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Breton J, Watson CWM, Kamalyan L, Franklin D, Fazeli P, Umlauf A, Moore RC, Ellis R, Grant I, Heaton RK, Cherner M, Moore DJ, Marquine MJ. Neurocognition and its predictors in a linguistically and culturally diverse cohort of people with HIV. Clin Neuropsychol 2024:1-20. [PMID: 38588669 DOI: 10.1080/13854046.2024.2319900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 02/09/2024] [Indexed: 04/10/2024]
Abstract
Objective: HIV/AIDS disproportionately affects Black and Latino people in the United States, yet there is a lack of research on predictors of neurocognitive outcomes in these groups. We examined neurocognitive performance and its key predictors across White, Black, and Latino people with HIV (PWH). Method: Participants included 586 PWH of White, Black, and Latino (English- and Spanish-speaking) background. Neurocognition was assessed via demographically-adjusted Fluid Cognition Composite T-scores from the NIH-Toolbox cognition battery, and individual tests comprising this composite. Predictors examined included sociodemographic and HIV disease characteristics, and medical, psychiatric and substance comorbidities. Results: Compared to White PWH, English-speaking Latino PWH had lower T-scores on the Fluid Cognition Composite, as well as Flanker Inhibition and Picture Sequence Memory tests. While there were no other significant group differences on Fluid Cognition, both Latino PWH language groups performed worse than Black PWH on Flanker Inhibition, and Black PWH performed worse than White PWH on List Sorting. Separate multivariable linear regression models by ethnic/racial/language group showed that significant correlates of worse Fluid Cognition included depressive symptoms among White PWH; hepatitis C co-infection among Black PWH; hypertension among English-speaking Latino PWH; and higher estimated duration of HIV disease and depressive symptoms in Spanish-speaking Latino PWH. Conclusions: Findings suggest worse neurocognition among English-speaking Latino PWH compared to Whites. Predictors of neurocognitive function among PWH differ across ethnic/racial and language groups. Consideration of these HIV disease characteristics and comorbidities may be valuable in developing targeted culturally-relevant interventions aimed at ameliorating neurocognitive dysfunction among diverse PWH.
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Affiliation(s)
- Jordana Breton
- HIV Neurobehavioral Research Program, University of California San Diego, San Diego, CA, USA
- Department of Psychology, University of Texas at Austin, Austin, TX, USA
| | - Caitlin Wei-Ming Watson
- HIV Neurobehavioral Research Program, University of California San Diego, San Diego, CA, USA
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
- San Diego Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, San Diego, CA, USA
| | - Lily Kamalyan
- HIV Neurobehavioral Research Program, University of California San Diego, San Diego, CA, USA
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
- San Diego Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, San Diego, CA, USA
| | - Donald Franklin
- HIV Neurobehavioral Research Program, University of California San Diego, San Diego, CA, USA
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Pariya Fazeli
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Anya Umlauf
- HIV Neurobehavioral Research Program, University of California San Diego, San Diego, CA, USA
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Raeanne C Moore
- HIV Neurobehavioral Research Program, University of California San Diego, San Diego, CA, USA
