Cognitive Performance and Frailty in Older HIV-Positive Adults

Paul, Robert; Cooley, Sarah; García-Egan, P; Ances, Beau M.

doi:10.1097/qai.0000000000001790

Cited by 34 publications

(20 citation statements)

References 57 publications

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“…Participants completed a NP battery designed to assess cognitive domains frequently affected by HIV. 25 Fifteen NP tests were completed representing 5 domains: learning, recall, executive function, motor/psychomotor speed, and language. Raw scores were converted into demographically adjusted (age, sex, race, and education) z-scores using published normative standards and averaged into domain-specific z-scores.…”

Section: Methodsmentioning

confidence: 99%

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Effects of Framingham 10-Year Cardiovascular Risk Score and Viral Load on Brain Integrity in Persons With HIV

Glans

Cooley

Vaida

et al. 2022

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Background: Combination antiretroviral therapy (cART) has allowed for viral load (VL) suppression and increased life expectancy for persons with HIV (PWH). Altered brain integrity, measured by neuropsychological (NP) performance and neuroimaging, is still prevalent among virally suppressed PWH. Age-related conditions such as cardiovascular disease may also affect brain integrity. This study investigated the effects of cardiovascular risk, VL, and HIV serostatus on cerebral blood flow (CBF), brain volumetrics, and cognitive function in PWH and persons without HIV (PWoH).Methods: Ten-year cardiovascular risk, using the Framingham Heart Study criteria, was calculated in PWH (n = 164) on cART with undetectable (#20 copies/mL; n = 134) or detectable (.20 copies/mL; n = 30) VL and PWoH (n = 66). The effects of cardiovascular risk on brain integrity (CBF, volume, and cognition) were compared for PWH (undetectable and detectable VL) and PWoH.Results: PWH had smaller brain volumes and worse NP scores than PWoH. PWH with detectable and undetectable VL had similar brain integrity measures. Higher cardiovascular risk was associated with smaller volumes and lower CBF in multiple brain regions for PWH and PWoH. Significant interactions between HIV serostatus and cardiovascular risk on brain volumes were observed in frontal, orbitofrontal, and motor regions. Cardiovascular risk was not associated with cognition for PWH or PWoH. Conclusions:Neuroimaging, but not cognitive measures, was associated with elevated cardiovascular risk. HIV serostatus was associated with diminished brain volumes and worse cognition while CBF remained unchanged, reflecting potential protective effects of cART. Neuroimaging measures of structure (volume) and function (CBF) may identify contributions of comorbidities, but future longitudinal studies are needed.

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Section: Methodsmentioning

confidence: 99%

“…Raw scores were converted into demographically adjusted (age, sex, race, and education) z-scores using published normative standards and averaged into domain-specific z-scores. 25,26 Domains were then averaged to create a global z-score. Only participants who completed at least 10 of 15 NP tests were included.…”

Section: Np Evaluationsmentioning

confidence: 99%

Effects of Framingham 10-Year Cardiovascular Risk Score and Viral Load on Brain Integrity in Persons With HIV

Glans

Cooley

Vaida

et al. 2022

JAIDS Journal of Acquired Immune Deficiency Syndromes

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“…Participants completed a comprehensive neuropsychological battery designed to assess cognitive impairment in PLWH. 25 Fifteen standard tests were administered, which represented 5 cognitive domains: learning, retention, executive functioning, motor/psychomotor speed, and language. Raw scores were transformed into Z scores adjusted for appropriate demographics (age, sex, race, and education).…”

Section: Methodsmentioning

confidence: 99%

Relationships Between Viral Load, Neuroimaging, and NP in Persons Living With HIV

