|
1
|
Fazeli PL, Davey CH, Webel AR, Oliveira V, Buford TW, Vance DE, Burkholder G, Crane HM, Fleming J, Willig AL. Select Dietary Components Are Associated With Better Global Cognition in Adults With HIV. J Assoc Nurses AIDS Care 2024:00001782-990000000-00117. [PMID: 39137410 DOI: 10.1097/jnc.0000000000000479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/15/2024]
Abstract
ABSTRACT People with HIV (PWH) are at an increased risk for cognitive impairment. Lifestyle factors can have protective effects on cognition; little work has examined diet and cognitive function in PWH. In this cross-sectional pilot study, 86 PWH (mean age 56 years) completed diet recalls and a neurocognitive assessment. Correlations were conducted between diet and cognitive function, adjusting for total calories, sex, and education (multiple comparison correction p values are reported). Diet quality of the sample was poor. Greater calories per day (r = 0.28, p =.08) and greater percentage of calories from saturated fatty acids (SFAs; r = 0.26, p = 0.08) were associated with better cognition. Higher intake of SFAs (rs 0.30-0.31, ps = 0.07), amino acids (rs = 0.27, ps = 0.08), and phosphorus (r = 0.29, p = .07) and magnesium (r = 0.25, p = .08) were associated with better cognition. A diet reflecting higher protein and fat relative to carbohydrates was associated with better cognition. Targeting individual nutrients, improving diet quality, and adequate caloric intake may preserve cognition in PWH.
Collapse
Affiliation(s)
- Pariya L Fazeli
- Pariya L. Fazeli, PhD is an Associate Professor, Department of Family, Community, and Health Systems, School of Nursing, The University of Alabama Birmingham, Birmingham, Alabama, USA
- Christine Horvat Davey, PhD, is an Assistant Professor, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio, USA
- Allison R. Webel, PhD, RN, is the Aljoya Endowed Professor in Aging and Interim Robert G. and Jean A. Reid Executive Dean, School of Nursing, University of Washington, Seattle, Washington, USA
- Vitor Oliveira, PhD, is an Acting Instructor, School of Nursing, University of Washington, Seattle, Washington, USA
- Thomas W. Buford, PhD, is a Professor, Division of Gerontology, Geriatrics, and Palliative Care, Department of Medicine, The University of Alabama Birmingham, Birmingham, Alabama, USA, and Birmingham/Atlanta Geriatric Research, Education, and Clinical Center, Birmingham VA Medical Center, Birmingham, Alabama, USA
- David E. Vance, PhD, is a Professor, Department of Acute, Chronic & Continuing Care, School of Nursing, The University of Alabama Birmingham, Birmingham, Alabama, USA
- Greer Burkholder, MD, is an Associate Professor, Division of Infectious Diseases, Department of Medicine, The University of Alabama Birmingham, Birmingham, Alabama, USA
- Heidi M. Crane, MD, MPH, is a Professor, Division of Allergy & Infectious Diseases, Department of Medicine, University of Washington, Seattle, Washington, USA
- Julia Fleming, MD, is the Medical Director for Public Health Programs, The Fenway Institute, Boston, Massachusetts, USA
- Amanda L. Willig, PhD, RD, is an Associate Professor, Division of Infectious Diseases, Department of Medicine, The University of Alabama Birmingham, Birmingham, Alabama, USA
| | - Christine Horvat Davey
- Pariya L. Fazeli, PhD is an Associate Professor, Department of Family, Community, and Health Systems, School of Nursing, The University of Alabama Birmingham, Birmingham, Alabama, USA
- Christine Horvat Davey, PhD, is an Assistant Professor, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio, USA
- Allison R. Webel, PhD, RN, is the Aljoya Endowed Professor in Aging and Interim Robert G. and Jean A. Reid Executive Dean, School of Nursing, University of Washington, Seattle, Washington, USA
- Vitor Oliveira, PhD, is an Acting Instructor, School of Nursing, University of Washington, Seattle, Washington, USA
- Thomas W. Buford, PhD, is a Professor, Division of Gerontology, Geriatrics, and Palliative Care, Department of Medicine, The University of Alabama Birmingham, Birmingham, Alabama, USA, and Birmingham/Atlanta Geriatric Research, Education, and Clinical Center, Birmingham VA Medical Center, Birmingham, Alabama, USA
- David E. Vance, PhD, is a Professor, Department of Acute, Chronic & Continuing Care, School of Nursing, The University of Alabama Birmingham, Birmingham, Alabama, USA
- Greer Burkholder, MD, is an Associate Professor, Division of Infectious Diseases, Department of Medicine, The University of Alabama Birmingham, Birmingham, Alabama, USA
- Heidi M. Crane, MD, MPH, is a Professor, Division of Allergy & Infectious Diseases, Department of Medicine, University of Washington, Seattle, Washington, USA
- Julia Fleming, MD, is the Medical Director for Public Health Programs, The Fenway Institute, Boston, Massachusetts, USA
- Amanda L. Willig, PhD, RD, is an Associate Professor, Division of Infectious Diseases, Department of Medicine, The University of Alabama Birmingham, Birmingham, Alabama, USA
| | - Allison R Webel
- Pariya L. Fazeli, PhD is an Associate Professor, Department of Family, Community, and Health Systems, School of Nursing, The University of Alabama Birmingham, Birmingham, Alabama, USA
- Christine Horvat Davey, PhD, is an Assistant Professor, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio, USA
- Allison R. Webel, PhD, RN, is the Aljoya Endowed Professor in Aging and Interim Robert G. and Jean A. Reid Executive Dean, School of Nursing, University of Washington, Seattle, Washington, USA
- Vitor Oliveira, PhD, is an Acting Instructor, School of Nursing, University of Washington, Seattle, Washington, USA
- Thomas W. Buford, PhD, is a Professor, Division of Gerontology, Geriatrics, and Palliative Care, Department of Medicine, The University of Alabama Birmingham, Birmingham, Alabama, USA, and Birmingham/Atlanta Geriatric Research, Education, and Clinical Center, Birmingham VA Medical Center, Birmingham, Alabama, USA
- David E. Vance, PhD, is a Professor, Department of Acute, Chronic & Continuing Care, School of Nursing, The University of Alabama Birmingham, Birmingham, Alabama, USA
