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Cooley SA, Petersen KJ, Tice C, Langford D, Burdo TH, Roman J, Ances BM. Relationships between plasma neurofilament light chain protein, cognition, and brain aging in people with HIV. AIDS 2024; 38:955-962. [PMID: 38329137 PMCID: PMC11062811 DOI: 10.1097/qad.0000000000003861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2024]
Abstract
OBJECTIVE Neurofilament light chain protein (NfL) is a marker of neuronal injury and neurodegeneration. Typically assessed in cerebrospinal fluid, recent advances have allowed this biomarker to be more easily measured in plasma. This study assesses plasma NfL in people with HIV (PWH) compared with people without HIV (PWoH), and its relationship with cognitive impairment, cardiovascular risk, and a neuroimaging metric of brain aging [brain-age gap (BAG)]. DESIGN One hundred and four PWH (HIV RNA <50 copies/ml) and 42 PWoH provided blood samples and completed a cardiovascular risk score calculator, neuroimaging, and cognitive testing. METHOD Plasma NfL was compared between PWoH and PWH and assessed for relationships with age, HIV clinical markers, cardiovascular disease risk, cognition, and BAG (difference between a brain-predicted age and chronological age). RESULTS Plasma NfL was not significantly different between PWoH and PWH. Higher NfL related to increasing age in both groups. Plasma NfL was not associated with typical HIV disease variables. Within PWH, NfL was higher with higher cardiovascular risk, cognitive impairment and a greater BAG. CONCLUSION Virally suppressed PWH who are cognitively normal likely do not have significant ongoing neurodegeneration, as evidenced by similar plasma NfL compared with PWoH. However, NfL may represent a biomarker of cognitive impairment and brain aging in PWH. Further research examining NfL with longitudinal cognitive decline is needed to understand this relationship more fully.
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Affiliation(s)
- Sarah A Cooley
- Department of Neurology, Washington University in St. Louis, St. Louis, MO
| | - Kalen J Petersen
- Department of Neurology, Washington University in St. Louis, St. Louis, MO
| | | | | | - Tricia H Burdo
- Department of Microbiology, Immunology, and Inflammation, Center for Neurovirology and Gene Editing, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA
| | - June Roman
- Department of Neurology, Washington University in St. Louis, St. Louis, MO
| | - Beau M Ances
- Department of Neurology, Washington University in St. Louis, St. Louis, MO
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2
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Thompson JL, Woods SP, Medina LD, Garcia JM, Teixeira AL. Apathy in persons living with HIV disease: A systematic narrative review. J Affect Disord 2024; 350:133-147. [PMID: 38224740 DOI: 10.1016/j.jad.2024.01.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 11/28/2023] [Accepted: 01/03/2024] [Indexed: 01/17/2024]
Abstract
BACKGROUND Apathy was identified as a feature of HIV early in the epidemic; however, there are no systematic reviews of the diverse literature on the sociodemographic and clinical correlates of apathy in HIV disease. METHODS The current study adopted a hybrid systematic-narrative review methodology in which we used PRISMA guidelines to identify, summarize, and critique peer-reviewed, empirical studies of apathy in HIV disease in the era of combination antiretroviral therapy. RESULTS A total of 34 studies of apathy in persons living with HIV (PLWH) were identified. Findings across these studies showed that apathy was reliably related to the structure of grey and white matter pathways commonly implicated in apathy, poorer everyday functioning, education, and other neuropsychiatric symptoms (e.g., depression). Apathy was not reliably associated with age, sex, race/ethnicity, cognition, and clinical markers of HIV disease. LIMITATIONS The current review does not provide rigorous quantitative estimates of clinical correlates of apathy, and the exclusion criteria of non-English and non-peer reviewed publications introduces risk of bias and Type I error. CONCLUSIONS Apathy occurs at higher rates in PLWH and is linked to neuroanatomical differences, as well as negative outcomes for everyday functions, aspects of neurocognition, and neuropsychiatric symptoms. As such, apathy is an important component to consider in the clinical assessment, diagnosis, and management of neurocognitive disorders in PLWH. Future work is needed to replicate existing findings with larger sample sizes and longitudinal designs, examine apathy as a multi-dimensional construct, and develop evidence-based treatments for apathy in PLWH.
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Affiliation(s)
| | - Steven Paul Woods
- Department of Psychology, University of Houston, Houston, TX 77004, USA.