Cooley

Navid

Wisch

et al. 2021

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Background: This study examined whether recommended viral load (VL) classifications by the Department of Health and Human Services map onto changes in brain integrity observed in people living with HIV (PLWH).Methods: Three hundred forty-nine PLWH on combination antiretroviral therapy meeting criteria for virologic suppression (VS) (VL # 20 copies/mL; n = 206), "low-level viremia" (20-200 copies/mL; n = 63), or virologic failure (VF) (.200 copies/mL; n = 80) and 195 demographically similar HIV-negative controls were compared for cognition and brain volumes from 10 regions of interest that are sensitive to HIV. Changes in cognition and brain volumes were examined in a subset of PLWH (n = 132) who completed a follow-up evaluation (mean interval = 28 months) and had no change in treatment regimen.Results: Significant differences in cognition and brain volumes were observed between the HIV-negative control and VS groups compared with those in the VF groups, with few differences observed between the 3 PLWH subgroups. Longitudinally, PLWH who continued to have VF exhibited a greater decline in cognition and brain volumes compared with PLWH who remained with VS. Observed longitudinal changes in cognition correlated with brain volume changes. Conclusion:PLWH with continued VF (consecutive VL measurements of .200 copies/mL) represent a cause for clinical concern and may benefit from change in treatment in addition to consideration of other potential etiologies of VF to reduce loss of brain integrity.

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“…Raw test scores were converted into demographically adjusted (age, sex, race, and education) standardized z scores using appropriate normative standards (see Table, Supplemental Digital Content 1, http:// links.lww.com/QAI/B783, which summarizes results of individual cognitive tests). 27,28 The Z scores were averaged to create domain Z scores. The 4 domain Z scores were then averaged to create an overall cognition Z score.…”

Section: Neuropsychological Performance Measurementmentioning

confidence: 99%

“…Participants were administered an NP battery designed to assess cognitive domains commonly affected by HIV. 27 The battery consisted of 14 tests representing 4 cognitive domains: learning, memory, executive function, and psychomotor/processing speed. Raw test scores were converted into demographically adjusted (age, sex, race, and education) standardized z scores using appropriate normative standards (see Table, Supplemental Digital Content 1, http:// links.lww.com/QAI/B783, which summarizes results of individual cognitive tests).…”

Section: Neuropsychological Performance Measurementmentioning

confidence: 99%

Cardiorespiratory Fitness Is Associated With Better White Matter Integrity in Persons Living With HIV

Kilgore

Strain

Nelson

et al. 2022

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Background: Despite improved survival rates, neurocognitive impairment persists in persons living with HIV (PLWH). An active lifestyle is linked to improved cognition among PLWH, yet the neural substrates remain unclear. Diffusion tensor imaging and diffusion basis spectrum imaging measure HIV-related changes in brain white matter integrity. We used these measures of structural brain integrity to assess white matter changes, physical fitness, and cognition in a cross-sectional study of PLWH.Methods: Forty-four virologically well-controlled PLWH were recruited (average age of 56 years, a median recent CD4 + count of 682 cells/mm 3 ). Diffusion tensor imaging -derived fractional anisotropy (FA) and diffusion basis spectrum imaging-derived axonal density were calculated. Cardiorespiratory fitness [maximal volume of oxygen consumption (VO 2 max)] was measured by performing indirect calorimetry during exercise to volitional exhaustion. Cardiovascular risk was assessed by the Framingham risk score. Neuropsychological performance (NP) testing evaluated learning, memory, psychomotor/processing speed, and executive function. Partial correlations assessed the relationships among cardiorespiratory fitness, neuroimaging, NP, and HIV clinical metrics (CD4 + count and time since diagnosis).Results: Higher VO 2 max was associated with higher FA and higher axonal density in multiple white matter tracts, including the corticospinal tract and superior longitudinal fasciculus. Better NP in the motor/psychomotor domain was positively associated with FA and axonal density in diverse tracts including those associated with motor and visuospatial processing. However, higher VO 2 max was not associated with NP or HIV clinical metrics.Conclusions: An active lifestyle promoting cardiorespiratory fitness may lead to better white matter integrity and decreased susceptibility to cognitive decline in virologically wellcontrolled PLWH.

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Cognitive Performance and Frailty in Older HIV-Positive Adults

Abstract: These results emphasize the importance of sex distribution and mental health in explanatory models of frailty in HIV. Further, interventions targeting symptoms of depression may increase resilience in older HIV+ individuals.

Cited by 34 publications

References 57 publications

Effects of Framingham 10-Year Cardiovascular Risk Score and Viral Load on Brain Integrity in Persons With HIV

Effects of Framingham 10-Year Cardiovascular Risk Score and Viral Load on Brain Integrity in Persons With HIV

Relationships Between Viral Load, Neuroimaging, and NP in Persons Living With HIV

Cardiorespiratory Fitness Is Associated With Better White Matter Integrity in Persons Living With HIV

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