Effects of HIV-1 infection and aging on neurobehavioral functioning

Cherner, Mariana; Ellis, Ronald J.; Lazzaretto, Deborah; Young, Corinna; Mindt, Monica Rivera; Atkinson, J. Hampton; Grant, Igor; Heaton, Robert K.

doi:10.1097/00002030-200418001-00005

Cited by 42 publications

(40 citation statements)

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“…The current findings extend the line of prior literature suggesting increased risk of neurocognitive decline for older HIVinfected adults, 6,7 at least with regard to certain at-risk groups such as older HIVseropositive Latina/os. Specifically, a number of studies show that older HIV-seropositive individuals tend to perform more poorly across multiple neurocognitive domains (eg, learning, memory, executive functions, motor speed) than their younger HIV-seropositive counterparts and be at increased risk for meeting criteria for HAND.…”

Section: Discussionsupporting

confidence: 88%

“…Specifically, a number of studies show that older HIV-seropositive individuals tend to perform more poorly across multiple neurocognitive domains (eg, learning, memory, executive functions, motor speed) than their younger HIV-seropositive counterparts and be at increased risk for meeting criteria for HAND. 6,7,[31][32][33][34] Similarities have led some to observe that the neurocognitive effects of HIV are actually quite similar to the changes in cognition associated with the normal aging process. 33 Older adults are also at an increased risk for vascular disorders and degenerative disease, as well as immunological changes and expression of apolipoprotein E4 (APOE4), all of which may have a negative impact neurocognitive functioning.…”

Section: Discussionmentioning

confidence: 99%

“…5 Emerging evidence further suggests that older PLWH may be at even higher risk for developing HAND, although this literature remains somewhat equivocal (Cherner et al, 2004;Valcour, 2004). 6,7 A number of factors may potentially confer increased risk of neurocognitive decline in older PLWH, including increased risk for cardiovascular and cerebrovascular pathology, immunological changes, and expression of apolipoprotein E4 (APOE4), among others.…”

Section: Hhs Public Accessmentioning

confidence: 99%

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Aging and HIV/AIDS: Neurocognitive Implications for Older HIV-Positive Latina/o Adults

Mindt¹

2013

PsycEXTRA Dataset

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In recent years, HIV/AIDS populations have become older and increasingly more ethnically diverse. Concurrently, the prevalence of HIV-related neurocognitive (NC) impairment remains high. This study examined the effects of age and ethnicity on NC function in HIV-positive adults. The sample (N = 126; 84 Latina/o and 42 Non-Hispanic White) completed a comprehensive NC battery. Global NC and domain average demographically-corrected t-scores were generated. There were no significant differences between Younger (<50 years) Latina/os and non-Hispanic Whites on Global NC function or NC domains (all p's >.10), with generally small effect sizes. Older Latina/os (≥50 years) were significantly more impaired than Older Non-Hispanic Whites on Correspondence should be addressed to Monica Rivera Mindt, PhD, ABPP-CN, Fordham University, Department of Psychology-DE 322, New York, NY 10024, USA. riveramindt@fordham.edu. 2009. 3,4 Estimates suggest that these trends will continue, 4 and will contribute to the "graying of HIV." HHS Public AccessDespite advancements in treatment, recent research indicates that the prevalence of HIVassociated neurocognitive disorders (HAND) continue to remain as high as 52%, similar to rates reported in the pre-cART era. 5 Emerging evidence further suggests that older PLWH may be at even higher risk for developing HAND, although this literature remains somewhat equivocal (Cherner et al., 2004;Valcour, 2004). 6,7 A number of factors may potentially confer increased risk of neurocognitive decline in older PLWH, including increased risk for cardiovascular and cerebrovascular pathology, immunological changes, and expression of apolipoprotein E4 (APOE4), among others. 8 However, the potential interactions of aging and HIV disease remain poorly understood. 8The risk factors for neurocognitive decline are especially salient for older racial/ethnic minority PLWHA, and this remains an understudied and poorly understood area. Not only has the HIV/AIDS population become older overall, but this population has also become increasingly ethnically diverse. In the US, the Latina/o population is disproportionately impacted by the HIV/AIDS epidemic. Among people 50 years or older in the US, Latina/os are five times as likely as their white counterparts to be living with HIV, 3 and once infected, the HIV-seropositive Latina/o population carries greater disease burden compared to nonHispanic white adults. 9 For instance, HIV-seropositive Latina/o adults have a higher mortality rate, are more likely to die at significantly younger ages, and demonstrate significantly worse executive functioning (even after accounting for relevant covariates such as reading level which is a proxy for quality of education) compared to their non-Hispanic White counterparts. 10,11,12,13 The general US Latina/o population also suffers from myriad other health disparities, including higher rates of stroke, diabetes, obesity, and hypertension. 10,14,15 Within an aging, HIV-seropositive, and ethnically diverse urban cohort similar to tha...

