showed that SRDs cannot be used to certainly determine nor to exclude any neurocognitive impairments. In only 56.8% of the cases, the data from SRDs were consistent with the neuropsychological test results. Moreover, it was examined whether certain influencing factors significantly influence the self-assessment of the patients. As the study proved, only two influencing factors were identified; the duration of the HIV infection and the presence of depression. The longer patients were infected, the poorer they did on their self-assessment and the more frequently the results were pathological. Additionally, the more depressed the patients were, the more limited they were in their self-assessment, and thus the more likely they were classified as Over- or Underreporters. In summary, it can be ascertained that self-reported deficits are not sufficient as the sole screening method for neurocognitive deficits of HIV-positive patients. Patients always need to be examined neuropsychological in addition to SRDs. It is important to note that the reasons, which are responsible for the overall poor metacognition in HIV patients, could not be clarified in this study. | |||||||
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| Lizenz: |  Urheberrechtsschutz | |||||||
| Fachbereich / Einrichtung: | Medizinische Fakultät | |||||||
| Dokument erstellt am: | 10.09.2018 | |||||||
| Dateien geändert am: | 10.09.2018 | |||||||
| Promotionsantrag am: | 05.12.2017 | |||||||
| Datum der Promotion: | 28.08.2018 |