| | - Luis D Medina
- Department of Psychology, University of Houston, Houston, TX 77004, USA
| | - Joshua M Garcia
- Department of Psychology, University of Houston, Houston, TX 77004, USA
| | - Antonio L Teixeira
- Neuropsychiatry Program, Department of Psychiatry & Behavioral Sciences, University of Texas Health Sciences Center at Houston, Houston, TX 77054, USA
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3
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Mazzitelli M, Trunfio M, Coin A, Sasset L, Farina J, Brundu M, Scaglione V, Devita M, Sergi G, Cattelan AM. Use of different anticholinergic scales and their correlation with anticholinergic symptom burden in a cohort of people living with HIV. J Antimicrob Chemother 2024; 79:66-77. [PMID: 37965917 PMCID: PMC11032244 DOI: 10.1093/jac/dkad348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 10/24/2023] [Indexed: 11/16/2023] Open
Abstract
OBJECTIVES How to detect the clinical impact of anticholinergic (AC) burden in people with HIV (PWH) remains poorly investigated. We cross-sectionally described the prevalence and type of AC signs/symptoms and the screening accuracy of three AC scales in detecting their presence in a modern cohort of PWH. METHODS We calculated AC Burden Scale (ABS), AC Risk Score (ARS) and AC Drug Score (ADS) in 721 adult PWH and recorded the presence of AC signs/symptoms over the previous 3 months. High AC risk was defined by ABS score ≥2, and ARS or ADS score ≥3. Comparisons among the scale were based on Cohen's inter-rater agreement, and their screening accuracy was assessed by receiver operating characteristics (ROC) curves and performance measures. RESULTS We enrolled 721 PWH, of whom 72.0% of participants were male; the median age was 53 years, and 164 participants (22.7%) were on at least one AC drug. Among these, 28.6% experienced at least one AC sign/symptom. Agreement in AC risk classification was substantial only between ARS and ADS (k = 0.6). Lower and higher risk of AC signs/symptoms was associated with dual regimens [adjusted OR (aOR) = 0.12 versus three-drug regimens, P = 0.002] and increasing number of AC drugs (aOR = 12.91, P < 0.001). Depression and COPD were also associated with higher risk of AC signs/symptoms in analysis unadjusted for number of AC drugs. ABS and ADS showed the best area under the ROC curve (AUROC) of 0.85 (0.78-0.92) and 0.84 (0.75-0.92; P < 0.001 for both). However, at the cut-off used for the general population, the sensitivity of all three scales was very low (34.0%, 46.8% and 46.8%). CONCLUSIONS Up to one-fourth of participants in our cohort were exposed to at least one AC drug, and among them AC signs/symptoms affected more than one-fourth. Both polypharmacy (as number of antiretrovirals and of co-medications with AC properties) and to a lesser extent specific comorbidities shaped the risk of developing AC signs/symptoms. Sensitive screenings for AC risk in PWH should prefer ABS or ADS based on lower cut-offs than those suggested for the general population.
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Affiliation(s)
- Maria Mazzitelli
- Infectious and Tropical Diseases Unit, Padua University Hospital, 35128 Padua, Italy
| | - Mattia Trunfio
- Infectious Diseases Unit, Department of Medical Sciences, University of Turin at Amedeo di Savoia Hospital, 10149 Turin, Italy
- HIV Neurobehavioral Research Program and Departments of Neurosciences and Psychiatry, School of Medicine, University of California, San Diego, CA, USA
| | - Alessandra Coin
- Geriatric Unit, Padua University Hospital, 35128 Padua, Italy
| | - Lolita Sasset
- Infectious and Tropical Diseases Unit, Padua University Hospital, 35128 Padua, Italy
| | - Jacopo Farina
- Geriatric Unit, Padua University Hospital, 35128 Padua, Italy
| | - Monica Brundu
- Infectious and Tropical Diseases Unit, Padua University Hospital, 35128 Padua, Italy
| | - Vincenzo Scaglione
- Infectious and Tropical Diseases Unit, Padua University Hospital, 35128 Padua, Italy
| | - Maria Devita
- General Psychology Department, Padua University, 35131 Padua, Italy
| | - Giuseppe Sergi
- Geriatric Unit, Padua University Hospital, 35128 Padua, Italy
| | - Anna M Cattelan
- Infectious and Tropical Diseases Unit, Padua University Hospital, 35128 Padua, Italy
- Department of Molecular Medicine, Padua University, 35128 Padua, Italy
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4
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Cooley SA, Nelson B, Boerwinkle A, Yarasheski KE, Kirmess KM, Meyer MR, Schindler SE, Morris JC, Fagan A, Ances BM, O’Halloran JA. Plasma Aβ42/Aβ40 Ratios in Older People With Human Immunodeficiency Virus. Clin Infect Dis 2023; 76:1776-1783. [PMID: 36610788 PMCID: PMC10209437 DOI: 10.1093/cid/ciad001] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 12/19/2022] [Accepted: 01/03/2023] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND As people with human immunodeficiency virus (HIV) (PWH) age, it remains unclear whether they are at higher risk for age-related neurodegenerative disorders-for example, Alzheimer disease (AD)-and, if so, how to differentiate HIV-associated neurocognitive impairment from AD. We examined a clinically available blood biomarker test for AD (plasma amyloid-β [Aβ] 42/Aβ40 ratio) in PWH who were cognitively normal (PWH_CN) or cognitively impaired (PWH_CI) and people without HIV (PWoH) who were cognitively normal (PWoH_CN) or had symptomatic AD (PWoH_AD). METHODS A total of 66 PWH (age >40 years) (HIV RNA <50 copies/mL) and 195 PWoH provided blood samples, underwent magnetic resonance imaging, and completed a neuropsychological battery or clinical dementia rating scale. Participants were categorized by impairment (PWH_CN, n = 43; PWH_CI, n = 23; PWoH_CN, n = 138; PWoH_AD, n = 57). Plasma Aβ42 and Aβ40 concentrations were obtained using a liquid chromatography-tandem mass spectrometry method to calculate the PrecivityAD amyloid probability score (APS). The APS incorporates age and apolipoprotein E proteotype into a risk score for brain amyloidosis. Plasma Aβ42/Aβ40 ratios and APSs were compared between groups and assessed for relationships with hippocampal volumes or cognition and HIV clinical characteristics (PWH only). RESULTS The plasma Aβ42/Aβ40 ratio was significantly lower, and the APS higher, in PWoH_AD than in other groups. A lower Aβ42/Aβ40 ratio and higher APS was associated with smaller hippocampal volumes for PWoH_AD. The Aβ42/Aβ40 ratio and APS were not associated with cognition or HIV clinical measures for PWH. CONCLUSIONS The plasma Aβ42/Aβ40 ratio can serve as a screening tool for AD and may help differentiate effects of HIV from AD within PWH, but larger studies with older PWH are needed.