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Section: Hhs Public Accessmentioning

confidence: 99%

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Aging and HIV/AIDS: Neurocognitive Implications for Older HIV-Positive Latina/o Adults

Mindt¹

2013

PsycEXTRA Dataset

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“…It occurs in 30-50% of patients, depending on both the cohort under study and how the impairment is identified [1][2][3][4][5][6][7][8]. The current diagnostic approach is descriptive: HIV-associated neurocognitive disorder (HAND) is termed 'asymptomatic neurocognitive impairment' when found on testing in the absence of symptoms, and 'mild neurocognitive disorder' when both signs and symptoms are present, but are not severe enough to constitute frank dementia [9].…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2011

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Existing tools for rapid cognitive assessment in HIV-positive individuals with mild cognitive deficits lack sensitivity or do not meet psychometric requirements for tracking changes in cognitive ability over time. MethodsSeventy-five nondemented HIV-positive patients were evaluated with the Montreal Cognitive Assessment (MoCA), a brief battery of standardized neuropsychological tests, and computerized tasks evaluating frontal-executive function and processing speed. Rasch analyses were applied to the MoCA data set and subsequently to the full set of data from all tests. ResultsThe MoCA was found to adequately measure cognitive ability as a single, global construct in this HIV-positive cohort, although it showed poorer precision for measuring patients of higher ability. Combining the additional tests with the MoCA resulted in a battery with better psychometric properties that also better targeted the range of abilities in this cohort. ConclusionThis application of modern test development techniques shows a path towards a quick, quantitative, global approach to cognitive assessment with promise both for initial detection and for longitudinal follow-up of cognitive impairment in patients with HIV infection. IntroductionMild cognitive impairment has been increasingly recognized as a common feature of chronic HIV infection, even in patients with good viral control on highly active antiretroviral therapy (HAART) [1]. It occurs in 30-50% of patients, depending on both the cohort under study and how the impairment is identified [1][2][3][4][5][6][7][8]. The current diagnostic approach is descriptive: HIV-associated neurocognitive disorder (HAND) is termed 'asymptomatic neurocognitive impairment' when found on testing in the absence of symptoms, and 'mild neurocognitive disorder' when both signs and symptoms are present, but are not severe enough to constitute frank dementia [9]. The underlying pathophysiology remains poorly understood [10], posing challenges in the everyday management of these mildly affected patients.How should cognitive impairment be detected in routine practice? Should those found to be affected have their HAART regimen changed, to emphasize antiretrovirals with better central nervous system penetration? Should additional therapies, such as anti-excitotoxic agents or drugs targeting neurodegenerative changes, be added to their treatment? If such changes are made, how should the effects be monitored? The answers to such questions require better tools to assess cognition in HIV-infected individuals. The ideal measure should not only establish the diagnosis, but also quantify the severity of impairment. DOI: 10.1111/j.1468-1293.2010.00910.x HIV Medicine (2011 r 2011 British HIV Association 472It should also be free, brief, easy to administer with minimal training by any health professional, and available to clinics where HIV-infected patients receive their care. The present study describes the initial steps in the development of such a method to measure cognition across the intact to mildly impaired ...

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“…Older adults with HIV are particularly vulnerable to CNS dysfunction due to overlapping neuropathological processes common to both normal aging and HIV. A number of studies have demonstrated that older HIV-infected adults have higher prevalence and severity of cognitive abnormality when compared to both younger HIV+ and HIV-seronegative healthy elderly controls [1][2][3][4][5][6][7]. Yet, very few studies have looked within the older HIV cohort to understand factors that may place some older adults at risk for cognitive and functional decline.…”

Section: Introductionmentioning

confidence: 99%

Past Stimulant Abuse is Associated with Reduced Basal Ganglia and Hippocampal Integrity in Older HIV+ Adults: A Diffusion Tensor Imaging Study

AD¹

2011

J AIDS Clin Res

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Effects of HIV-1 infection and aging on neurobehavioral functioning

Cited by 42 publications

References 23 publications

Aging and HIV/AIDS: Neurocognitive Implications for Older HIV-Positive Latina/o Adults

Aging and HIV/AIDS: Neurocognitive Implications for Older HIV-Positive Latina/o Adults

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

Past Stimulant Abuse is Associated with Reduced Basal Ganglia and Hippocampal Integrity in Older HIV+ Adults: A Diffusion Tensor Imaging Study

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