- Greer Burkholder, MD, is an Associate Professor, Division of Infectious Diseases, Department of Medicine, The University of Alabama Birmingham, Birmingham, Alabama, USA
- Heidi M. Crane, MD, MPH, is a Professor, Division of Allergy & Infectious Diseases, Department of Medicine, University of Washington, Seattle, Washington, USA
- Julia Fleming, MD, is the Medical Director for Public Health Programs, The Fenway Institute, Boston, Massachusetts, USA
- Amanda L. Willig, PhD, RD, is an Associate Professor, Division of Infectious Diseases, Department of Medicine, The University of Alabama Birmingham, Birmingham, Alabama, USA
| | - Vitor Oliveira
- Pariya L. Fazeli, PhD is an Associate Professor, Department of Family, Community, and Health Systems, School of Nursing, The University of Alabama Birmingham, Birmingham, Alabama, USA
- Christine Horvat Davey, PhD, is an Assistant Professor, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio, USA
- Allison R. Webel, PhD, RN, is the Aljoya Endowed Professor in Aging and Interim Robert G. and Jean A. Reid Executive Dean, School of Nursing, University of Washington, Seattle, Washington, USA
- Vitor Oliveira, PhD, is an Acting Instructor, School of Nursing, University of Washington, Seattle, Washington, USA
- Thomas W. Buford, PhD, is a Professor, Division of Gerontology, Geriatrics, and Palliative Care, Department of Medicine, The University of Alabama Birmingham, Birmingham, Alabama, USA, and Birmingham/Atlanta Geriatric Research, Education, and Clinical Center, Birmingham VA Medical Center, Birmingham, Alabama, USA
- David E. Vance, PhD, is a Professor, Department of Acute, Chronic & Continuing Care, School of Nursing, The University of Alabama Birmingham, Birmingham, Alabama, USA
- Greer Burkholder, MD, is an Associate Professor, Division of Infectious Diseases, Department of Medicine, The University of Alabama Birmingham, Birmingham, Alabama, USA
- Heidi M. Crane, MD, MPH, is a Professor, Division of Allergy & Infectious Diseases, Department of Medicine, University of Washington, Seattle, Washington, USA
- Julia Fleming, MD, is the Medical Director for Public Health Programs, The Fenway Institute, Boston, Massachusetts, USA
- Amanda L. Willig, PhD, RD, is an Associate Professor, Division of Infectious Diseases, Department of Medicine, The University of Alabama Birmingham, Birmingham, Alabama, USA
| | - Thomas W Buford
- Pariya L. Fazeli, PhD is an Associate Professor, Department of Family, Community, and Health Systems, School of Nursing, The University of Alabama Birmingham, Birmingham, Alabama, USA
- Christine Horvat Davey, PhD, is an Assistant Professor, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio, USA
- Allison R. Webel, PhD, RN, is the Aljoya Endowed Professor in Aging and Interim Robert G. and Jean A. Reid Executive Dean, School of Nursing, University of Washington, Seattle, Washington, USA
- Vitor Oliveira, PhD, is an Acting Instructor, School of Nursing, University of Washington, Seattle, Washington, USA
- Thomas W. Buford, PhD, is a Professor, Division of Gerontology, Geriatrics, and Palliative Care, Department of Medicine, The University of Alabama Birmingham, Birmingham, Alabama, USA, and Birmingham/Atlanta Geriatric Research, Education, and Clinical Center, Birmingham VA Medical Center, Birmingham, Alabama, USA
- David E. Vance, PhD, is a Professor, Department of Acute, Chronic & Continuing Care, School of Nursing, The University of Alabama Birmingham, Birmingham, Alabama, USA
- Greer Burkholder, MD, is an Associate Professor, Division of Infectious Diseases, Department of Medicine, The University of Alabama Birmingham, Birmingham, Alabama, USA
- Heidi M. Crane, MD, MPH, is a Professor, Division of Allergy & Infectious Diseases, Department of Medicine, University of Washington, Seattle, Washington, USA
- Julia Fleming, MD, is the Medical Director for Public Health Programs, The Fenway Institute, Boston, Massachusetts, USA
- Amanda L. Willig, PhD, RD, is an Associate Professor, Division of Infectious Diseases, Department of Medicine, The University of Alabama Birmingham, Birmingham, Alabama, USA
| | - David E Vance
- Pariya L. Fazeli, PhD is an Associate Professor, Department of Family, Community, and Health Systems, School of Nursing, The University of Alabama Birmingham, Birmingham, Alabama, USA
- Christine Horvat Davey, PhD, is an Assistant Professor, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio, USA
- Allison R. Webel, PhD, RN, is the Aljoya Endowed Professor in Aging and Interim Robert G. and Jean A. Reid Executive Dean, School of Nursing, University of Washington, Seattle, Washington, USA
- Vitor Oliveira, PhD, is an Acting Instructor, School of Nursing, University of Washington, Seattle, Washington, USA
- Thomas W. Buford, PhD, is a Professor, Division of Gerontology, Geriatrics, and Palliative Care, Department of Medicine, The University of Alabama Birmingham, Birmingham, Alabama, USA, and Birmingham/Atlanta Geriatric Research, Education, and Clinical Center, Birmingham VA Medical Center, Birmingham, Alabama, USA
- David E. Vance, PhD, is a Professor, Department of Acute, Chronic & Continuing Care, School of Nursing, The University of Alabama Birmingham, Birmingham, Alabama, USA
- Greer Burkholder, MD, is an Associate Professor, Division of Infectious Diseases, Department of Medicine, The University of Alabama Birmingham, Birmingham, Alabama, USA
- Heidi M. Crane, MD, MPH, is a Professor, Division of Allergy & Infectious Diseases, Department of Medicine, University of Washington, Seattle, Washington, USA
- Julia Fleming, MD, is the Medical Director for Public Health Programs, The Fenway Institute, Boston, Massachusetts, USA
- Amanda L. Willig, PhD, RD, is an Associate Professor, Division of Infectious Diseases, Department of Medicine, The University of Alabama Birmingham, Birmingham, Alabama, USA
| | - Greer Burkholder