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Affiliation(s)
- Sarah A Cooley
- Department of Neurology, Washington University in St Louis, St Louis, Missouri, USA
| | - Brittany Nelson
- Department of Neurology, Washington University in St Louis, St Louis, Missouri, USA
| | - Anna Boerwinkle
- Department of Neurology, Washington University in St Louis, St Louis, Missouri, USA
| | | | | | | | - Suzanne E Schindler
- Department of Neurology, Washington University in St Louis, St Louis, Missouri, USA
- Knight Alzheimer Disease Research Center, Washington University School of Medicine, St Louis, Missouri, USA
| | - John C Morris
- Department of Neurology, Washington University in St Louis, St Louis, Missouri, USA
- Knight Alzheimer Disease Research Center, Washington University School of Medicine, St Louis, Missouri, USA
- Department of Radiology, Washington University in St Louis, St Louis, Missouri, USA
| | - Anne Fagan
- Knight Alzheimer Disease Research Center, Washington University School of Medicine, St Louis, Missouri, USA
| | - Beau M Ances
- Department of Neurology, Washington University in St Louis, St Louis, Missouri, USA
| | - Jane A O’Halloran
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St Louis, Missouri, USA
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5
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Thompson JL, Matchanova A, Beltran-Najera I, Ridgely NC, Mustafa A, Babicz MA, Hasbun R, Giordano TP, Woods SP. Preliminary Validity of a Telephone-Based Neuropsychological Battery in a Consecutive Series of Persons with HIV Disease Referred for Clinical Evaluation. ARCHIVES OF CLINICAL NEUROPSYCHOLOGY : THE OFFICIAL JOURNAL OF THE NATIONAL ACADEMY OF NEUROPSYCHOLOGISTS 2022; 38:570-585. [PMID: 36566509 DOI: 10.1093/arclin/acac104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/24/2022] [Indexed: 12/26/2022]
Abstract
OBJECTIVE The COVID-19 pandemic necessitated use of remote assessments by clinical neuropsychologists. Telehealth was particularly important for vulnerable groups, including persons living with HIV (PLWH); however, limited internet access can be a serious barrier to care. This study examined the preliminary validity of a telephone-based neuropsychological assessment in a clinical sample of PLWH. METHOD A consecutive series of 59 PLWH were assessed via telephone at an HIV clinic in the southern U.S. between April 2020 and July 2022. The battery included auditory-verbal neuropsychological tests of memory, attention, and executive functions, and questionnaires assessing self-reported mood and activities of daily living (ADL). RESULTS Study measures demonstrated acceptable internal consistency. PLWH demonstrated worse neuropsychological performance compared with expectations derived from the normal curve and an HIV-seronegative adult sample (N = 44). PLWH assessed via telephone demonstrated similar impairment rates to that of a consecutive series of PLWH (N = 41) assessed in-person immediately prior to the pandemic. Higher telephone-based global neuropsychological scores were related to younger age, more education, better fund of knowledge, White race/ethnicity, fewer medical conditions, and fewer depression symptoms. Global neuropsychological impairment was strongly and independently associated with greater dependence in ADL domains, particularly for instrumental activities. CONCLUSIONS Although telephone-based approaches to neuropsychological assessment are not ideal, these data provide support for the feasibility, internal consistency, and preliminary validity of this method in a consecutive clinical series of PLWH. The direct comparability of telephone-based and in-person neuropsychological assessments remains to be determined by prospective, counterbalanced study designs examining both PLWH and seronegative individuals.
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Affiliation(s)
| | | | | | | | - Andrea Mustafa
- Department of Psychology, University of Houston, Houston, TX, USA
| | - Michelle A Babicz
- Department of Psychology, University of Houston, Houston, TX, USA.,Mental Health and Behavioral Science Service, James A. Haley Veterans' Hospital, Tampa, FL, USA
| | - Rodrigo Hasbun
- Department of Medicine, University of Texas Health Science Center, Houston, TX, USA
| | - Thomas P Giordano
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA.,Center for Innovation in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA
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6
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Paul RH, Cho K, Belden A, Carrico AW, Martin E, Bolzenius J, Luckett P, Cooley SA, Mannarino J, Gilman JM, Miano M, Ances BM. Cognitive Phenotypes of HIV Defined Using a Novel Data-driven Approach. J Neuroimmune Pharmacol 2022; 17:515-525. [PMID: 34981318 PMCID: PMC10364465 DOI: 10.1007/s11481-021-10045-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 12/13/2021] [Indexed: 01/13/2023]
Abstract
The current study applied data-driven methods to identify and explain novel cognitive phenotypes of HIV. Methods: 388 people with HIV (PWH) with an average age of 46 (15.8) and median plasma CD4+ T-cell count of 555 copies/mL (79% virally suppressed) underwent cognitive testing and 3T neuroimaging. Demographics, HIV disease variables, and health comorbidities were recorded within three months of cognitive testing/neuroimaging. Hierarchical clustering was employed to identify cognitive phenotypes followed by ensemble machine learning to delineate the features that determined membership in the cognitive phenotypes. Hierarchical clustering identified five cognitive phenotypes. Cluster 1 (n=97) was comprised of individuals with normative performance on all cognitive tests. The remaining clusters were defined by impairment on action fluency (Cluster 2; n=46); verbal learning/memory (Cluster 3; n=73); action fluency and verbal learning/memory (Cluster 4; n=56); and action fluency, verbal learning/memory, and tests of executive function (Cluster 5; n=114). HIV detectability was most common in Cluster 5. Machine learning revealed that polysubstance use, race, educational attainment, and volumes of the precuneus, cingulate, nucleus accumbens, and thalamus differentiated membership in the normal vs. impaired clusters. The determinants of persistent cognitive impairment among PWH receiving suppressive treatment are multifactorial nature. Viral replication after ART plays a role in the causal pathway, but psychosocial factors (race inequities, substance use) merit increased attention as critical determinants of cognitive impairment in the context of ART. Results underscore the need for comprehensive person-centered interventions that go beyond adherence to patient care to achieve optimal cognitive health among PWH.
