Psychiatric symptom burden in older people living with HIV with and without cognitive impairment: the UCSF HIV over 60 cohort study

Abstract

Psychiatric comorbidities are common in people living with HIV (PLWH) and adversely affect life satisfaction, treatment adherence and disease progression. There are few data to inform the burden of psychiatric symptoms in older PLWH, a rapidly growing demographic in the U.S. We performed a cross-sectional analysis to understand the degree to which symptom burden was associated with cognitive disorders in PLWH over age 60. Participants completed a standardized neuropsychological battery and were assigned cognitive diagnoses using Frascati criteria. We captured psychiatric symptom burden using the Geriatric Depression Scale (GDS) and proxy-informed Neuropsychiatric Inventory-Questionnaire (NPI-Q). Those diagnosed with HIV-associated Neurocognitive Disorders (HAND, n = 39) were similar to those without HAND (n = 35) by age (median = 67 years for each group, p = 0.696), education (mean = 16 years vs. 17 years, p = 0.096), CD4+ T-lymphocyte counts (mean = 520 vs. 579, p = 0.240), duration of HIV (median = 21 years for each group, p = 0.911) and sex (92% male in HAND vs. 97% in non-HAND, p = 0.617). Our findings showed similarities in HAND and non-HAND groups on both NPI-Q (items and clusters) and GDS scores. However, there was a greater overall symptom burden in HIV compared to healthy elder controls (n = 236, p < 0.05), with more frequent agitation, depression, anxiety, apathy, irritability and nighttime behavior disturbances (p < 0.05). Our findings demonstrate no differences in psychiatric comorbidity by HAND status in older HIV participants; but confirm a substantial neurobehavioral burden in this older HIV-infected population.

Longitudinal Modeling of Depressive Trajectories Among HIV-Infected Men Using Cocaine

“…While depressive symptoms and cognitive impairment are common co-morbidities in HIV-infection (1, 28, 29, 45, 46), several studies suggest psychiatric and neurocognitive sequelae of HIV-infection are largely independent of each other (69–72). A recent report of depression in older people living with HIV on ART showed that despite greater overall depressive symptom burden among HIV-infected participants compared to HIV-uninfected controls, depressive symptoms were not associated with HIV-associated neurocognitive disorders, suggesting a disconnect between depressive and neurocognitive symptoms in HIV infection (72). Thus, findings in the present study along with studies from the literature highlight that in the context of HIV infection, etiological mechanisms underlying depressive symptoms may be distinct from mechanisms that influence cognitive decline.…”

Differentiating HIV-Associated Neurocognitive Disorders From Alzheimer’s Disease: an Emerging Issue in Geriatric NeuroHIV

“…Through proxy reporting, HIV-infected elders over age 60 more frequently experienced agitation, depression, anxiety, apathy, irritability and sleep difficulties compared to health controls, regardless of cognitive status. [61] Similarly, neuropsychiatric symptoms such as apathy, agitation and anxiety affect more that 80% of AD patients during the course of the disease and may be present at the earliest AD stages, while their severity worsens throughout the disease progression. [62-65] Data from HIV-infected patients with reliable and proximal informants would add greatly to understanding how the symptom and neuropsychiatric presentations of mild disease differs from early AD.…”

Mechanisms of Cognitive Aging in the HIV-Positive Adult

“…Not only are older persons more vulnerable to more persistent depressive symptoms despite treatment [92], but depression in this older population is associated with cognitive impairments in and of itself: in the domains of executive functioning, processing speed, episodic memory, all of which are already impaired by the process of cognitive aging [93, 94]. In HIV-positive adults, this higher incidence of cognitive and mood disorders [95] can also exacerbate risk of substance abuse, relative to younger HIV-positive adults or older HIV-negative adults [96] and the combination of these factors may impact quality of life [97, 98]. Treating mood symptoms without addressing cognitive impairments may be one reason that depression symptoms are less responsive to treatment in older and HIV-positive persons, and more consistent monitoring and treatment of both may lead to better outcomes.…”