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Ronald Ellis
- HIV Neurobehavioral Research Program, University of California San Diego, San Diego, CA, USA
- Department of Neurosciences, University of California San Diego, San Diego, CA, USA
| | - Igor Grant
- HIV Neurobehavioral Research Program, University of California San Diego, San Diego, CA, USA
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Robert K Heaton
- HIV Neurobehavioral Research Program, University of California San Diego, San Diego, CA, USA
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Mariana Cherner
- HIV Neurobehavioral Research Program, University of California San Diego, San Diego, CA, USA
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - David J Moore
- HIV Neurobehavioral Research Program, University of California San Diego, San Diego, CA, USA
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - María J Marquine
- Department of Medicine, University of California San Diego, San Diego, CA, USA
- Department of Medicine, Duke University, Durham, NC, USA
- Duke Center for the Study of Aging and Human Development, Duke University, Durham, NC, USA
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Chapman S, Rentería MA, Dworkin JD, Garriga SM, Barker MS, Avila-Rieger J, Gonzalez C, Joyce JL, Vonk JMJ, Soto E, Manly JJ, Brickman AM, Mayeux RP, Cosentino SA. Association of Subjective Cognitive Decline With Progression to Dementia in a Cognitively Unimpaired Multiracial Community Sample. Neurology 2023; 100:e1020-e1027. [PMID: 36450605 PMCID: PMC9990861 DOI: 10.1212/wnl.0000000000201658] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 10/20/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND AND OBJECTIVES This prospective study seeks to examine the utility of subjective cognitive decline (SCD) as a marker of future progression to dementia in a community-based cohort of non-Latinx White, non-Latinx Black, and Latinx individuals. Debate surrounds the utility of SCD, the subjective perception of decline in one's cognition before such impairment is evident in traditional neuropsychological assessments, as an early indicator of impending Alzheimer disease. Unfortunately, most studies examining SCD have been conducted in non-Latinx White samples and commonly exclude groups of individuals shown to be most vulnerable to dementia. METHODS Participants were enrolled into this cohort study from the Washington Heights-Inwood Columbia Aging Project if they were cognitively unimpaired, had baseline measurement of SCD, and self-identified as non-Latinx White, non-Latinx Black, or Latinx. SCD was measured as a continuous sum of 10 items assessing cognitive complaints. Competing risk models tested the main effects of baseline SCD on progression to dementia. Models were adjusted for age, sex/gender, years of education, medical comorbidity burden, enrollment cohort, and baseline memory test performance with death jointly modelled as a function of race/ethnicity. RESULTS A total of 4,043 (1,063 non-Latinx White, 1,267 non-Latinx Black, and 1,713 Latinx) participants were selected for this study with a mean age of 75 years, 67% women, and with a mean follow-up of 5 years. Higher baseline SCD was associated with increased rates of incident dementia over time in the full sample (hazard ratio [HR] 1.085, CI 1.047-1.125, p < 0.001) and within Latinx (HR 1.084, CI 1.039-1.130, p < 0.001) and non-Latinx Black individuals (HR 1.099, CI 1.012-1.194, p = 0.024). DISCUSSION Overall results of this study support SCD as a prodromal marker of dementia in a