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Affiliation(s)
- Robert H Paul
- Department of Psychological Sciences, University of Missouri Saint Louis, Missouri, Saint Louis, US. .,Missouri Institute of Mental Health, University of Missouri Saint Louis, Missouri, Saint Louis, US.
| | - Kyu Cho
- Missouri Institute of Mental Health, University of Missouri Saint Louis, Missouri, Saint Louis, US
| | - Andrew Belden
- Missouri Institute of Mental Health, University of Missouri Saint Louis, Missouri, Saint Louis, US
| | - Adam W Carrico
- Department of Public Health, University of Miami School of Medicine, Coral Gables, Florida, US
| | - Eileen Martin
- Department of Psychiatry, Rush University School of Medicine, Chicago, Illinois, US
| | - Jacob Bolzenius
- Missouri Institute of Mental Health, University of Missouri Saint Louis, Missouri, Saint Louis, US
| | - Patrick Luckett
- Department of Neurology, Washington University, Saint Louis, Missouri, US
| | - Sarah A Cooley
- Department of Neurology, Washington University, Saint Louis, Missouri, US
| | - Julie Mannarino
- Missouri Institute of Mental Health, University of Missouri Saint Louis, Missouri, Saint Louis, US
| | - Jodi M Gilman
- Center for Addiction Medicine, Harvard Medical School/Massachusetts General Hospital, Boston, Massachusetts, US
| | - Mariah Miano
- Department of Communication Sciences and Disorders, Northern Arizona University, Flagstaff, Arizona, US
| | - Beau M Ances
- Department of Neurology, Washington University, Saint Louis, Missouri, US
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7
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What are the predictors of TOMM failure in clinical TBI populations? A retrospective analysis. J Int Neuropsychol Soc 2022; 29:336-345. [PMID: 35811454 DOI: 10.1017/s1355617722000339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES To determine base rates of invalid performance on the Test of Memory Malingering (TOMM) in patients with traumatic brain injury (TBI) undertaking rehabilitation who were referred for clinical assessment, and the factors contributing to TOMM failure. METHODS Retrospective file review of consecutive TBI referrals for neuropsychological assessment over seven years. TOMM failure was conventionally defined as performance <45/50 on Trial 2 or Retention Trial. Demographic, injury, financial compensation, occupational, and medical variables were collected. RESULTS Four hundred and ninety one TBI cases (Median age = 40 years [IQR = 26-52], 79% male, 82% severe TBI) were identified. Overall, 48 cases (9.78%) failed the TOMM. Logistic regression analyses revealed that use of an interpreter during the assessment (adjusted odds ratio [aOR] = 8.25, 95%CI = 3.96-17.18), outpatient setting (aOR = 4.80, 95%CI = 1.87-12.31) and post-injury psychological distress (aOR = 2.77, 95%CI = 1.35-5.70) were significant multivariate predictors of TOMM failure. The TOMM failure rate for interpreter cases was 49% (21/43) in the outpatient setting vs. 7% (2/30) in the inpatient setting. By comparison, 9% (21/230) of non-interpreter outpatient cases failed the TOMM vs. 2% (4/188) of inpatient cases. CONCLUSIONS TOMM failure very rarely occurs in clinical assessment of TBI patients in the inpatient rehabilitation setting. It is more common in the outpatient setting, particularly in non-English-speaking people requiring an interpreter. The findings reinforce the importance of routinely administering stand-alone performance validity tests in assessments of clinical TBI populations, particularly in outpatient settings, to ensure that neuropsychological test results can be interpreted with a high degree of confidence.
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Glans M, Cooley SA, Vaida F, Boerwinkle A, Tomov D, Petersen KJ, Rosenow A, Paul RH, Ances BM. Effects of Framingham 10-Year Cardiovascular Risk Score and Viral Load on Brain Integrity in Persons With HIV. J Acquir Immune Defic Syndr 2022; 90:79-87. [PMID: 35067658 PMCID: PMC8986573 DOI: 10.1097/qai.0000000000002913] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 12/28/2021] [Indexed: 01/29/2023]
Abstract
BACKGROUND Combination antiretroviral therapy (cART) has allowed for viral load (VL) suppression and increased life expectancy for persons with HIV (PWH). Altered brain integrity, measured by neuropsychological (NP) performance and neuroimaging, is still prevalent among virally suppressed PWH. Age-related conditions such as cardiovascular disease may also affect brain integrity. This study investigated the effects of cardiovascular risk, VL, and HIV serostatus on cerebral blood flow (CBF), brain volumetrics, and cognitive function in PWH and persons without HIV (PWoH). METHODS Ten-year cardiovascular risk, using the Framingham Heart Study criteria, was calculated in PWH (n = 164) on cART with undetectable (≤20 copies/mL; n = 134) or detectable (>20 copies/mL; n = 30) VL and PWoH (n = 66). The effects of cardiovascular risk on brain integrity (CBF, volume, and cognition) were compared for PWH (undetectable and detectable VL) and PWoH. RESULTS PWH had smaller brain volumes and worse NP scores than PWoH. PWH with detectable and undetectable VL had similar brain integrity measures. Higher cardiovascular risk was associated with smaller volumes and lower CBF in multiple brain regions for PWH and PWoH. Significant interactions between HIV serostatus and cardiovascular risk on brain volumes were observed in frontal, orbitofrontal, and motor regions. Cardiovascular risk was not associated with cognition for PWH or PWoH. CONCLUSIONS Neuroimaging, but not cognitive measures, was associated with elevated cardiovascular risk. HIV serostatus was associated with diminished brain volumes and worse cognition while CBF remained unchanged, reflecting potential protective effects of cART. Neuroimaging measures of structure (volume) and function (CBF) may identify contributions of comorbidities, but future longitudinal studies are needed.
