Subjective Cognitive Complaints: Predictors and Health Outcomes in People Living with HIV

Memory complaints after COVID-19: a potential indicator of primary cognitive impairment or a correlate of psychiatric symptoms?

Cognitive impairment and symptoms of psychiatric disorders have been reported frequently as features of post-acute sequelae of SARS-CoV-2 infection. This study aims to investigate subjective memory complaints in COVID-19 survivors and determine if these are more strongly associated with objective cognitive impairment related to sequelae of SARS-CoV-2 infection or with symptoms of psychiatric conditions. A total of 608 COVID-19 survivors were evaluated in-person 6-11 months after hospitalization, with 377 patients assigned to a "no subjective memory complaint (SMC)" group and 231 patients assigned to an SMC group based on their Memory Complaint Scale scores. Follow-up evaluations included an objective cognitive battery and scale-based assessments of anxiety, depression, and post-traumatic stress symptoms. We found the perception of memory impairment in COVID-19 survivors to be more strongly associated to core symptoms of psychiatric conditions rather than to primary objective cognitive impairment. Univariate analysis indicated significant differences between the "no SMC" and SMC groups, both for the psychiatric symptom evaluations and for the cognitive evaluations (p < 0.05); however, the psychiatric symptoms all had large partial eta-squared values (ranging from 0.181 to 0.213), whereas the cognitive variables had small/medium partial eta-squared values (ranging from 0.002 to 0.024). Additionally, multiple regression analysis indicated that only female sex and depressive and post-traumatic stress symptoms were predictors of subjective memory complaints. These findings may help guide clinical evaluations for COVID-19 survivors presenting with memory complaints while also serving to expand our growing understanding of the relationship between COVID-19, subjective memory complaints, and the risk of cognitive decline.

Frequency, Characteristics, and Correlates of Cognitive Complaints in a Cohort of Individuals with Post-Acute Sequelae of COVID-19

BACKGROUND

Cognitive complaints are among the most frequent symptoms of post-acute sequelae of COVID-19 (PASC). This study aimed to investigate the frequency, characteristics, and clinical correlates of cognitive complaints (CC) in PASC, particularly in relation to objective neuropsychological (NP) performance.

METHODS

Seventy-four participants underwent psychiatric, medical, and NP testing approximately 7 months after acute COVID-19. The Patient Assessment of Own Functioning Inventory (PAOFI) was used to characterize the frequency and severity of CC in domains of memory, language, and cognitive/executive function. The associations of CC with sociodemographic, medical, psychiatric, and NP variables were assessed utilizing correlational analysis, logistic regression, and pairwise comparisons of those categorized as having CC vs. not having CC.

RESULTS

Taken together, approximately one-third of the study participants had clinically significant CC. Memory difficulty was the most frequent CC, although all categories were frequently endorsed. Memory and cognitive/executive complaints correlated with NP tests in these and multiple other NP domains. CC were more likely to be under-reported in those with diminished NP performance than over-reported in those without diminished performance. Acute COVID-19 symptom severity, elevated depressive symptoms, and NP tests of diminished attention and psychomotor processing speed were independent predictors of CC in logistic regression.

CONCLUSIONS

Cognitive complaints after acute COVID-19 should be taken seriously, as they are likely to reflect diminished NP performance, as well as medical, psychiatric, and functional burdens. However, patients with PASC may not accurately identify or characterize objective cognitive difficulties, so programs offering comprehensive care for patients with PASC should offer formal neuropsychological testing.

Frailty in people 50 years or older living with HIV: A sex perspective

OBJECTIVE

To estimate prefrailty and frailty prevalence and associated factors in people living with HIV (PLHIV) from a sex perspective.

METHODS

Cross-sectional study on PLHIV at specialized public health centres in Brazil. Data were obtained from individuals aged ≥50 years using antiretroviral therapy (ART) and with an undetectable viral load through personal interviews, clinical evaluations and medical records. Frailty and prefrailty were characterized using the Fried Frailty Phenotype tool. Multinomial regression models were performed, and the associated factors were selected through the backward stepwise method.

RESULTS

Among 670 patients, 373 men and 297 women were included. The prevalence of frailty and prefrailty was significantly higher for women (16.2% and 56.2%, respectively) than for men (11.5% and 46.4%, respectively). Low socioeconomic and educational level, multimorbidity, depression, subjective cognitive complaints, and low scores on the Mini-Mental State Exam (MMSE) were associated (P < 0.05) with frailty for both sexes. However, in the sex-specific analysis, while smoking (OR = 3.66, 95% CI: 1.58-8.48) and a history of low adherence to ART (OR = 3.10, 95% CI: 1.33-7.23) were associated with frailty in men, depression (OR = 3.39, 95% CI: 1.36- 8.44) and the absence of functional dentition (OR = 3.77, 95% CI: 1.36- 10.43) were associated with frailty in women.

CONCLUSIONS

This study adds self-reported cognitive complaints as a potential predictor of frailty in both sexes and supports the known deleterious effect of multimorbidity on frailty in adults living with HIV. Furthermore, it suggests that other possible predictors, such as depression, oral health status and adherence to ART, may be sex-specific.