multiracial community sample, and in Latinx and non-Latinx Black individuals in particular. Because models examining the risk of dementia were adjusted for baseline memory test performance, the results support the idea that SCD, a subjective reflection of one's own current cognitive functioning, contributes information above and beyond standard memory testing. Current findings highlight the importance of carefully evaluating any memory concerns raised by older adults during routine visits and underscore the potential utility of screening older adults for SCD.
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Affiliation(s)
- Silvia Chapman
- From the Cognitive Neuroscience Division (S.C., M.A.R., S.M.G., M.S.B., J.A.-R., J.L.J., E.S., J.J.M., A.M.B., R.P.M., S.A.C.), Taub Institute for Research on Alzheimer's Disease and the Aging Brain (S.C., M.A.R., S.M.G., M.S.B., J.A.-R., J.J.M., A.M.B., R.P.M., S.A.C.), Gertrude H. Sergievsky Center (M.A.R., J.A.-R., J.L.J., E.S., J.J.M., A.M.B., R.P.M., S.A.C.), Department of Neurology (M.A.R., J.J.M., A.M.B., R.P.M., S.A.C.), Columbia University Irving Medical Center, New York; New York State Psychiatric Institute (J.D.D.); Departments of Psychiatry and Biostatistics (J.D.D.), Columbia University Irving Medical Center, New York; Department of Psychology (C.G.), Illinois Institute of Technology, Chicago; Memory and Aging Center (J.M.J.V.), Department of Neurology, University of California San Francisco; and Julius Center for Health Sciences and Primary Care (J.M.J.V.), Department of Epidemiology, Utrecht University Medical Centre, the Netherlands
| | - Miguel Arce Rentería
- From the Cognitive Neuroscience Division (S.C., M.A.R., S.M.G., M.S.B., J.A.-R., J.L.J., E.S., J.J.M., A.M.B., R.P.M., S.A.C.), Taub Institute for Research on Alzheimer's Disease and the Aging Brain (S.C., M.A.R., S.M.G., M.S.B., J.A.-R., J.J.M., A.M.B., R.P.M., S.A.C.), Gertrude H. Sergievsky Center (M.A.R., J.A.-R., J.L.J., E.S., J.J.M., A.M.B., R.P.M., S.A.C.), Department of Neurology (M.A.R., J.J.M., A.M.B., R.P.M., S.A.C.), Columbia University Irving Medical Center, New York; New York State Psychiatric Institute (J.D.D.); Departments of Psychiatry and Biostatistics (J.D.D.), Columbia University Irving Medical Center, New York; Department of Psychology (C.G.), Illinois Institute of Technology, Chicago; Memory and Aging Center (J.M.J.V.), Department of Neurology, University of California San Francisco; and Julius Center for Health Sciences and Primary Care (J.M.J.V.), Department of Epidemiology, Utrecht University Medical Centre, the Netherlands
| | - Jordan D Dworkin
- From the Cognitive Neuroscience Division (S.C., M.A.R., S.M.G., M.S.B., J.A.-R., J.L.J., E.S., J.J.M., A.M.B., R.P.M., S.A.C.), Taub Institute for Research on Alzheimer's Disease and the Aging Brain (S.C., M.A.R., S.M.G., M.S.B., J.A.-R., J.J.M., A.M.B., R.P.M., S.A.C.), Gertrude H. Sergievsky Center (M.A.R., J.A.-R., J.L.J., E.S., J.J.M., A.M.B., R.P.M., S.A.C.), Department of Neurology (M.A.R., J.J.M., A.M.B., R.P.M., S.A.C.), Columbia University Irving Medical Center, New York; New York State Psychiatric Institute (J.D.D.); Departments of Psychiatry and Biostatistics (J.D.D.), Columbia University Irving Medical Center, New York; Department of Psychology (C.G.), Illinois Institute of Technology, Chicago; Memory and Aging Center (J.M.J.V.), Department of Neurology, University of California San Francisco; and Julius Center for Health Sciences and Primary Care (J.M.J.V.), Department of Epidemiology, Utrecht University Medical Centre, the Netherlands
| | - Stella M Garriga