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Affiliation(s)
- Michelle Glans
- Department of Neurology, Washington University in Saint Louis, Saint Louis, MO
| | - Sarah A Cooley
- Department of Neurology, Washington University in Saint Louis, Saint Louis, MO
| | - Florin Vaida
- Department of Family Medicine and Public Health, University of California, San Diego, CA
| | - Anna Boerwinkle
- Department of Neurology, Washington University in Saint Louis, Saint Louis, MO
| | - Dimitre Tomov
- Department of Neurology, Washington University in Saint Louis, Saint Louis, MO
| | - Kalen J Petersen
- Department of Neurology, Washington University in Saint Louis, Saint Louis, MO
| | - Alexander Rosenow
- Department of Neurology, Washington University in Saint Louis, Saint Louis, MO
| | - Robert H Paul
- Department of Psychology, University of Missouri, Saint Louis, Saint Louis, MO
| | - Beau M Ances
- Department of Neurology, Washington University in Saint Louis, Saint Louis, MO
- Department of Radiology, Washington University in Saint Louis, Saint Louis, MO; and
- Hope Center for Neurological Disorders, Washington University in Saint Louis, Saint Louis, MO
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9
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Kilgore CB, Strain JF, Nelson B, Cooley SA, Rosenow A, Glans M, Cade WT, Reeds DN, Paul RH, Ances BM. Cardiorespiratory Fitness Is Associated With Better White Matter Integrity in Persons Living With HIV. J Acquir Immune Defic Syndr 2022; 89:558-565. [PMID: 34966145 PMCID: PMC9058177 DOI: 10.1097/qai.0000000000002907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 11/29/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Despite improved survival rates, neurocognitive impairment persists in persons living with HIV (PLWH). An active lifestyle is linked to improved cognition among PLWH, yet the neural substrates remain unclear. Diffusion tensor imaging and diffusion basis spectrum imaging measure HIV-related changes in brain white matter integrity. We used these measures of structural brain integrity to assess white matter changes, physical fitness, and cognition in a cross-sectional study of PLWH. METHODS Forty-four virologically well-controlled PLWH were recruited (average age of 56 years, a median recent CD4+ count of 682 cells/mm3). Diffusion tensor imaging -derived fractional anisotropy (FA) and diffusion basis spectrum imaging-derived axonal density were calculated. Cardiorespiratory fitness [maximal volume of oxygen consumption (VO2 max)] was measured by performing indirect calorimetry during exercise to volitional exhaustion. Cardiovascular risk was assessed by the Framingham risk score. Neuropsychological performance (NP) testing evaluated learning, memory, psychomotor/processing speed, and executive function. Partial correlations assessed the relationships among cardiorespiratory fitness, neuroimaging, NP, and HIV clinical metrics (CD4+ count and time since diagnosis). RESULTS Higher VO2 max was associated with higher FA and higher axonal density in multiple white matter tracts, including the corticospinal tract and superior longitudinal fasciculus. Better NP in the motor/psychomotor domain was positively associated with FA and axonal density in diverse tracts including those associated with motor and visuospatial processing. However, higher VO2 max was not associated with NP or HIV clinical metrics. CONCLUSIONS An active lifestyle promoting cardiorespiratory fitness may lead to better white matter integrity and decreased susceptibility to cognitive decline in virologically well-controlled PLWH.
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Affiliation(s)
- Collin B Kilgore
- Department of Neurology, Washington University in St. Louis, St. Louis, MO
| | - Jeremy F Strain
- Department of Neurology, Washington University in St. Louis, St. Louis, MO
| | - Brittany Nelson
- Department of Neurology, Washington University in St. Louis, St. Louis, MO
| | - Sarah A Cooley
- Department of Neurology, Washington University in St. Louis, St. Louis, MO
| | - Alexander Rosenow
- Department of Neurology, Washington University in St. Louis, St. Louis, MO
| | - Michelle Glans
- Department of Neurology, Washington University in St. Louis, St. Louis, MO
| | | | - Dominic N Reeds
- Department of Medicine, Washington University in St. Louis, St. Louis, MO
| | - Robert H Paul
- Department of Psychology, University of Missouri-St. Louis, St. Louis, MO
| | - Beau M Ances
- Department of Neurology, Washington University in St. Louis, St. Louis, MO
- Department of Radiology, Washington University in St. Louis, St. Louis, MO; and
- Hope Center for Neurological Disorders, Washington University in St. Louis, St. Louis, MO
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10
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Cooley SA, Navid J, Wisch JK, Boerwinkle A, Doyle J, Paul RH, Ances BM. Relationships Between Viral Load, Neuroimaging, and NP in Persons Living With HIV. J Acquir Immune Defic Syndr 2021; 87:985-992. [PMID: 33675615 PMCID: PMC8192437 DOI: 10.1097/qai.0000000000002677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 12/30/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND This study examined whether recommended viral load (VL) classifications by the Department of Health and Human Services map onto changes in brain integrity observed in people living with HIV (PLWH). METHODS Three hundred forty-nine PLWH on combination antiretroviral therapy meeting criteria for virologic suppression (VS) (VL ≤ 20 copies/mL; n = 206), "low-level viremia" (20-200 copies/mL; n = 63), or virologic failure (VF) (>200 copies/mL; n = 80) and 195 demographically similar HIV-negative controls were compared for cognition and brain volumes from 10 regions of interest that are sensitive to HIV. Changes in cognition and brain volumes were examined in a subset of PLWH (n = 132) who completed a follow-up evaluation (mean interval = 28 months) and had no change in treatment regimen. RESULTS Significant differences in cognition and brain volumes were observed between the HIV-negative control and VS groups compared with those in the VF groups, with few differences observed between the 3 PLWH subgroups. Longitudinally, PLWH who continued to have VF exhibited a greater decline in cognition and brain volumes compared with PLWH who remained with VS. Observed longitudinal changes in cognition correlated with brain volume changes. CONCLUSION PLWH with continued VF (consecutive VL measurements of >200 copies/mL) represent a cause for clinical concern and may benefit from change in treatment in addition to consideration of other potential etiologies of VF to reduce loss of brain integrity.
