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Open Access 01-02-2011

Successful cognitive aging in persons living with HIV infection

Authors: Lauren Malaspina, Steven Paul Woods, David J. Moore, Colin Depp, Scott L. Letendre, Dilip Jeste, Igor Grant, The HIV Neurobehavioral Research Programs (HNRP) Group

Published in: Journal of NeuroVirology | Issue 1/2011

Abstract

The number of older adults living with human immunodeficiency virus (HIV) infection is growing and this subpopulation of the epidemic is at heightened risk for a variety of poor health outcomes including HIV-associated neurocognitive disorders. The current study sought to examine the factors associated with freedom from neurocognitive impairment in older HIV-infected adults. Participants included 74 middle-aged and older (mean age 51 years), HIV-infected individuals with a mean estimated duration of infection of 17 years who underwent comprehensive neuropsychological, psychiatric, and medical evaluations. Successful cognitive aging (SCA) was operationally defined as the absence of neurocognitive deficits as determined by a battery of well-validated cognitive tests and self-endorsed cognitive complaints. Thirty-two percent of the cohort met these criteria. Compared to the group that did not meet these criteria, successful cognitive agers had significantly lower lifetime rates of major depressive disorder and current affective distress (e.g., depression, anxiety). Moreover, the SCA group evidenced better everyday functioning outcomes, including medication adherence, lower self-reported rates of declines in activities of daily living, and superior abilities related to medication management and dealing with healthcare providers. SCA was not related to demographic composition, HIV disease or treatment factors, medical comorbidities, or histories of substance use disorders. Findings from this preliminary study suggest that approximately one-third of older persons with HIV were free of cognitive impairments, which is associated with more favorable emotional, psychosocial, and everyday functioning.

Aguero-Torres H, von Strauss E, Viitanen M, Winblad B, Fratiglioni L (2001) Institutionalization in the elderly: the role of chronic diseases and dementia. cross-sectional and longitudinal data from a population-based study. J Clin Epidemiol 54(8):795–801CrossRefPubMed

American Psychiatric Association (1994) Diagnostic and statistical manual of mental disorders, 4th edn. American Psychiatric Association, Washington, DC

Antinori A, Arendt G, Becker JT, Brew BJ, Byrd DA, Cherner M et al (2007) Updated research nosology for HIV-associated neurocognitive disorders. Neurology 69(18):1789–1799CrossRefPubMed

Bamford LP, Ehrenkranz PD, Eberhart MG, Shpaner M, Brady KA (2010) Factors associated with delayed entry into primary HIV medical care after HIV diagnosis. AIDS 24(6):928–930CrossRefPubMed

Basso MR, Bornstein RA (2000) Estimated premorbid intelligence mediates neurobehavioral change in individuals infected with HIV across 12 months. J Clin Exp Neuropsychol 22:208–218CrossRefPubMed

Becker JT, Lopez OL, Dew MA, Aizenstein HJ (2004) Prevalence of cognitive disorders differs as a function of age in HIV virus infection. AIDS 18(Suppl 1):S11–S18PubMed

Becker JT, Kingsley L, Mullen J, Cohen B, Martin E, Miller EN et al (2009) Vascular risk factors, HIV serostatus, and cognitive dysfunction in gay and bisexual men. Neurology 73(16):1292–1299CrossRefPubMed

Blazer DG (2006) Successful aging. Am J Geriatr Psychiatry 14(1):2–5CrossRefPubMed

Burns SM, Young LRL, Maniss S (2006) Predictors of employment and disability among people living with HIV/AIDS. Rehabil Psychol 51(2):127–134CrossRef

Centers for Disease Control and Prevention (2008a) HIV surveillance report. Centers for Disease Control and Prevention, Atlanta

Centers for Disease Control and Prevention (2008b) HIV/AIDS among persons aged 50 and older. Centers for Disease Control and Prevention, Atlanta

Cherner M, Ellis RJ, Lazzaretto D, Young C, Mindt MR, Atkinson JH et al (2004) Effects of HIV-1 infection and aging on neurobehavioral functioning: preliminary findings. AIDS 18(Suppl 1):S27–S34PubMed

Chodosh J, Kado DM, Seeman TE, Karlamangla AS (2007) Depressive symptoms as a predictor of cognitive decline: MacArthur studies of successful aging. Am J Geriatr Psychiatry 15(5):406–415CrossRefPubMed