- Pariya L. Fazeli, PhD is an Associate Professor, Department of Family, Community, and Health Systems, School of Nursing, The University of Alabama Birmingham, Birmingham, Alabama, USA
- Christine Horvat Davey, PhD, is an Assistant Professor, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio, USA
- Allison R. Webel, PhD, RN, is the Aljoya Endowed Professor in Aging and Interim Robert G. and Jean A. Reid Executive Dean, School of Nursing, University of Washington, Seattle, Washington, USA
- Vitor Oliveira, PhD, is an Acting Instructor, School of Nursing, University of Washington, Seattle, Washington, USA
- Thomas W. Buford, PhD, is a Professor, Division of Gerontology, Geriatrics, and Palliative Care, Department of Medicine, The University of Alabama Birmingham, Birmingham, Alabama, USA, and Birmingham/Atlanta Geriatric Research, Education, and Clinical Center, Birmingham VA Medical Center, Birmingham, Alabama, USA
- David E. Vance, PhD, is a Professor, Department of Acute, Chronic & Continuing Care, School of Nursing, The University of Alabama Birmingham, Birmingham, Alabama, USA
- Greer Burkholder, MD, is an Associate Professor, Division of Infectious Diseases, Department of Medicine, The University of Alabama Birmingham, Birmingham, Alabama, USA
- Heidi M. Crane, MD, MPH, is a Professor, Division of Allergy & Infectious Diseases, Department of Medicine, University of Washington, Seattle, Washington, USA
- Julia Fleming, MD, is the Medical Director for Public Health Programs, The Fenway Institute, Boston, Massachusetts, USA
- Amanda L. Willig, PhD, RD, is an Associate Professor, Division of Infectious Diseases, Department of Medicine, The University of Alabama Birmingham, Birmingham, Alabama, USA
| | - Heidi M Crane
- Pariya L. Fazeli, PhD is an Associate Professor, Department of Family, Community, and Health Systems, School of Nursing, The University of Alabama Birmingham, Birmingham, Alabama, USA
- Christine Horvat Davey, PhD, is an Assistant Professor, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio, USA
- Allison R. Webel, PhD, RN, is the Aljoya Endowed Professor in Aging and Interim Robert G. and Jean A. Reid Executive Dean, School of Nursing, University of Washington, Seattle, Washington, USA
- Vitor Oliveira, PhD, is an Acting Instructor, School of Nursing, University of Washington, Seattle, Washington, USA
- Thomas W. Buford, PhD, is a Professor, Division of Gerontology, Geriatrics, and Palliative Care, Department of Medicine, The University of Alabama Birmingham, Birmingham, Alabama, USA, and Birmingham/Atlanta Geriatric Research, Education, and Clinical Center, Birmingham VA Medical Center, Birmingham, Alabama, USA
- David E. Vance, PhD, is a Professor, Department of Acute, Chronic & Continuing Care, School of Nursing, The University of Alabama Birmingham, Birmingham, Alabama, USA
- Greer Burkholder, MD, is an Associate Professor, Division of Infectious Diseases, Department of Medicine, The University of Alabama Birmingham, Birmingham, Alabama, USA
- Heidi M. Crane, MD, MPH, is a Professor, Division of Allergy & Infectious Diseases, Department of Medicine, University of Washington, Seattle, Washington, USA
- Julia Fleming, MD, is the Medical Director for Public Health Programs, The Fenway Institute, Boston, Massachusetts, USA
- Amanda L. Willig, PhD, RD, is an Associate Professor, Division of Infectious Diseases, Department of Medicine, The University of Alabama Birmingham, Birmingham, Alabama, USA
| | - Julia Fleming
- Pariya L. Fazeli, PhD is an Associate Professor, Department of Family, Community, and Health Systems, School of Nursing, The University of Alabama Birmingham, Birmingham, Alabama, USA
- Christine Horvat Davey, PhD, is an Assistant Professor, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio, USA
- Allison R. Webel, PhD, RN, is the Aljoya Endowed Professor in Aging and Interim Robert G. and Jean A. Reid Executive Dean, School of Nursing, University of Washington, Seattle, Washington, USA
- Vitor Oliveira, PhD, is an Acting Instructor, School of Nursing, University of Washington, Seattle, Washington, USA
- Thomas W. Buford, PhD, is a Professor, Division of Gerontology, Geriatrics, and Palliative Care, Department of Medicine, The University of Alabama Birmingham, Birmingham, Alabama, USA, and Birmingham/Atlanta Geriatric Research, Education, and Clinical Center, Birmingham VA Medical Center, Birmingham, Alabama, USA
- David E. Vance, PhD, is a Professor, Department of Acute, Chronic & Continuing Care, School of Nursing, The University of Alabama Birmingham, Birmingham, Alabama, USA
- Greer Burkholder, MD, is an Associate Professor, Division of Infectious Diseases, Department of Medicine, The University of Alabama Birmingham, Birmingham, Alabama, USA
- Heidi M. Crane, MD, MPH, is a Professor, Division of Allergy & Infectious Diseases, Department of Medicine, University of Washington, Seattle, Washington, USA
- Julia Fleming, MD, is the Medical Director for Public Health Programs, The Fenway Institute, Boston, Massachusetts, USA
- Amanda L. Willig, PhD, RD, is an Associate Professor, Division of Infectious Diseases, Department of Medicine, The University of Alabama Birmingham, Birmingham, Alabama, USA
| | - Amanda L Willig
- Pariya L. Fazeli, PhD is an Associate Professor, Department of Family, Community, and Health Systems, School of Nursing, The University of Alabama Birmingham, Birmingham, Alabama, USA
- Christine Horvat Davey, PhD, is an Assistant Professor, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio, USA
- Allison R. Webel, PhD, RN, is the Aljoya Endowed Professor in Aging and Interim Robert G. and Jean A. Reid Executive Dean, School of Nursing, University of Washington, Seattle, Washington, USA
- Vitor Oliveira, PhD, is an Acting Instructor, School of Nursing, University of Washington, Seattle, Washington, USA
- Thomas W. Buford, PhD, is a Professor, Division of Gerontology, Geriatrics, and Palliative Care, Department of Medicine, The University of Alabama Birmingham, Birmingham, Alabama, USA, and Birmingham/Atlanta Geriatric Research, Education, and Clinical Center, Birmingham VA Medical Center, Birmingham, Alabama, USA
