Depression and neurocognitive performance in individuals with HIV/AIDS: 2‐year follow‐up

Abstract

ObjectivesThe aims of this study were to follow a cohort of HIV-infected individuals for 2 years to assess changes in depression and neuropsychological performance over time, to explore the relationship between depression, HIV illness and neuropsychological performance, and to examine the natural history of the effect of highly active antiretroviral therapy (HAART) on depression and neurocognitive performance.Methods HIV-seropositive out-patients were assessed at baseline and at 2-year follow-up. At each assessment, patients were assessed for depression [using the Beck Depression Inventory (BDI) and Structured Clinical Interview (SCID-CV)] and completed a battery of neuropsychological tests including the Cambridge Neuropsychological Test Automated Battery (CANTAB) and the Hopkins HIV Dementia Scale (HDS). ResultsAt baseline, 34.8% scored ! 14 on the BDI [ ! 14 suggests depressive symptoms (DS)]. The SCID-CV revealed that 27% of participants met the criteria for current mood disorder. Seven per cent of the participants' scores on the HDS indicated HIV-associated cognitive changes. Eighty participants were re-tested at 2-year follow-up and were split into two groups based on BDI scores at baseline. CANTAB results revealed that the cohort were significantly impaired on nine of 10 measures compared with age-matched normative data. Neurocognitive performance significantly improved for participants with no DS at baseline, whereas participants with DS at baseline did not show as much improvement. Multivariate analysis revealed that 40% of the change in cognitive performance was attributable to the variables age, AIDS and HAART regimen. ConclusionThese results suggest a significant decline in depression scores and an improvement in several neurocognitive domains over time, with a relationship between HIV illness, HAART, symptoms of depression and neurocognitive performance. Introduction HIV/AIDS has been shown to have detrimental effects on neurocognitive function. Impairment can range from mild cognitive and motor difficulties to AIDS dementia complex (ADC) and is consistent with frontal-subcortical pathology with evidence of decreased attention and concentration, memory problems and psychomotor slowing [1,2]. Neuropsychological impairment is associated with increased mortality risk, increased risk of developing ADC and higher rates of unemployment, and persists in the era of highly active antiretroviral therapy (HAART) [2]. Further, individuals with neuropsychological impairment are at risk of medication nonadherence and poor self-care [3].Numerous investigations have revealed that up to 50% of people with HIV/AIDS experience depression [4][5][6]. Since the introduction of HAART in 1996, a decline in HIV-associated depression has been suggested. Judd et al. [11] assessed HIV-infected participants for symptoms of depression, HIV illness progression and antiretroviral treatment at 6-monthly intervals over 2 years. Antiretroviral medications changed significantly over the study period, with most participants commencing t...

Cognitive function in treated HIV patients

“…42 Other authors reported similar findings in different populations of HIV-infected patients treated with HAART (Table 1). 22,33,35 These observations were supported by the analysis of two cohorts performed before and after the advent of HAART showing no difference in the overall occurrence of HIV dementia and NP abnormalities. 13 Similarly, Cysique et al reported that the prevalence of NP impairment was not different across pre-HAART and HAART eras.…”

“…Interestingly, several interactions with depression scores were noted in this study since patients without depression improved significantly at cognitive testing while those with depression did not. 22 Stable or improving cognition over a 2-year period was also reported in advanced HIVinfected patients. 35 Within the randomized, double-blinded, controlled ACTG 5095 trial, a battery of three NP tests was administered to 303 ARV-naive patients randomly assigned to zidovudine-lamivudine-abacavir or zidovudine-lamivudineefavirenz or zidovudine-lamivudine-abacavir-efavirenz.…”

“…These include hepatitis C, current or previous substance abuse (methamphetamine, narcotics, alcohol, and cocaine), major psychiatric disorders (bipolar illness, schizophrenia, and major depression), CNS opportunistic infections and/or tumors, major stroke, transient ischemic attacks, head injury, multiple sclerosis, and other dementing disorders (Alzheimer's disease). 1,20,22 Finally, aging itself could play a role in contributing to cognitive impairment in patients with HIV infection. 9,12,23 The role of comorbidities has been recently categorized as incidental, contributing, and confounding.…”

HIV infection and psychiatric illness

“…57 In addition, patients who demonstrate depression and cognitive impairment together may not respond well to treatment. 58 Instruments to assess depression that allow one to separate out items describing somatic symptoms from those concerning depressed mood should be used, as somatic symptoms associated with depression may also be caused by HIV infection. 20 Some neuropsychological test may help in differentiating patients with HIV cognitive impairment with and 1 12 20 0 without depression.…”

Computerized testing augments pencil-and-paper tasks in measuring HIV-associated mild cognitive impairment*

“…Further, such testing provides the advantages of standardized administration and scoring with minimal training of evaluators. Existing computerized batteries, such as the CANTAB and Cog-State, are useful for assessment of mild cognitive deficits and for tracking changes in cognition over time [20,21], but neither has been well validated in HIV-infected patients with mild cognitive deficits. In addition, these tests are expensive to purchase and maintain.…”