Apathy in Persons with HIV Infection /

Apathy is a cluster of symptoms that include a reduction in self-initiated, goal-directed behavior, and a lack of motoric, emotional, and cognitive motivation. It has been recognized as a clinical manifestation of HIV infection, but has received limited empirical attention. Previous studies of other neurologic groups indicate that apathy is associated with poor treatment response, deficits in everyday functioning, lower quality of life, and worse global cognitive functioning. HIV-associated brain pathology involves frontostriatal circuits, which are also implicated in the expression of apathy. Three studies were conducted to examine the neural, psychiatric (e.g., depression), and functional correlates of apathy in HIV infection. In all three studies, self-reported ratings of apathy were obtained using the Frontal Systems Behavior Scale (FrSBe). In the first investigation, relative to seronegative comparison subjects, HIV+ persons reported higher levels of apathy. Independent of major depressive disorder and other disease covariates, apathy ratings were found to be significantly associated with increased cognitive complaints and dependence in activities of daily living. Next, in a separate cohort, MRI Diffusion Tensor Imaging was used to examine the correspondence between these ratings and white matter abnormalities in the cortical nodes of the thalamocorticostriatal loop that reportedly subserves apathy. Results indicated that apathy severity was related to changes in neural integrity in frontomedial regions (i.e., anterior corona radiata, genu of corpus callosum, and orbitomedial prefrontal cortex). The strength of this relationship was associated with lower CD4 count, raising the possibility that dynamic changes in immune functioning may modify CNS pathology and consequent psychiatric outcomes. Finally, we examined whether depression, a comorbid psychiatric condition that is distinct from apathy, is related to change in apathy ratings across two visits in a cohort of 258 HIV+ participants. An inter-visit major depressive episode was associated with an increase in apathy ratings only in those participants who were not apathetic at their first visit. Regardless of initial apathy status, a new episode of major depression resulted in a higher risk of developing or maintaining clinically elevated apathy. These findings highlight the necessity to assess both depression and apathy, as they may interact to exacerbate psychiatric burden in HIV-infected cohorts. The findings of these three studies provide a greater understanding of the etiology of apathy and factors contributing to its expression in HIV+ individuals. Such information may help to identify patients at particular risk for functional impairments and potentially inform psychopharmacologic, behavioral, and HIV-treatment specific interventions that may mitigate apathy. This would be expected to help persons with HIV infection maintain better levels of functioning in their daily live

Successful aging in community seniors and stroke survivors: current and future strategies.

There is growing evidence to suggest that aging is accompanied by enhancement in psychosocial well-being, despite age-related declines in physical and cognitive functioning. A small but growing body of research has reported on positive trajectories of well-being, and its determinants, among community-dwelling seniors as well as in people with specific diseases such as stroke. Current strategies for promoting successful aging include physical, cognitive and social activities, healthy lifestyle, social support, and positive traits such as resilience and optimism. These strategies have typically been employed in samples without serious illnesses, but an emerging body of evidence suggests that they are as relevant in cohorts with neurologic and other diseases. Future strategies will include those that work at the community level and not just at individual level, and will focus on use of technology as well as group interventions to enhance resilience and building age-friendly communities

Successful aging in community seniors and stroke survivors: current and future strategies.

There is growing evidence to suggest that aging is accompanied by enhancement in psychosocial well-being, despite age-related declines in physical and cognitive functioning. A small but growing body of research has reported on positive trajectories of well-being, and its determinants, among community-dwelling seniors as well as in people with specific diseases such as stroke. Current strategies for promoting successful aging include physical, cognitive and social activities, healthy lifestyle, social support, and positive traits such as resilience and optimism. These strategies have typically been employed in samples without serious illnesses, but an emerging body of evidence suggests that they are as relevant in cohorts with neurologic and other diseases. Future strategies will include those that work at the community level and not just at individual level, and will focus on use of technology as well as group interventions to enhance resilience and building age-friendly communities

Obstructive sleep apnea and neurocognitive performance: the role of cortisol.

BackgroundObstructive sleep apnea (OSA) is a prevalent disorder with multiple consequences including negative effects on neurocognitive function. Several domains of cognitive function are impaired in OSA patients, but the mechanisms through which this sleep disorder results in impairment are not clear. Given the well-known effects of cortisol on cognitive function, in particular memory, the dysregulating effects of OSA on cortisol levels are hypothesized as a potential pathway leading to cognitive impairment.MethodsFifty-five participants with OSA (mean apnea-hypopnea index [AHI], 30.3) were assessed over 2 days. Over a 24-h period, blood samples were collected every 2h to examine cortisol levels. The following night, sleep was monitored with polysomnography (PSG). Participants were given a battery of neurocognitive tests, which assessed seven cognitive domains.ResultsOSA severity assessed by oxygen desaturation index (ODI) was associated with 24-h cortisol levels. AHI, ODI, and nighttime cortisol levels were associated with global deficit scores (GDS) in cognitive functioning, particularly in domains of learning, memory, and working memory (P<.05 for all). Hierarchical linear regression analysis revealed that nighttime cortisol accounted for 9-16% of variance in learning (P=.018), memory (P=.003), and working memory (P=.016) domains, though apnea severity did not significantly predict any additional variance.ConclusionsIn our sample of patients with OSA, nocturnal cortisol levels were associated with neuropsychologic functioning above and beyond the influence of covariates and apnea severity. These findings suggest that OSA-related alterations in cortisol activity may partially explain the pathophysiology of neuropsychologic impairments in sleep apnea

Obstructive sleep apnea and neurocognitive performance: the role of cortisol.

BackgroundObstructive sleep apnea (OSA) is a prevalent disorder with multiple consequences including negative effects on neurocognitive function. Several domains of cognitive function are impaired in OSA patients, but the mechanisms through which this sleep disorder results in impairment are not clear. Given the well-known effects of cortisol on cognitive function, in particular memory, the dysregulating effects of OSA on cortisol levels are hypothesized as a potential pathway leading to cognitive impairment.MethodsFifty-five participants with OSA (mean apnea-hypopnea index [AHI], 30.3) were assessed over 2 days. Over a 24-h period, blood samples were collected every 2h to examine cortisol levels. The following night, sleep was monitored with polysomnography (PSG). Participants were given a battery of neurocognitive tests, which assessed seven cognitive domains.ResultsOSA severity assessed by oxygen desaturation index (ODI) was associated with 24-h cortisol levels. AHI, ODI, and nighttime cortisol levels were associated with global deficit scores (GDS) in cognitive functioning, particularly in domains of learning, memory, and working memory (P<.05 for all). Hierarchical linear regression analysis revealed that nighttime cortisol accounted for 9-16% of variance in learning (P=.018), memory (P=.003), and working memory (P=.016) domains, though apnea severity did not significantly predict any additional variance.ConclusionsIn our sample of patients with OSA, nocturnal cortisol levels were associated with neuropsychologic functioning above and beyond the influence of covariates and apnea severity. These findings suggest that OSA-related alterations in cortisol activity may partially explain the pathophysiology of neuropsychologic impairments in sleep apnea