- David E. Vance, PhD, is a Professor, Department of Acute, Chronic & Continuing Care, School of Nursing, The University of Alabama Birmingham, Birmingham, Alabama, USA
- Greer Burkholder, MD, is an Associate Professor, Division of Infectious Diseases, Department of Medicine, The University of Alabama Birmingham, Birmingham, Alabama, USA
- Heidi M. Crane, MD, MPH, is a Professor, Division of Allergy & Infectious Diseases, Department of Medicine, University of Washington, Seattle, Washington, USA
- Julia Fleming, MD, is the Medical Director for Public Health Programs, The Fenway Institute, Boston, Massachusetts, USA
- Amanda L. Willig, PhD, RD, is an Associate Professor, Division of Infectious Diseases, Department of Medicine, The University of Alabama Birmingham, Birmingham, Alabama, USA
| |
Collapse
|
|
2
|
Vance DE, Fazeli PL, Azuero A, Frank JS, Wadley VG, Raper JL, Pope CN, Ball KK. A 2-Year Longitudinal Randomized Control Trial of Speed of Processing Cognitive Training in Aging Adults with HIV-Associated Neurocognitive Disorder: Results of the Think Fast Study. AIDS Behav 2024:10.1007/s10461-024-04409-9. [PMID: 38954173 DOI: 10.1007/s10461-024-04409-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/03/2024] [Indexed: 07/04/2024]
Abstract
Nearly 40% of people with HIV (PWH) experience HIV-associated Neurocognitive Disorder (HAND). In this 3-group efficacy study, 216 PWH 40 + years with HAND or borderline HAND were randomized to either: (1) 10 h of SOP training (n = 70); (2) 20 h of SOP training (n = 73), or (3) 10 h of Internet navigation training (n = 73; contact control group). Participants were administered a measure of SOP [i.e., the Useful Field of View Test (UFOV®)] at baseline, at posttest immediately after training, and at year 1 and year 2 follow up. Intent-to-treat linear mixed-effect models with subject-specific intercept and slope were fitted to estimate between-group mean differences at the follow-up time-points. At the post-intervention time-point, small beneficial SOP training effects were observed for the 10-h group in UFOV® total (d = 0.28, p = 0.002). Effects were of larger magnitude for the 20-h group in these same outcomes [UFOV® total (d = 0.43, p < 0.001)]. These results indicated better benefit with more training. No intervention effect was observed at year 1. At year 2, beneficial effects of small magnitude were observed again in the 10-h group [UFOV® total (d = 0.22, p = 0.253)] with larger small-to-moderate magnitude in the 20-h group [UFOV® total (d = 0.32, p = 0.104)]. This study suggests that SOP training can improve a key indicator of this cognitive performance and that treatment gains are small-to-moderate over a two-year period. Prior literature suggests slower SOP is predictive of impairment in everyday functioning in older PWH; such an approach could potentially improve everyday functioning in PWH.
Collapse
Affiliation(s)
- David E Vance
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, 35294-1210, USA.
| | - Pariya L Fazeli
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, 35294-1210, USA
| | - Andres Azuero
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, 35294-1210, USA
| | - Jennifer S Frank
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, 35294-1210, USA
| | - Virginia G Wadley
- School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - James L Raper
- The 1917 (HIV/AIDS) Clinic, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Caitlin N Pope
- Department of Health, Behavior & Society, University of Kentucky, Lexington, KY, USA
| | - Karlene K Ball
- Department of Psychology, UAB, University of Alabama at Birmingham, Birmingham, AL, USA
| |
Collapse
|
|
3
|
Chan FHF, Sim P, Lim PXH, Khan BA, Choo JCJ, Griva K. Exploring the Cognitive Profiles of Haemodialysis Patients using Objective and Subjective Indicators: A Cross-sectional Observational Study. Int J Behav Med 2024:10.1007/s12529-024-10301-6. [PMID: 38918280 DOI: 10.1007/s12529-024-10301-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/20/2024] [Indexed: 06/27/2024]
Abstract
BACKGROUND Cognitive impairment is common in haemodialysis patients and associated with adverse health outcomes. Previous work focused primarily on neuropsychological tests, the gold standard measure of cognition. However, these tests reflect performance under optimal conditions rather than performance in everyday life. This study aims to assess both objective and subjective cognition in haemodialysis patients. METHODS Adult haemodialysis patients completed measures of objective cognitive impairment (Montreal Cognitive Assessment), subjective cognitive complaints, mood and fatigue symptoms, and provided sociodemographic information. Clinical data such as comorbidity were extracted from patients' medical record. RESULTS A total of 268 haemodialysis patients (mean age = 59.87 years; 42.5% female) participated. Only 25.0% of the sample had normal cognition, while the rest had either objective cognitive impairments or clinically significant cognitive complaints, or both (both objective impairments and subjective complaints: 26.1%; objective impairments without complaint: 38.4%; significant complaints without objective impairments: 10.4%). Lower education was associated with the presence of objective cognitive impairments, whereas depression was associated with the presence of clinically significant cognitive complaints. Patients who exhibited both objective cognitive impairments and significant cognitive complaints were more likely to have diabetes and higher dialysis dose (Kt/V). Patients with objective cognitive impairments but no significant complaints were significantly older. CONCLUSIONS The cognitive burden of haemodialysis patients can be manifested as objective impairments and/or subjective complaints. When combined the two indicators may better represent the overall cognitive well-being in this population. There is a need to screen for cognitive difficulties and develop cognitive rehabilitative strategies in dialysis settings.