Cole MA, Margolick JB, Cox C, Li X, Selnes OA, Martin EM et al (2007) Longitudinally preserved psychomotor performance in long-term asymptomatic HIV-infected individuals. Neurology 69(24):2213–2220CrossRefPubMed

Cysique LA, Deutsch R, Atkinson JH, Young C, Marcotte TD, Dawson L et al (2007) Incident major depression does not affect neuropsychological functioning in HIV-infected men. J Int Neuropsychol Soc 13(1):1–11CrossRefPubMed

Daffner KR (2010) Promoting successful cognitive aging: a comprehensive review. J Alzheimers Dis 19(4):1101–1122PubMed

Department of Economic and Social Affairs Population Division (2009) World population ageing 2009. United Nations, New York

Depp CA, Jeste DV (2006) Definitions and predictors of successful aging: a comprehensive review of larger quantitative studies. Am J Geriatr Psychiatry 14(1):6–20CrossRefPubMed

Depp C, Vahia I, Jeste DV (2010) Successful aging: focus on cognitive and emotional health. Annu Rev Clin Psychol 6:527–550CrossRefPubMed

Egger M, May M, Chene G, Phillips AN, Ledergerber B, Dabis F et al (2002) Prognosis of HIV-1-infected patients starting highly active antiretroviral therapy: a collaborative analysis of prospective studies. Lancet 360(9327):119–129CrossRefPubMed

Erdfelder E, Faul F, Buchner A (1996) GPOWER: a general power analysis program. Behav Res Meth Instrum Comput 28:1–11CrossRef

Ernst T, Chang L (2004) Effect of aging on brain metabolism in antiretroviral-naive HIV patients. AIDS 18(Suppl 1):S61–S67PubMed

Ettenhofer ML, Hinkin CH, Castellon SA, Durvasula R, Ullman J, Lam M et al (2009) Aging, neurocognition, and medication adherence in HIV infection. Am J Geriatr Psychiatry 17(4):281–290CrossRefPubMed

Ettenhofer ML, Foley J, Castellon SA, Hinkin CH (2010) Reciprocal prediction of medication adherence and neurocognition in HIV/AIDS. Neurology 74(15):1217–1222CrossRefPubMed

Fiocco AJ, Yaffe K (2010) Defining successful aging: the importance of including cognitive function over time. Arch Neurol 67(7):876–880CrossRefPubMed

Foley J, Ettenhofer M, Wright MJ, Siddiqi I, Choi M, Thames AD et al (2010) Neurocognitive functioning in HIV-1 infection: effects of cerebrovascular risk factors and age. Clin Neuropsychol 24(2):265–285CrossRefPubMed

Gardner ID (1980) The effect of aging on susceptibility to infection. Rev Infect Dis 2(5):801–810PubMed

Heaton RK, Marcotte TD, Mindt MR, Sadek J, Moore DJ, Bentley H et al (2004) The impact of HIV-associated neuropsychological impairment on everyday functioning. J Int Neuropsychol Soc 10(3):317–331CrossRefPubMed

Hinkin CH, Castellon SA, Durvasula RS, Hardy DJ, Lam MN, Mason KI et al (2002) Medication adherence among HIV+adults: effects of cognitive dysfunction and regimen complexity. Neurology 59:1944–1950PubMed

Hinkin CH, Hardy DJ, Mason KI, Castellon SA, Durvasula RS, Lam MN, Stefaniak M (2004) Medication adherence in HIV-infected adults: effect of patient age, cognitive status, and substance abuse. AIDS 18(Suppl 1):S19–S25PubMed

Hoare J, Fouche JP, Spottiswoode B, Joska JA, Schoeman R, Stein DJ, Carey PD (2010) White matter correlates of apathy in HIV-positive subjects: a diffusion tensor imaging study. J Neuropsychiatry Clin Neurosci 22(3):313–320PubMed

Hollingshead AB (1975) Four-factor index of social status. Unpublished manuscript. Yale University, New Haven

Jernigan TL, Gamst AC, Archibald SL, Fennema-Notestine C, Rivera Mindt M, Marcotte TD et al (2005) Effects of methamphetamine dependence and HIV infection on cerebral morphology. Am J Psychiatry 162:1461–1472CrossRefPubMed

Kissel EC, Pukay-Martin ND, Bornstein RA (2005) The relationship between age and cognitive function in HIV-infected men. J Neuropsychiatry Clin Neurosci 17(2):180–184PubMed