- From the Cognitive Neuroscience Division (S.C., M.A.R., S.M.G., M.S.B., J.A.-R., J.L.J., E.S., J.J.M., A.M.B., R.P.M., S.A.C.), Taub Institute for Research on Alzheimer's Disease and the Aging Brain (S.C., M.A.R., S.M.G., M.S.B., J.A.-R., J.J.M., A.M.B., R.P.M., S.A.C.), Gertrude H. Sergievsky Center (M.A.R., J.A.-R., J.L.J., E.S., J.J.M., A.M.B., R.P.M., S.A.C.), Department of Neurology (M.A.R., J.J.M., A.M.B., R.P.M., S.A.C.), Columbia University Irving Medical Center, New York; New York State Psychiatric Institute (J.D.D.); Departments of Psychiatry and Biostatistics (J.D.D.), Columbia University Irving Medical Center, New York; Department of Psychology (C.G.), Illinois Institute of Technology, Chicago; Memory and Aging Center (J.M.J.V.), Department of Neurology, University of California San Francisco; and Julius Center for Health Sciences and Primary Care (J.M.J.V.), Department of Epidemiology, Utrecht University Medical Centre, the Netherlands
| | - Megan S Barker
- From the Cognitive Neuroscience Division (S.C., M.A.R., S.M.G., M.S.B., J.A.-R., J.L.J., E.S., J.J.M., A.M.B., R.P.M., S.A.C.), Taub Institute for Research on Alzheimer's Disease and the Aging Brain (S.C., M.A.R., S.M.G., M.S.B., J.A.-R., J.J.M., A.M.B., R.P.M., S.A.C.), Gertrude H. Sergievsky Center (M.A.R., J.A.-R., J.L.J., E.S., J.J.M., A.M.B., R.P.M., S.A.C.), Department of Neurology (M.A.R., J.J.M., A.M.B., R.P.M., S.A.C.), Columbia University Irving Medical Center, New York; New York State Psychiatric Institute (J.D.D.); Departments of Psychiatry and Biostatistics (J.D.D.), Columbia University Irving Medical Center, New York; Department of Psychology (C.G.), Illinois Institute of Technology, Chicago; Memory and Aging Center (J.M.J.V.), Department of Neurology, University of California San Francisco; and Julius Center for Health Sciences and Primary Care (J.M.J.V.), Department of Epidemiology, Utrecht University Medical Centre, the Netherlands
| | - Justina Avila-Rieger
- From the Cognitive Neuroscience Division (S.C., M.A.R., S.M.G., M.S.B., J.A.-R., J.L.J., E.S., J.J.M., A.M.B., R.P.M., S.A.C.), Taub Institute for Research on Alzheimer's Disease and the Aging Brain (S.C., M.A.R., S.M.G., M.S.B., J.A.-R., J.J.M., A.M.B., R.P.M., S.A.C.), Gertrude H. Sergievsky Center (M.A.R., J.A.-R., J.L.J., E.S., J.J.M., A.M.B., R.P.M., S.A.C.), Department of Neurology (M.A.R., J.J.M., A.M.B., R.P.M., S.A.C.), Columbia University Irving Medical Center, New York; New York State Psychiatric Institute (J.D.D.); Departments of Psychiatry and Biostatistics (J.D.D.), Columbia University Irving Medical Center, New York; Department of Psychology (C.G.), Illinois Institute of Technology, Chicago; Memory and Aging Center (J.M.J.V.), Department of Neurology, University of California San Francisco; and Julius Center for Health Sciences and Primary Care (J.M.J.V.), Department of Epidemiology, Utrecht University Medical Centre, the Netherlands
| | - Christopher Gonzalez
- From the Cognitive Neuroscience Division (S.C., M.A.R., S.M.G., M.S.B., J.A.-R., J.L.J., E.S., J.J.M., A.M.B., R.P.M., S.A.C.), Taub Institute for Research on Alzheimer's Disease and the Aging Brain (S.C., M.A.R., S.M.G., M.S.B., J.A.-R., J.J.M., A.M.B., R.P.M., S.A.C.), Gertrude H. Sergievsky Center (M.A.R., J.A.-R., J.L.J., E.S., J.J.M., A.M.B., R.P.M., S.A.C.), Department of Neurology (M.A.R., J.J.M., A.M.B., R.P.M., S.A.C.), Columbia University Irving Medical Center, New York; New York State Psychiatric Institute (J.D.D.); Departments of Psychiatry and Biostatistics (J.D.D.), Columbia University Irving Medical Center, New York; Department of Psychology (C.G.), Illinois Institute of Technology, Chicago; Memory and Aging Center (J.M.J.V.), Department of Neurology, University of California San Francisco; and Julius Center for Health Sciences and Primary Care (J.M.J.V.), Department of Epidemiology, Utrecht University Medical Centre, the Netherlands