Collapse
Affiliation(s)
- Frederick H F Chan
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Pearl Sim
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Phoebe X H Lim
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Behram A Khan
- Renal Health Services, Singapore, Singapore
- National University Health System, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Jason C J Choo
- National Kidney Foundation, Singapore, Singapore
- Department of Renal Medicine, Singapore General Hospital, Singapore, Singapore
| | - Konstadina Griva
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.
| |
Collapse
|
|
4
|
Vance DE, Billings R, Lambert CC, Fazeli PL, Goodin BR, Kempf MC, Rubin LH, Turan B, Wise J, Hellemann G, Lee J. A Systematic Review and Meta-Analysis of Social Cognition Among People Living with HIV: Implications for Non-Social Cognition and Social Everyday Functioning. Neuropsychol Rev 2024:10.1007/s11065-024-09643-5. [PMID: 38869661 DOI: 10.1007/s11065-024-09643-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 05/05/2024] [Indexed: 06/14/2024]
Abstract
Social cognition-the complex mental ability to perceive social stimuli and negotiate the social environment-has emerged as an important cognitive ability needed for social functioning, everyday functioning, and quality of life. Deficits in social cognition have been well documented in those with severe mental illness including schizophrenia and depression, those along the autism spectrum, and those with other brain disorders where such deficits profoundly impact everyday life. Moreover, subtle deficits in social cognition have been observed in other clinical populations, especially those that may have compromised non-social cognition (i.e., fluid intelligence such as memory). Among people living with HIV (PLHIV), 44% experience cognitive impairment; likewise, social cognitive deficits in theory of mind, prosody, empathy, and emotional face recognition/perception are gradually being recognized. This systematic review and meta-analysis aim to summarize the current knowledge of social cognitive ability among PLHIV, identified by 14 studies focused on social cognition among PLHIV, and provides an objective consensus of the findings. In general, the literature suggests that PLHIV may be at-risk of developing subtle social cognitive deficits that may impact their everyday social functioning and quality of life. The causes of such social cognitive deficits remain unclear, but perhaps develop due to (1) HIV-related sequelae that are damaging the same neurological systems in which social cognition and non-social cognition are processed; (2) stress related to coping with HIV disease itself that overwhelms one's social cognitive resources; or (3) may have been present pre-morbidly, possibly contributing to an HIV infection. From this, a theoretical framework is proposed highlighting the relationships between social cognition, non-social cognition, and social everyday functioning.
Collapse
Affiliation(s)
- David E Vance
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA.
| | - Rebecca Billings
- UAB Libraries, University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Pariya L Fazeli
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Burel R Goodin
- Department of Anesthesiology, Washington University Pain Center, Washington University, St. Louis, MO, USA
| | | | - Leah H Rubin
- Department of Neurology, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Bulent Turan
- Department of Psychology, Koc University, Rumelifeneri Caddesi, Turkey
| | - Jenni Wise
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Gerhard Hellemann
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Junghee Lee
- Department of Psychiatry and Behavioral Neurobiology, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| |
Collapse
|
|
5
|
Vance DE, Brew BJ. Plasma neurofilament light chain protein predicts greater brain-age gap, cognition, and cardiovascular risk in people with HIV. AIDS 2024; 38:1081-1083. [PMID: 38691050 DOI: 10.1097/qad.0000000000003880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2024]
Affiliation(s)
- David E Vance
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Bruce James Brew
- Departments of Neurology and Immunology, Peter Duncan Neurosciences Unit, St Vincent's Centre for Applied Medical Research, St Vincent's Hospital, Sydney, University of New South Wales and University of Notre Dame, Sydney, New South Wales, Australia
| |
Collapse
|
|
6
|
Zdanowicz MM, Valdes B, Salani D. Management of HIV in the older adults: Clinical and public health challenge. Public Health Nurs 2024; 41:406-415. [PMID: 38323718 DOI: 10.1111/phn.13288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 01/13/2024] [Accepted: 01/18/2024] [Indexed: 02/08/2024]
Abstract
As a result of significant advances in antiretroviral therapy (ART), the number of people living with human immunodeficiency virus (PLWH) who are alive well into their senior years has increased significantly in recent years. While increased life expectancy is a highly desired outcome for PLWH, it brings with it a number of challenges that are only now starting to be understood and fully appreciated. These challenges include higher rates of co-morbidities, polypharmacy, drug side effects, and cognitive deficits, as well as numerous psychosocial issues such as stigma, loneliness, and depression. Older PLWH also face challenges related to housing, health insurance, and long-term care. This review will discuss many of the challenges faced by older PLWH and present clinical and public health responses with suggested interventions that may improve outcomes for this population.