Lamond A, Depp CA, Reichstadt J, Moore DJ, Golshan S, Jeste DV (2008) Measurement and predictors of resilience in older adults. J Psychiatr Res 43:148–154CrossRefPubMed

Larussa D, Lorenzini P, Cingolani A, Bossolasco S, Grisetti S, Bonglovanni M et al (2006) HAART reduces the age-associated risk of dementia in a cohort of older HIV-1-infected patients. AIDS Res Hum Retroviruses 22:386–392CrossRefPubMed

Lawton MP, Brody EM (1969) Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist 9(3):179–186PubMed

Lopardo GD, Bissio E, Iannella Mdel C, Crespo AD, Garone DB, Cassetti LI (2009) Good neurocognitive performance measured by the international HIV dementia scale in early HIV-1 infection. J Acquir Immune Defic Syndr 1999 52(4):488–492CrossRef

Marcotte TD, Grant I (2010) Neuropsychology of everyday functioning. The Guilford Press

McDonald-Miszczak L, Maris P, Fitzgibbon T, Ritchie G (2004) A pilot study examining older adults’ beliefs related to medication adherence: the BERMA survey. J Aging Health 16(5):591–614CrossRefPubMed

McNair DM, Lorr M, Droppleman LF (1981) Manual for the profile of mood states. Educational and Industrial Testing Service, San Diego

Mocchetti I, Bachis A, Masliah E (2008) Chemokine receptors and neurotrophic factors: potential therapy against aids dementia? J Neurosci Res 86(2):243–255CrossRefPubMed

Montross LP, Depp CA, Daly J, Golshan S, Moore DJ, Sitzer DI, Jeste DV (2006) Defining successful aging: comparing self-ratings with different sets of criteria. Am J Geriatr Psychiatry 14:43–51CrossRefPubMed

Morgan EE, Woods SP, Scott JC, Childers M, Marquie-Beck J, Ellis RJ, Grant I, Heaton RK, The HNRC Group (2008) Predictive validity of demographically-adjusted normative standards for the HIV Dementia Scale. J Clin Exp Neuropsychol 30:83–90CrossRefPubMed

Nyenhuis DL, Yamamoto C, Luchetta T, Terrien A, Parmentier A (1999) Adult and geriatric normative data and validation of the profile of mood states. J Clin Psychol 55(1):79–86CrossRefPubMed

Onen NF, Overton ET, Seyfried W, Stumm ER, Snell M, Mondy K, Tebas P (2010) Aging and HIV infection: a comparison between older HIV-infected persons and the general population. HIV Clin Trials 11(2):100–109CrossRefPubMed

Paul R, Flanigan TP, Tashima K, Cohen R, Lawrence J, Alt E et al (2005) Apathy correlates with cognitive function but not CD4 status in patients with human immunodeficiency virus. J Neuropsychiatry Clin Neurosci 17(1):114–118PubMed

Phillips AN, Lee CA, Elford J, Webster A, Janossy G, Timms A, Bofill M, Kernoff PB (1991) More rapid progression to AIDS in older HIV-infected people: the role of CD4+ T-cell counts. J Acquir Immune Defic Syndr 4(10):970–975PubMed

Psychological Corporation (2001) Wechsler test of adult reading. Psychological Corporation, San Antonio

Rourke SB, Halman MH, Bassel C (1999) Neurocognitive complaints in HIV-infection and their relationship to depressive symptoms and neuropsychological functioning. J Clin Exp Neuropsychol 21(6):737–756CrossRefPubMed

Sacktor N, Skolasky R, Selnes OA et al (2007) Neuropsychological test profile differences between young and old human immunodeficiency virus-positive individuals. J Neurovirol 13(3):203–209CrossRefPubMed

Scott JC, Woods SP, Weber E, Carey CL, Dawson M, Bondi M, Grant I, The HNRC Group (in press) Neurocognitive consequences of HIV infection in older adults: an evaluation of the “cortical” hypothesis. AIDS Behav

Sevigny JJ, Albert SM, McDermott MP, McArthur JC, Sacktor N, Conant K et al (2004) Evaluation of HIV RNA and markers of immune activation as predictors of HIV-associated dementia. Neurology 63(11):2084–2090PubMed

Shen JM, Blank A, Selwyn PA (2005) Predictors of mortality for patients with advanced disease in an HIV palliative care program. J Acquir Immune Defic Syndr 40(4):445–447CrossRefPubMed

