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Metabolic Risk Factors as Differential Predictors of Profiles of Neurocognitive Impairment Among Older HIV+ and HIV- Adults: An Observational Study.
ObjectiveNeurocognitive performance among older persons, including those living with HIV (people living with HIV [PLWH]), exhibits significant heterogeneity, suggesting subpopulations with differing profiles of neurocognitive impairment (NCI). Metabolic factors are associated with NCI, but their relationships to cluster-derived NCI profiles are unknown.MethodParticipants (144 PLWH and 102 HIV uninfected) aged 50+ years completed a neuropsychological battery assessing seven cognitive domains. Latent class analysis (LCA) identified NCI profiles separately by HIV serostatus and in a combined sample. Obtained classes were examined against the Montreal Cognitive Assessment (MoCA) and diagnoses of HIV-associated neurocognitive disorders (HAND). Multinomial regression identified metabolic predictors of classification.ResultsLCA identified three latent classes in each participant sample: Class1Multidomain NCI (high probability of impairment across multiple domains), Class 2Learning & Recall NCI (high probability of impairment in learning and recall), and Class 3NC Unimpaired (low probability of NCI across all domains). Severity of NCI implied by classes corresponded with MoCA scores and HAND diagnoses. In analyses on the combined sample, compared to HIV-uninfected individuals, PLWH were more likely to be in Class1Multidomain NCI. Among PLWH, those with dyslipidemia and hypertension had greater odds of classification in Class 1Multidomain NCI while those with central obesity had higher odds of classification in Class 2Learning & Recall NCI; metabolic syndrome approached significance as a differential predictor. Regardless of HIV status, individuals with diabetes were more likely to be in Class 1Multidomain NCI.ConclusionsMetabolic risk factors confer heightened risk of NCI in HIV infection. Interventions to reduce metabolic risk may improve neurocognitive outcomes among PLWH
Sex-specific effects of SNAP-25 genotype on verbal memory and Alzheimers disease biomarkers in clinically normal older adults.
Frailty in Comorbid HIV and Lifetime Methamphetamine Use Disorder: Associations with Neurocognitive and Everyday Functioning.
Temporal Associations Between Social Activity and Mood, Fatigue, and Pain in Older Adults With HIV: An Ecological Momentary Assessment Study (Preprint)
Temporal Associations Between Social Activity and Mood, Fatigue, and Pain in Older Adults With HIV: An Ecological Momentary Assessment Study.
Using Ecological Momentary Assessment to Improve Assessment of Self-Reported Cognitive Difficulties among Adults with Comorbid HIV and Heavy Alcohol Use
Rationale: Heavy alcohol use is prevalent among people with HIV (PWH) and increases risk for neurocognitive and everyday functioning impairments. Although self-reports of cognitive difficulties are often used clinically to screen for neurocognitive impairment, such retrospective measures are subject to recall error and response bias. Thus, in a sample of PWH who were heavy alcohol drinkers, this study aimed to: 1) evaluate psychometric properties of real-time self-reported cognitive difficulties assessed via smartphone-based ecological momentary assessment (EMA), and 2) examine temporal relationships among EMA self-reported cognitive difficulties, alcohol use, mood, and daily activities.Design: Participants were 23 PWH recruited from existing studies at the HIV Neurobehavioral Research Program who reported current heavy alcohol use. Participants completed two in-person visits separated by a 14-day EMA monitoring period with up to four surveys per day. Objective neurocognition was measured in person by the NIH Toolbox Cognition Battery. Multiple regressions examined whether the proportion of surveys on which participants reported cognitive difficulties related to objective neurocognitive functioning. Mixed effects logistic regressions examined whether EMA-reported alcohol use, depressive symptoms, and cognitively demanding activities related to concurrent EMA-reported cognitive difficulties.
Results: Participants were 83% adherent to the EMA surveys on average. Higher proportions of surveys reporting cognitive difficulties were significantly associated with worse objective neurocognitive functioning (p = 0.040); however, EMA-reported real-time cognitive difficulties were not significantly more sensitive or specific in identifying objective neurocognitive impairment compared to an in-person retrospective measure (ps > 0.05). Greater EMA-reported alcohol use (OR = 1.37; p < 0.001) and depressive symptoms (OR = 1.80; p = 0.016) were significantly related to higher likelihood of concurrent cognitive difficulties within persons. EMA-reported engagement in cognitively demanding activities was related to a lower concurrent likelihood of attention difficulties within persons (OR = 0.54; p = 0.032).
Conclusions: EMA-reported cognitive difficulties were strongly related to real-time psychological/behavioral factors within persons. Additionally, the association between EMA-reported cognitive difficulties and objective neurocognition suggests that assessing cognitive difficulties in real time via EMA may have some clinical utility to identify individuals from this population who need early intervention and potentially a higher level of care
Smartphone-based ecological momentary assessment (EMA) of alcohol and cannabis use in older adults with and without HIV infection.
Wearable Use in an Observational Study Among Older Adults: Adherence, Feasibility, and Effects of Clinicodemographic Factors.
At-Risk Alcohol Use is Associated with Antiretroviral Treatment Nonadherence Among Adults Living with HIV/AIDS.
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