Collapse
Affiliation(s)
- Martin M Zdanowicz
- Professor of Phamaceutical and Appplied Life Science, Keck Graduate Institute, School of Pharmacy and Health Sciences, Claremont, California, USA
| | - Beatriz Valdes
- Associate Professor of Clinical, University of Miami School of Nursing and Health Studies, Coral Gables, Florida, USA
| | - Deborah Salani
- Professor of Clinical, University of Miami School of Nursing and Health Studies, Coral Gables, Florida, USA
| |
Collapse
|
|
7
|
Jones R, Jessee MB, Booker R, Martin SL, Vance DE, Fazeli PL. Associations Between Estimates of Arterial Stiffness and Cognitive Functioning in Adults With HIV. J Acquir Immune Defic Syndr 2024; 95:456-462. [PMID: 38133605 PMCID: PMC10951550 DOI: 10.1097/qai.0000000000003374] [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: 06/28/2023] [Accepted: 12/07/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Vascular aging, a precursor of arterial stiffness, is associated with neurocognitive impairment (NCI) and cardiovascular disease. Although HIV is associated with rapid vascular aging, it is unknown whether arterial stiffness mediates changes in cognitive function. We explored whether estimated markers of vascular aging were associated with NCI indices in HIV-positive individuals. METHODS This study was a secondary analysis of an observational study. Neurocognitive functioning was assessed using a battery of 7 domains (verbal fluency, executive functioning, speed of information processing, attention/working memory, memory [learning and delayed recall], and motor skills). Vascular aging was assessed using estimated markers of arterial stiffness (ie, estimated pulse wave velocity, pulse pressure, and vascular overload index). A multivariable regression adjusted for demographics, cardiovascular disease risk factors, and HIV clinical variables was used to examine the association between vascular aging and NCI outcomes. RESULTS Among 165 people with HIV, the mean age was 51.5 ± 6.9 years (62% men and 83% African American/Black or Other). In fully adjusted models, an increase in estimated pulse wave velocity and pulse pressure was associated with lower T scores in learning (-2.95 [-5.13, -0.77]) and working memory (-2.37 [-4.36, -0.37]), respectively. An increase in vascular overload index was associated with lower T scores in working memory (-2.33 [-4.37, -0.29]) and learning (-1.85 [-3.49, -0.21]). CONCLUSIONS Estimated markers of arterial stiffness were weakly associated with neurocognitive functioning, suggesting that vascular aging may have a role in cognitive decline among people with HIV.
Collapse
Affiliation(s)
- Raymond Jones
- Department of Medicine, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL
- Center for Exercise Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Matthew B. Jessee
- Department of Health, Exercise Science, and Recreation Management, University of Mississippi, University, MS
| | - Robert Booker
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Samantha L. Martin
- Department of Obstetrics and Gynecology, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - David E. Vance
- Department of Family, Community, and Health Systems, School of Nursing, University of Alabama at Birmingham, Birmingham, AL
| | - Pariya L. Fazeli
- Department of Family, Community, and Health Systems, School of Nursing, University of Alabama at Birmingham, Birmingham, AL
| |
Collapse
|
|
8
|
Byun JY, Chapman Lambert C, Fazeli PL, Iyer AS, Batey DS, Vance DE. Symptomatology and Quality of Life of Older People With HIV and Comorbid Chronic Obstructive Pulmonary Diseases From an HIV Clinic in Birmingham, Alabama. J Assoc Nurses AIDS Care 2024; 35:91-103. [PMID: 38319887 PMCID: PMC11216896 DOI: 10.1097/jnc.0000000000000452] [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: 02/08/2024]
Abstract
ABSTRACT Psychological symptomatology and quality of life (QoL) have been studied in older people with HIV (PWH) and those with chronic obstructive pulmonary disease (COPD), respectively, but there is a dearth of studies in older PWH with COPD. Our study compared depressive symptoms, anxiety, and QoL between older PWH with and without COPD using data from an HIV clinic in Birmingham, Alabama, from January 2018 to February 2020. Data on depressive symptoms (Patient Health Questionnaire-9), anxiety (Patient Health Questionnaire-5 Anxiety), and QoL (EuroQoL-5 Dimension) were analyzed. Among 690 PWH aged 50 years or older, 102 individuals (14.8%) had COPD. Significant differences were found between the two groups in depressive symptoms and components of QoL (e.g., mobility, self-care, usual activities, and pain/discomfort), but not in anxiety and general health. Experiencing COPD may worsen depressive symptomatology and QoL in older PWH, highlighting the need for tailored health care and research for this population.
Collapse
Affiliation(s)
- Jun Y Byun
- Jun Y. Byun, PhD, MSN, is a Postdoctoral Fellow, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Crystal Chapman Lambert, PhD, MSPH, CRNP, FNP-BC, ACRN, is an Associate Professor, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Pariya L. Fazeli, PhD, is an Associate Professor, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Anand S. Iyer, MD, MSPH, is an Assistant Professor in the Division of Pulmonary, Allergy, and Critical Care Medicine and the School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
- D. Scott Batey, PhD, MSW, is an Associate Professor, School of Social Work, Tulane University, New Orleans, Louisiana, USA
- David E. Vance, PhD, MGS, is a Professor, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Crystal Chapman Lambert
- Jun Y. Byun, PhD, MSN, is a Postdoctoral Fellow, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Crystal Chapman Lambert, PhD, MSPH, CRNP, FNP-BC, ACRN, is an Associate Professor, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Pariya L. Fazeli, PhD, is an Associate Professor, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Anand S. Iyer, MD, MSPH, is an Assistant Professor in the Division of Pulmonary, Allergy, and Critical Care Medicine and the School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
- D. Scott Batey, PhD, MSW, is an Associate Professor, School of Social Work, Tulane University, New Orleans, Louisiana, USA
- David E. Vance, PhD, MGS, is a Professor, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Pariya L Fazeli
- Jun Y. Byun, PhD, MSN, is a Postdoctoral Fellow, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Crystal Chapman Lambert, PhD, MSPH, CRNP, FNP-BC, ACRN, is an Associate Professor, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Pariya L. Fazeli, PhD, is an Associate Professor, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Anand S. Iyer, MD, MSPH, is an Assistant Professor in the Division of Pulmonary, Allergy, and Critical Care Medicine and the School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
- D. Scott Batey, PhD, MSW, is an Associate Professor, School of Social Work, Tulane University, New Orleans, Louisiana, USA
- David E. Vance, PhD, MGS, is a Professor, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Anand S Iyer
- Jun Y. Byun, PhD, MSN, is a Postdoctoral Fellow, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Crystal Chapman Lambert, PhD, MSPH, CRNP, FNP-BC, ACRN, is an Associate Professor, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Pariya L. Fazeli, PhD, is an Associate Professor, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Anand S. Iyer, MD, MSPH, is an Assistant Professor in the Division of Pulmonary, Allergy, and Critical Care Medicine and the School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