Smith G (2006) Aging hearing: HIV over fifty, exploring the new threat. Senate Committee on Aging, Washington, DC

Stern Y (2003) The concept of cognitive reserve: a catalyst for research. J Clin Exp Neuropsychol 25(5):589–593CrossRefPubMed

Stern RA, Silva SG, Chaisson N, Evans DL (1996) Influence of cognitive reserve on neuropsychological functioning in asymptomatic human immunodeficiency virus-1 infection. Arch Neurol 53(2):148–153PubMed

Sumowski JF, Chiaravalloti N, DeLuca J (2009) Cognitive reserve protects against cognitive dysfunction in multiple sclerosis. J Clin Exp Neuropsychol 31(8):913–926CrossRefPubMed

Thames AD, Kim MS, Becker BW, Foley JM, Hines LJ, Singer EJ et al (in press) Medication and finance management among HIV-infected adults: the impact of age and cogntion. J Clin Exp Neuropsychol

Tomaszewski Farias S, Cahn-Weiner DA, Harvey DJ, Reed BR, Mungas D, Kramer JH, Chui H (2009) Longitudinal changes in memory and executive functioning are associated with longitudinal change in instrumental activities of daily living in older adults. Clin Neuropsychol 23(3):446–461CrossRefPubMed

Valcour V, Shikuma C, Shiramizu B, Watters M, Poff P, Selnes O, Holck P, Grove J, Sacktor N (2004) Higher frequency of dementia in older HIV-1 individuals: the Hawaii aging with HIV-1 cohort. Neurology 63(5):822–827PubMed

Vahia IV, Meeks TW, Thompson WK, Depp CA, Zissok S, Allison M et al (2009) Subthreshold depression and successful aging in older women. Am J Geriatr Psychiatry 8:212–220

Vahia I, Depp C, Palmer B, Fellows I, Golshan S, Thompson W, Allison M, Jeste D (in press) Correlates of spirituality in older women. Aging Ment Health

Woods SP, Rippeth JD, Frol AB, Levy JK, Ryan E, Soukup VM et al (2004) Interrater reliability of clinical ratings and neurocognitive diagnoses in HIV. J Clin Exp Neuropsychol 26(6):759–778CrossRefPubMed

Woods SP, Iudicello JE, Moran LM, Carey CL, Dawson MS, Grant I et al (2008a) HIV-associated prospective memory impairment increases risk of dependence in everyday functioning. Neuropsychology 22:110–117CrossRefPubMed

Woods SP, Moran LM, Carey CL, Dawson MS, Iudicello JE, Gibson S et al (2008b) Prospective memory in HIV infection: Is “remembering to remember” a unique predictor of self-reported medication management? Arch Clin Neuropsychol 23:257–270CrossRefPubMed

Woods SP, Dawson MS, Weber E, Gibson S, Grant I, Atkinson JH, HNRC Group (2009) Timing is everything: antiretroviral nonadherence is associated with impairment in time-based prospective memory. J Int Neuropsychol Soc 15(1):42–52CrossRefPubMed

Woods SP, Dawson MD, Weber E, Grant I, The HNRC Group (2010) The semantic relatedness of cue-intention pairings influences event-based prospective memory failures in older adults with HIV infection. J Clin Exp Neuropsychol 32:398–407CrossRefPubMed

World Health Organization (1998) Composite international diagnostic interview (CIDI, version 2.1). World Health Organization, Geneva

Yaffe K, Fiocco AJ, Lindquist K, Vittinghoff E, Simonsick EM, Newman AB et al (2009) Predictors of maintaining cognitive function in older adults: the health ABC study. Neurology 72(23):2029–2035CrossRefPubMed

Yaffe K, Lindquist K, Vittinghoff E, Barnes D, Simonsick EM, Newman A et al (2010) The effect of maintaining cognition on risk of disability and death. J Am Geriatr Soc 58(5):889–894CrossRefPubMed

Title: Successful cognitive aging in persons living with HIV infection
Authors: Lauren Malaspina
Steven Paul Woods
David J. Moore
Colin Depp
Scott L. Letendre
Dilip Jeste
Igor Grant
The HIV Neurobehavioral Research Programs (HNRP) Group
Publication date: 01-02-2011
Publisher: Springer US
Published in: Journal of NeuroVirology / Issue 1/2011
Print ISSN: 1355-0284
Electronic ISSN: 1538-2443
DOI: https://doi.org/10.1007/s13365-010-0008-z

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