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Affiliation(s)
- Sarah A. Cooley
- Department of Neurology, Washington University in Saint Louis, Saint Louis, MO 63110, USA
| | - Jaimie Navid
- Department of Neurology, Washington University in Saint Louis, Saint Louis, MO 63110, USA
| | - Julie K. Wisch
- Department of Neurology, Washington University in Saint Louis, Saint Louis, MO 63110, USA
| | - Anna Boerwinkle
- Department of Neurology, Washington University in Saint Louis, Saint Louis, MO 63110, USA
| | - John Doyle
- Department of Neurology, Washington University in Saint Louis, Saint Louis, MO 63110, USA
| | - Robert H. Paul
- Department of Psychology, University of Missouri, Saint Louis, Saint Louis, MO 63134, USA
| | - Beau M. Ances
- Department of Neurology, Washington University in Saint Louis, Saint Louis, MO 63110, USA
- Department of Radiology, Washington University in Saint Louis, Saint Louis, MO 63110, USA
- Hope Center for Neurological Disorders, Washington University in Saint Louis, Saint Louis, MO 63110, USA
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11
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Comparison of [11C]-PBR28 Binding Between Persons Living With HIV and HIV-Uninfected Individuals. J Acquir Immune Defic Syndr 2021; 85:244-251. [PMID: 32658129 DOI: 10.1097/qai.0000000000002435] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Despite combined antiretroviral therapy, neuroinflammation may persist in persons living with HIV (PLWH) and contribute to cognitive impairment in this population. Positron emission tomography (PET) imaging targeting 18 kDa translocator protein (TSPO) has been used to localize neuroinflammation. We aimed to use TSPO-PET imaging to evaluate neuroinflammation in PLWH. DESIGN Twenty-four virologically suppressed PLWH on combined antiretroviral therapy and 13 HIV-negative (HIV-) controls completed TSPO-PET imaging using the radiotracer [C]PBR28. Because of tracer complexity and differing procedures used in previous studies, we employed an expansive methodological approach, using binding potential (BP) and standard uptake value ratio and multiple different reference regions to estimate [C]PBR28 binding. METHODS [C]PBR28 binding was measured in 30 cortical and subcortical regions and compared between PLWH and HIV- controls. Pearson correlation evaluated the association between [C]PBR28 binding and cognition and clinical measures of HIV. RESULTS Analyses conducted using multiple reference regions and measures of tracer uptake revealed no significant differences between [C]PBR28 binding in PLWH compared with HIV- controls. In addition, [C]PBR28 binding in PLWH was not significantly associated with clinical measures of HIV or plasma biomarkers of inflammation. [C]PBR28 binding was not significantly elevated in cognitively impaired PLWH compared with unimpaired PLWH, but there were inverse relationships between cognitive performance (executive and global function) and [C]PBR28 binding in PLWH. CONCLUSIONS Our results suggest that neuroinflammation may play a role in cognitive deficits, but overall neuroinflammatory levels as measured by TSPO-PET imaging in PLWH are not significantly different from those seen in HIV- controls.
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Cooley SA, Paul RH, Strain JF, Boerwinkle A, Kilgore C, Ances BM. Effects of anticholinergic medication use on brain integrity in persons living with HIV and persons without HIV. AIDS 2021; 35:381-391. [PMID: 33252494 PMCID: PMC7855412 DOI: 10.1097/qad.0000000000002768] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE This study examined relationships between anticholinergic medication burden and brain integrity in people living with HIV (PLWH) and people without HIV (HIV-). METHODS Neuropsychological performance z-scores (learning, retention, executive function, motor/psychomotor speed, language domains, and global cognition), and neuroimaging measures (brain volumetrics and white matter fractional anisotropy) were analyzed in PLWH (n = 209) and HIV- (n = 95) grouped according to the Anticholinergic Cognitive Burden (ACB) scale (0 = no burden, 1-3 = low burden, >3 = high burden). Neuropsychological performance and neuroimaging outcomes were compared between HIV- and PLWH with high anticholinergic burden. Within a cohort of PLWH (n = 90), longitudinal change in ACB score over ∼2 years was correlated to the rate of change per month of study interval in neuropsychological performance and neuroimaging measures. RESULTS A higher number of anticholinergic medications and ACB was observed in PLWH compared with HIV- (P < 0.05). A higher ACB was associated with worse motor/psychomotor performance, smaller occipital lobe, putamen, subcortical gray matter and total gray matter volumes in HIV-; and poorer executive function, retention and global cognition, smaller brain volumes (frontal, parietal and temporal lobes, hippocampus, amygdala, cortex, subcortical gray matter and total gray matter), and reduced fractional anisotropy (posterior corpus callosum, perforant pathway) in PLWH. PLWH with high anticholinergic burden performed worse on tests of learning and executive function compared with HIV- with high anticholinergic burden. Longitudinally, PLWH who reduced their ACB over time had better neuropsychological performance and neuroimaging measures. CONCLUSION Anticholinergic medications were associated with worse neuropsychological performance and reduced structural brain integrity, and these effects were more widespread in PLWH. Use of anticholinergic medications should be carefully monitored in older adults with deprescription considered whenever possible.