- D. Scott Batey, PhD, MSW, is an Associate Professor, School of Social Work, Tulane University, New Orleans, Louisiana, USA
- David E. Vance, PhD, MGS, is a Professor, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - D Scott Batey
- Jun Y. Byun, PhD, MSN, is a Postdoctoral Fellow, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Crystal Chapman Lambert, PhD, MSPH, CRNP, FNP-BC, ACRN, is an Associate Professor, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Pariya L. Fazeli, PhD, is an Associate Professor, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Anand S. Iyer, MD, MSPH, is an Assistant Professor in the Division of Pulmonary, Allergy, and Critical Care Medicine and the School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
- D. Scott Batey, PhD, MSW, is an Associate Professor, School of Social Work, Tulane University, New Orleans, Louisiana, USA
- David E. Vance, PhD, MGS, is a Professor, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - David E Vance
- Jun Y. Byun, PhD, MSN, is a Postdoctoral Fellow, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Crystal Chapman Lambert, PhD, MSPH, CRNP, FNP-BC, ACRN, is an Associate Professor, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Pariya L. Fazeli, PhD, is an Associate Professor, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Anand S. Iyer, MD, MSPH, is an Assistant Professor in the Division of Pulmonary, Allergy, and Critical Care Medicine and the School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
- D. Scott Batey, PhD, MSW, is an Associate Professor, School of Social Work, Tulane University, New Orleans, Louisiana, USA
- David E. Vance, PhD, MGS, is a Professor, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
| |
Collapse
|
|
9
|
Vance DE, Fazeli PL, Azuero A, Frank JS, Wadley VG, Raper JL, Pope CN, Jacob A, Ball KK. A 2-Year, Randomized, Clinical Trial Examining the Effects of Speed of Processing Cognitive Training on Quality-of-Life Indicators in Adults With HIV-Associated Neurocognitive Disorder in Birmingham, Alabama: Results of the Think Fast Study. J Assoc Nurses AIDS Care 2024; 35:104-121. [PMID: 38949906 PMCID: PMC11217600 DOI: 10.1097/jnc.0000000000000449] [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: 07/03/2024]
Abstract
ABSTRACT Speed of processing (SOP) cognitive training may improve indicators of the quality of life (QoL) in people living with HIV. In this 2-year, longitudinal, randomized, controlled trial, 216 participants ages 40 years and older with HIV-associated neurocognitive disorder or borderline HIV-associated neurocognitive disorder were assigned to one of three groups: (a) 10 hr of SOP training (n = 70); (b) 20 hr of SOP training (n = 73), or (c) 10 hr of internet navigation control training (a contact control group; n = 73). Participants completed several QoL measures at baseline, posttest, and Year 1 and Year 2 follow-ups. Using linear mixed-effect models, no strong pattern of training effects across QoL outcomes was apparent, with small-magnitude, nonsignificant, between-group differences in depression, locus of control, and Medical Outcomes Study-HIV scales. In conclusion, despite prior work showing some transfer of SOP cognitive training improving QoL, that was not observed. Implications for research and practice are posited.
Collapse
Affiliation(s)
- David E Vance
- David E. Vance is a Professor, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Pariya L. Fazeli is an Associate Professor, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Andres Azuero is a Professor, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Jennifer S. Frank is an Instructor, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Virginia G. Wadley is an Associate Professor (retired), School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
- James L. Raper is a Professor and Director of the 1917 (HIV/AIDS) Clinic (retired), School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Caitlin N. Pope is an Assistant Professor, Department of Health, Behavior & Society, University of Kentucky, Lexington, Kentucky, USA
- Alexandra Jacob is a Medical Clinical Psychology Doctoral Student, Department of Psychology, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Karlene K. Ball is a Professor, Department of Psychology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Pariya L Fazeli
- David E. Vance is a Professor, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Pariya L. Fazeli is an Associate Professor, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Andres Azuero is a Professor, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Jennifer S. Frank is an Instructor, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Virginia G. Wadley is an Associate Professor (retired), School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
- James L. Raper is a Professor and Director of the 1917 (HIV/AIDS) Clinic (retired), School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Caitlin N. Pope is an Assistant Professor, Department of Health, Behavior & Society, University of Kentucky, Lexington, Kentucky, USA
- Alexandra Jacob is a Medical Clinical Psychology Doctoral Student, Department of Psychology, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Karlene K. Ball is a Professor, Department of Psychology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Andres Azuero
- David E. Vance is a Professor, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Pariya L. Fazeli is an Associate Professor, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Andres Azuero is a Professor, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Jennifer S. Frank is an Instructor, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Virginia G. Wadley is an Associate Professor (retired), School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
- James L. Raper is a Professor and Director of the 1917 (HIV/AIDS) Clinic (retired), School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Caitlin N. Pope is an Assistant Professor, Department of Health, Behavior & Society, University of Kentucky, Lexington, Kentucky, USA
- Alexandra Jacob is a Medical Clinical Psychology Doctoral Student, Department of Psychology, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Karlene K. Ball is a Professor, Department of Psychology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Jennifer S Frank
- David E. Vance is a Professor, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Pariya L. Fazeli is an Associate Professor, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Andres Azuero is a Professor, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Jennifer S. Frank is an Instructor, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Virginia G. Wadley is an Associate Professor (retired), School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
- James L. Raper is a Professor and Director of the 1917 (HIV/AIDS) Clinic (retired), School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Caitlin N. Pope is an Assistant Professor, Department of Health, Behavior & Society, University of Kentucky, Lexington, Kentucky, USA
- Alexandra Jacob is a Medical Clinical Psychology Doctoral Student, Department of Psychology, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Karlene K. Ball is a Professor, Department of Psychology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Virginia G Wadley
- David E. Vance is a Professor, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Pariya L. Fazeli is an Associate Professor, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Andres Azuero is a Professor, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Jennifer S. Frank is an Instructor, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Virginia G. Wadley is an Associate Professor (retired), School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
