Undiagnosed Cognitive Impairment and Impact on Instrumental Activities of Daily Living Among People With HIV Infection in Primary Care

Abstract

Background Little is known about the prevalence of undiagnosed cognitive impairment and its impact on instrumental activities of daily living (IADL) among people with HIV (PWH) in primary care Setting U.S. integrated healthcare system Methods PWH were recruited from an integrated healthcare setting. PWH were eligible for recruitment if they were ≥50 years old, taking antiretroviral therapy (i.e., ≥1 ART prescription fill in the past year), and had no clinical diagnosis of dementia. Participants completed a cognitive screen (St. Louis University Mental Status exam) and a questionnaire on IADL (modified Lawton-Brody). Results Study participants (N=47) were mostly male (85.1%), 51.1% White, 25.5% Black, 17.0% Hispanic, and the average age was 59.7 years (standard deviation, SD=7.0 years). Overall, 27 (57.5%) participants were categorized as cognitively normal, 17 (36.2%) as having mild cognitive impairment, and 3 (6.4%) as having possible dementia. Of the 20 participants with mild cognitive impairment or possible dementia, 85.0% were men, the average age was 60.4 years (SD=7.1 years); 45.0% were White, 40.0% were Black, 10.0% were Hispanic, and 30.0% reported difficulty with at least one IADL. Most (66.7%) attributed difficulty with IADL primarily (33.3%) or in part (33.3%) to cognitive problems. Conclusion Undiagnosed cognitive impairment is frequent among ART-treated PWH, with possible elevated risk among Black PWH, and may be accompanied by difficulty with IADL. Efforts are needed to optimize identification of factors contributing to cognitive and IADL difficulties among ART-treated PWH in primary care.