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Affiliation(s)
- Sarah A Cooley
- Department of Neurology, Washington University in Saint Louis
| | - Robert H Paul
- Department of Psychology, University of Missouri, Saint Louis
| | - Jeremy F Strain
- Department of Neurology, Washington University in Saint Louis
| | - Anna Boerwinkle
- Department of Neurology, Washington University in Saint Louis
| | - Collin Kilgore
- Department of Neurology, Washington University in Saint Louis
| | - Beau M Ances
- Department of Neurology, Washington University in Saint Louis
- Department of Radiology
- Hope Center for Neurological Disorders, Washington University in Saint Louis, Saint Louis, Missouri, USA
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13
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Matchanova A, Woods SP, Cushman C, Morgan EE, Medina LD, Babicz MA, Verduzco M, Loft S. Online pharmacy navigation skills are associated with prospective memory in HIV disease. Clin Neuropsychol 2020; 35:518-540. [PMID: 33131420 DOI: 10.1080/13854046.2020.1840632] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The increased use of online pharmacy services in the midst of the COVID-19 pandemic provides an important backdrop against which to examine the role of neurocognitive functions in health-related Internet navigation skills among persons with chronic medical conditions, such as HIV disease. Prospective memory (PM) is reliably impaired in HIV disease and is related to laboratory-based measures of medication management capacity in other populations. This study examined whether PM shows veridicality in relationship to online pharmacy navigation skills in persons with HIV disease. METHOD Participants included 98 persons with HIV disease age 50 and older who completed the Cambridge Prospective Memory Test (CAMPROMPT) and the Medication-Management Test-Revised (MMT-R) as part of a neuropsychological study. Participants also completed the Test of Online Pharmacy Skills (TOPS), which required them to navigate a simulated, experimenter-controlled online pharmacy to perform several naturalistic tasks (e.g., refill an existing prescription). RESULTS Lower PM had medium associations with poorer MMT-R and TOPS accuracy scores that were not better explained by other neurocognitive functions. The association between PM and TOPS accuracy was driven by errors of omission and did not vary meaningfully based on whether the intention was cued by time or an event. CONCLUSIONS These data suggest that PM cue detection processes show veridicality with online pharmacy navigation skills. Future studies might examine the benefits of PM-based strategies (e.g., salient prompts) in supporting online health navigation skills in populations that experience clinically impactful PM failures.
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Affiliation(s)
| | - Steven Paul Woods
- Department of Psychology, University of Houston, Houston, TX, USA.,School of Psychological Science, University of Western, Perth, Australia
| | - Clint Cushman
- Department of Psychiatry, University of California, San Diego, CA, USA
| | - Erin E Morgan
- Department of Psychiatry, University of California, San Diego, CA, USA
| | - Luis D Medina
- Department of Psychology, University of Houston, Houston, TX, USA
| | | | - Marizela Verduzco
- Department of Psychiatry, University of California, San Diego, CA, USA
| | - Shayne Loft
- School of Psychological Science, University of Western, Perth, Australia
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14
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McWhirter L, Ritchie CW, Stone J, Carson A. Performance validity test failure in clinical populations-a systematic review. J Neurol Neurosurg Psychiatry 2020; 91:945-952. [PMID: 32651247 DOI: 10.1136/jnnp-2020-323776] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 06/03/2020] [Accepted: 06/07/2020] [Indexed: 12/27/2022]
Abstract
Performance validity tests (PVTs) are widely used in attempts to quantify effort and/or detect negative response bias during neuropsychological testing. However, it can be challenging to interpret the meaning of poor PVT performance in a clinical context. Compensation-seeking populations predominate in the PVT literature. We aimed to establish base rates of PVT failure in clinical populations without known external motivation to underperform. We searched MEDLINE, EMBASE and PsycINFO for studies reporting PVT failure rates in adults with defined clinical diagnoses, excluding studies of active or veteran military personnel, forensic populations or studies of participants known to be litigating or seeking disability benefits. Results were summarised by diagnostic group and implications discussed. Our review identified 69 studies, and 45 different PVTs or indices, in clinical populations with intellectual disability, degenerative brain disease, brain injury, psychiatric disorders, functional disorders and epilepsy. Various pass/fail cut-off scores were described. PVT failure was common in all clinical groups described, with failure rates for some groups and tests exceeding 25%. PVT failure is common across a range of clinical conditions, even in the absence of obvious incentive to underperform. Failure rates are no higher in functional disorders than in other clinical conditions. As PVT failure indicates invalidity of other attempted neuropsychological tests, the finding of frequent and unexpected failure in a range of clinical conditions raises important questions about the degree of objectivity afforded to neuropsychological tests in clinical practice and research.
