Multicenter European Prevalence Study of Neurocognitive Impairment and Associated Factors in HIV Positive Patients

Abstract

We conducted a cross-sectional study in 448 HIV positive patients attending five European outpatient clinics to determine prevalence of and factors associated with neurocognitive impairment (NCI) using computerized and pen-and-paper neuropsychological tests. NCI was defined as a normalized Z score ≤−1 in at least 2 out of 5 cognitive domains. Participants’ mean age was 45.8 years; 84% male; 87% white; 56% university educated; median CD4 count 550 cells/mm3; 89% on antiretroviral therapy. 156 (35%) participants had NCI, among whom 26 (17%; 5.8% overall) reported a decline in activities of daily living. Prevalence of NCI was lower in those always able to afford basic needs (adjusted prevalence ratio [aPR] 0.71, 95% confidence interval [CI] 0.54–0.94) or with a university education (aPR 0.72, 95% CI 0.54–0.97) and higher in those with severe depressive symptoms (aPR 1.53, 95% CI 1.09–2.14) or a significant comorbid condition (aPR 1.40, 95% CI 1.03–1.90).

Self-Reported Decline in Everyday Function, Cognitive Symptoms, and Cognitive Function in People With HIV

“…Limitations to CIPHER study methodology and Cogstate in general have been discussed in earlier reports, 11,25 but some deserve further mention here. Notably, selection biases may have arisen as a result of our opportunistic sampling strategy, with patients choosing to participate in the study on the basis of their own concerns and self-perceived cognitive symptoms.…”

“…In our recently published report of the same study population, we showed that severe depressive symptoms were associated with cognitive impairment, particularly on timed tests. 11 A controlled intervention to improve patients' depression or anxiety symptoms might tease out the effect of low of mood on subjective and objective cognitive outcomes.…”

“…We recently reported, along with detailed psychosocial and clinical cofactors, a 35% prevalence of cognitive impairment, of whom more than half met Frascati criteria for ANI and a quarter had confounding conditions, with the remaining 6% having MND or HAD. 11 Participants were recruited opportunistically from May 2011 to January 2013 regardless of symptoms, treatment, and comorbidities. All questionnaires were self-completed in a written format by the participant in the local language, and participants had to be sufficiently cognitively intact to complete study procedures.…”

“…To harmonize our results with Obermeit and others, we included ADLs that had been omitted in our previous analysis, 11 namely planning social activities, reading/watching television, and childcare. The associations of age, sex, ethnic group (white versus other ethnic groups), study site, educational attainment (as ordered categories of primary, secondary, and higher education), employment status (as a categorical variable of in employment, unable to work, or unemployed for other reasons), cognitive function (as a continuous variable by domain and as a mean score), clinical data, and psychosocial variables were estimated by odds ratios (ORs) and 95% confidence intervals (CIs).…”

“…Education, site, and ethnicity have been identified as factors associated with cognitive test scores in an earlier analysis of the same study sample. 11 The second outcome measure was symptom score from the MOS-HIV questionnaire in 5 ordered categories. The base category was defined as asymptomatic (0 points on the questionnaire) and subsequent categories corresponded to 4 quartiles of the remaining values.…”