| | - Jillian L Joyce
- From the Cognitive Neuroscience Division (S.C., M.A.R., S.M.G., M.S.B., J.A.-R., J.L.J., E.S., J.J.M., A.M.B., R.P.M., S.A.C.), Taub Institute for Research on Alzheimer's Disease and the Aging Brain (S.C., M.A.R., S.M.G., M.S.B., J.A.-R., J.J.M., A.M.B., R.P.M., S.A.C.), Gertrude H. Sergievsky Center (M.A.R., J.A.-R., J.L.J., E.S., J.J.M., A.M.B., R.P.M., S.A.C.), Department of Neurology (M.A.R., J.J.M., A.M.B., R.P.M., S.A.C.), Columbia University Irving Medical Center, New York; New York State Psychiatric Institute (J.D.D.); Departments of Psychiatry and Biostatistics (J.D.D.), Columbia University Irving Medical Center, New York; Department of Psychology (C.G.), Illinois Institute of Technology, Chicago; Memory and Aging Center (J.M.J.V.), Department of Neurology, University of California San Francisco; and Julius Center for Health Sciences and Primary Care (J.M.J.V.), Department of Epidemiology, Utrecht University Medical Centre, the Netherlands
| | - Jet M J Vonk
- From the Cognitive Neuroscience Division (S.C., M.A.R., S.M.G., M.S.B., J.A.-R., J.L.J., E.S., J.J.M., A.M.B., R.P.M., S.A.C.), Taub Institute for Research on Alzheimer's Disease and the Aging Brain (S.C., M.A.R., S.M.G., M.S.B., J.A.-R., J.J.M., A.M.B., R.P.M., S.A.C.), Gertrude H. Sergievsky Center (M.A.R., J.A.-R., J.L.J., E.S., J.J.M., A.M.B., R.P.M., S.A.C.), Department of Neurology (M.A.R., J.J.M., A.M.B., R.P.M., S.A.C.), Columbia University Irving Medical Center, New York; New York State Psychiatric Institute (J.D.D.); Departments of Psychiatry and Biostatistics (J.D.D.), Columbia University Irving Medical Center, New York; Department of Psychology (C.G.), Illinois Institute of Technology, Chicago; Memory and Aging Center (J.M.J.V.), Department of Neurology, University of California San Francisco; and Julius Center for Health Sciences and Primary Care (J.M.J.V.), Department of Epidemiology, Utrecht University Medical Centre, the Netherlands
| | - Elizabeth Soto
- From the Cognitive Neuroscience Division (S.C., M.A.R., S.M.G., M.S.B., J.A.-R., J.L.J., E.S., J.J.M., A.M.B., R.P.M., S.A.C.), Taub Institute for Research on Alzheimer's Disease and the Aging Brain (S.C., M.A.R., S.M.G., M.S.B., J.A.-R., J.J.M., A.M.B., R.P.M., S.A.C.), Gertrude H. Sergievsky Center (M.A.R., J.A.-R., J.L.J., E.S., J.J.M., A.M.B., R.P.M., S.A.C.), Department of Neurology (M.A.R., J.J.M., A.M.B., R.P.M., S.A.C.), Columbia University Irving Medical Center, New York; New York State Psychiatric Institute (J.D.D.); Departments of Psychiatry and Biostatistics (J.D.D.), Columbia University Irving Medical Center, New York; Department of Psychology (C.G.), Illinois Institute of Technology, Chicago; Memory and Aging Center (J.M.J.V.), Department of Neurology, University of California San Francisco; and Julius Center for Health Sciences and Primary Care (J.M.J.V.), Department of Epidemiology, Utrecht University Medical Centre, the Netherlands
| | - Jennifer J Manly