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Affiliation(s)
- Laura McWhirter
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Craig W Ritchie
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Jon Stone
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Alan Carson
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
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15
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Luckett P, Paul RH, Navid J, Cooley SA, Wisch JK, Boerwinkle AH, Tomov D, Ances BM. Deep Learning Analysis of Cerebral Blood Flow to Identify Cognitive Impairment and Frailty in Persons Living With HIV. J Acquir Immune Defic Syndr 2019; 82:496-502. [PMID: 31714429 PMCID: PMC6857844 DOI: 10.1097/qai.0000000000002181] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Deep learning algorithms of cerebral blood flow were used to classify cognitive impairment and frailty in people living with HIV (PLWH). Feature extraction techniques identified brain regions that were the strongest predictors. SETTING Virologically suppressed (<50 copies/mL) PLWH (n = 125) on combination antiretroviral therapy were enrolled. Participants averaged 51.4 (11.4) years of age and 13.7 (2.8) years of education. Participants were administered a neuropsychological battery, assessed for frailty, and completed structural neuroimaging. METHODS Deep neural network (DNN) models were trained to classify PLWH as cognitively unimpaired or impaired based on neuropsychological tests (Hopkins Verbal Learning Test-Revised and Brief Visuospatial Memory Test-Revised, Trail making, Letter-Number Sequencing, Verbal Fluency, and Color Word Interference), as well as frail, prefrail, or nonfrail based on the Fried phenotype criteria (at least 3 of the following 5: weight loss, physical inactivity, exhaustion, grip strength, walking time). RESULTS DNNs classified individuals with cognitive impairment in the learning, memory, and executive domains with 82%-86% accuracy (0.81-0.87 AUC). Our model classified nonfrail, prefrail, and frail PLWH with 75% accuracy. The strongest predictors of cognitive impairment were cortical (parietal, occipital, and temporal) and subcortical (amygdala, caudate, and hippocampus) regions, whereas the strongest predictors of frailty were subcortical (amygdala, caudate, hippocampus, thalamus, pallidum, and cerebellum). CONCLUSIONS DNN models achieved high accuracy in classifying cognitive impairment and frailty status in PLWH. Feature selection algorithms identified predictive regions in each domain and identified overlapping regions between cognitive impairment and frailty. Our results suggest frailty in HIV is primarily subcortical, whereas cognitive impairment in HIV involves subcortical and cortical brain regions.
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Affiliation(s)
- Patrick Luckett
- Department of Neurology, Washington University School of Medicine, St. Louis, MI
| | - Robert H Paul
- Department of Psychological Sciences, University of Missouri Saint Louis, St. Louis, MI
| | - Jaimie Navid
- Department of Neurology, Washington University School of Medicine, St. Louis, MI
| | - Sarah A Cooley
- Department of Neurology, Washington University School of Medicine, St. Louis, MI
| | - Julie K Wisch
- Department of Neurology, Washington University School of Medicine, St. Louis, MI
| | - Anna H Boerwinkle
- Department of Neurology, Washington University School of Medicine, St. Louis, MI
| | - Dimitre Tomov
- Department of Neurology, Washington University School of Medicine, St. Louis, MI
| | - Beau M Ances
- Department of Neurology, Washington University School of Medicine, St. Louis, MI
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16
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Levine AJ, Martin E, Munro CA, Sacktor N, Horvath S, Becker JT. Intraindividual variability in neurocognitive performance: No influence due to HIV status or self-reported effort. J Clin Exp Neuropsychol 2018; 40:1044-1049. [PMID: 30124355 DOI: 10.1080/13803395.2018.1508554] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
INTRODUCTION HIV-associated neurocognitive disorders (HAND) are estimated to affect approximately 50% of infected individuals at any one time. Dispersion, a type of intraindividual variability in neurocognitive test performance, has been identified as a potential behavioral marker of HAND; however, the specificity of dispersion to HAND and how it is influenced by participant effort when taking neurocognitive tests remain unclear. METHOD Data were analyzed from 996 (474 HIV-, 522 HIV+) men enrolled in the Multicenter AIDS Cohort Study (MACS). Dispersion was calculated based on the standard deviation of an individual's test scores within a single assessment. Effort was determined using the Visual Analogue Effort Scale. Predictors of dispersion were determined using stepwise linear regression. Dispersion was compared between the HIV serostatus groups using analysis of covariance (ANCOVA), considering demographic and psychosocial variables that differed between the groups. RESULTS Contrary to our hypothesis, dispersion was not influenced by effort. Instead, poorer neurocognitive ability and race were the sole predictors of dispersion. Dispersion did not differ between the serostatus groups. CONCLUSIONS Our results indicate that dispersion is a valid indicator of neurocognitive dysfunction that is not due to suboptimal effort; however, it is not specific to HIV and is therefore of limited utility as a behavioral marker of HIV-related neurocognitive impairment.
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Affiliation(s)
- Andrew J Levine
- a Department of Neurology , David Geffen School of Medicine at the University of California Los Angeles , Los Angeles , CA , USA
| | - Eileen Martin
- b Department of Psychiatry , Rush University Medical Center , Chicago , IL , USA
| | - Cynthia A Munro
- c Departments of Psychiatry and Neurology , Johns Hopkins University School of Medicine , Baltimore , MD , USA
| | - Ned Sacktor
- d Department of Neurology , Johns Hopkins University School of Medicine , Baltimore , MD , USA
| | - Steve Horvath
- e Departments of Human Genetics and Biostatistics , David Geffen School of Medicine at the University of California Los Angeles , Los Angeles , CA , USA
| | - James T Becker
- f Departments of Psychiatry, Neurology, and Psychology , University of Pittsburgh , Pittsburgh , PA , USA
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