- From the Cognitive Neuroscience Division (S.C., M.A.R., S.M.G., M.S.B., J.A.-R., J.L.J., E.S., J.J.M., A.M.B., R.P.M., S.A.C.), Taub Institute for Research on Alzheimer's Disease and the Aging Brain (S.C., M.A.R., S.M.G., M.S.B., J.A.-R., J.J.M., A.M.B., R.P.M., S.A.C.), Gertrude H. Sergievsky Center (M.A.R., J.A.-R., J.L.J., E.S., J.J.M., A.M.B., R.P.M., S.A.C.), Department of Neurology (M.A.R., J.J.M., A.M.B., R.P.M., S.A.C.), Columbia University Irving Medical Center, New York; New York State Psychiatric Institute (J.D.D.); Departments of Psychiatry and Biostatistics (J.D.D.), Columbia University Irving Medical Center, New York; Department of Psychology (C.G.), Illinois Institute of Technology, Chicago; Memory and Aging Center (J.M.J.V.), Department of Neurology, University of California San Francisco; and Julius Center for Health Sciences and Primary Care (J.M.J.V.), Department of Epidemiology, Utrecht University Medical Centre, the Netherlands
| | - Adam M Brickman
- From the Cognitive Neuroscience Division (S.C., M.A.R., S.M.G., M.S.B., J.A.-R., J.L.J., E.S., J.J.M., A.M.B., R.P.M., S.A.C.), Taub Institute for Research on Alzheimer's Disease and the Aging Brain (S.C., M.A.R., S.M.G., M.S.B., J.A.-R., J.J.M., A.M.B., R.P.M., S.A.C.), Gertrude H. Sergievsky Center (M.A.R., J.A.-R., J.L.J., E.S., J.J.M., A.M.B., R.P.M., S.A.C.), Department of Neurology (M.A.R., J.J.M., A.M.B., R.P.M., S.A.C.), Columbia University Irving Medical Center, New York; New York State Psychiatric Institute (J.D.D.); Departments of Psychiatry and Biostatistics (J.D.D.), Columbia University Irving Medical Center, New York; Department of Psychology (C.G.), Illinois Institute of Technology, Chicago; Memory and Aging Center (J.M.J.V.), Department of Neurology, University of California San Francisco; and Julius Center for Health Sciences and Primary Care (J.M.J.V.), Department of Epidemiology, Utrecht University Medical Centre, the Netherlands
| | - Richard P Mayeux
- From the Cognitive Neuroscience Division (S.C., M.A.R., S.M.G., M.S.B., J.A.-R., J.L.J., E.S., J.J.M., A.M.B., R.P.M., S.A.C.), Taub Institute for Research on Alzheimer's Disease and the Aging Brain (S.C., M.A.R., S.M.G., M.S.B., J.A.-R., J.J.M., A.M.B., R.P.M., S.A.C.), Gertrude H. Sergievsky Center (M.A.R., J.A.-R., J.L.J., E.S., J.J.M., A.M.B., R.P.M., S.A.C.), Department of Neurology (M.A.R., J.J.M., A.M.B., R.P.M., S.A.C.), Columbia University Irving Medical Center, New York; New York State Psychiatric Institute (J.D.D.); Departments of Psychiatry and Biostatistics (J.D.D.), Columbia University Irving Medical Center, New York; Department of Psychology (C.G.), Illinois Institute of Technology, Chicago; Memory and Aging Center (J.M.J.V.), Department of Neurology, University of California San Francisco; and Julius Center for Health Sciences and Primary Care (J.M.J.V.), Department of Epidemiology, Utrecht University Medical Centre, the Netherlands
| | - Stephanie A Cosentino
- From the Cognitive Neuroscience Division (S.C., M.A.R., S.M.G., M.S.B., J.A.-R., J.L.J., E.S., J.J.M., A.M.B., R.P.M., S.A.C.), Taub Institute for Research on Alzheimer's Disease and the Aging Brain (S.C., M.A.R., S.M.G., M.S.B., J.A.-R., J.J.M., A.M.B., R.P.M., S.A.C.), Gertrude H. Sergievsky Center (M.A.R., J.A.-R., J.L.J., E.S., J.J.M., A.M.B., R.P.M., S.A.C.), Department of Neurology (M.A.R., J.J.M., A.M.B., R.P.M., S.A.C.), Columbia University Irving Medical Center, New York; New York State Psychiatric Institute (J.D.D.); Departments of Psychiatry and Biostatistics (J.D.D.), Columbia University Irving Medical Center, New York; Department of Psychology (C.G.), Illinois Institute of Technology, Chicago; Memory and Aging Center (J.M.J.V.), Department of Neurology, University of California San Francisco; and Julius Center for Health Sciences and Primary Care (J.M.J.V.), Department of Epidemiology, Utrecht University Medical Centre, the Netherlands.
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