- James L. Raper is a Professor and Director of the 1917 (HIV/AIDS) Clinic (retired), School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Caitlin N. Pope is an Assistant Professor, Department of Health, Behavior & Society, University of Kentucky, Lexington, Kentucky, USA
- Alexandra Jacob is a Medical Clinical Psychology Doctoral Student, Department of Psychology, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Karlene K. Ball is a Professor, Department of Psychology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - James L Raper
- David E. Vance is a Professor, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Pariya L. Fazeli is an Associate Professor, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Andres Azuero is a Professor, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Jennifer S. Frank is an Instructor, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Virginia G. Wadley is an Associate Professor (retired), School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
- James L. Raper is a Professor and Director of the 1917 (HIV/AIDS) Clinic (retired), School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Caitlin N. Pope is an Assistant Professor, Department of Health, Behavior & Society, University of Kentucky, Lexington, Kentucky, USA
- Alexandra Jacob is a Medical Clinical Psychology Doctoral Student, Department of Psychology, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Karlene K. Ball is a Professor, Department of Psychology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Caitlin N Pope
- David E. Vance is a Professor, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Pariya L. Fazeli is an Associate Professor, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Andres Azuero is a Professor, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Jennifer S. Frank is an Instructor, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Virginia G. Wadley is an Associate Professor (retired), School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
- James L. Raper is a Professor and Director of the 1917 (HIV/AIDS) Clinic (retired), School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Caitlin N. Pope is an Assistant Professor, Department of Health, Behavior & Society, University of Kentucky, Lexington, Kentucky, USA
- Alexandra Jacob is a Medical Clinical Psychology Doctoral Student, Department of Psychology, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Karlene K. Ball is a Professor, Department of Psychology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Alexandra Jacob
- David E. Vance is a Professor, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Pariya L. Fazeli is an Associate Professor, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Andres Azuero is a Professor, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Jennifer S. Frank is an Instructor, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Virginia G. Wadley is an Associate Professor (retired), School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
- James L. Raper is a Professor and Director of the 1917 (HIV/AIDS) Clinic (retired), School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Caitlin N. Pope is an Assistant Professor, Department of Health, Behavior & Society, University of Kentucky, Lexington, Kentucky, USA
- Alexandra Jacob is a Medical Clinical Psychology Doctoral Student, Department of Psychology, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Karlene K. Ball is a Professor, Department of Psychology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Karlene K Ball
- David E. Vance is a Professor, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Pariya L. Fazeli is an Associate Professor, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Andres Azuero is a Professor, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Jennifer S. Frank is an Instructor, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Virginia G. Wadley is an Associate Professor (retired), School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
- James L. Raper is a Professor and Director of the 1917 (HIV/AIDS) Clinic (retired), School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Caitlin N. Pope is an Assistant Professor, Department of Health, Behavior & Society, University of Kentucky, Lexington, Kentucky, USA
- Alexandra Jacob is a Medical Clinical Psychology Doctoral Student, Department of Psychology, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Karlene K. Ball is a Professor, Department of Psychology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| |
Collapse
|
|
10
|
Vance DE, Fazeli PL, Azuero A, Frank JS, Wadley VG, Raper JL, Pope CN, Ball KK. A 2-year longitudinal randomized controlled trial examining the transfer of speed of processing training to secondary cognitive domains in middle-aged and older adults with HIV-associated neurocognitive disorder: Results of the think fast study. Clin Neuropsychol 2024; 38:471-492. [PMID: 37191339 PMCID: PMC10651797 DOI: 10.1080/13854046.2023.2212867] [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: 12/12/2022] [Accepted: 05/07/2023] [Indexed: 05/17/2023]
Abstract
OBJECTIVE As people with HIV (PWH) age, they are at-risk of developing cognitive impairments compared to their seronegative counterparts. Although speed of processing (SOP) training may help improve this cognitive ability, less work has examined transfer to other cognitive domains. This study examined the effect of SOP training has on secondary cognitive domains in PWH aged 40+ years. METHOD In this 3-group 2-year longitudinal study, 216 PWH with HIV-associated neurocognitive disorder (HAND) or borderline HAND were randomized to either: (1) 10 h of SOP training (n = 70); (2) 20 h of SOP training (n = 73); or (3) 10 h of an active control training (n = 73). Participants completed a comprehensive cognitive battery at baseline, immediately after training, and at 1 and 2 years. This battery yielded global and domain specific T-scores as well as a cognitive impairment variable. Generalized linear mixed-effect models were fitted to estimate between-group mean differences at the follow-up time-points adjusted for baseline. RESULTS No clinically or statistically significant improvements in any of the cognitive outcomes were observed. A sensitivity analysis was conducted; conclusions replicated those of the main analysis, with two exceptions: Global Function T and Psychomotor Speed T showed relevant training improvements among the intervention groups over the control group at the immediate post time point. CONCLUSIONS Although SOP training has been shown to improve cognitive abilities that correspond to driving and mobility, such training has limited therapeutic utility in improving cognition in other domains in PWH with HAND.
Collapse
Affiliation(s)
- David E. Vance
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Pariya L. Fazeli
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Andres Azuero
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Jennifer S. Frank
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Virginia G. Wadley
- School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - James L. Raper
- The 1917 (HIV/AIDS) Clinic, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Caitlin N. Pope
- Department of Health, Behavior & Society, University of Kentucky, Lexington, Kentucky, USA
| | - Karlene K. Ball
- UAB Department of Psychology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| |
Collapse
|
|
11
|
Smith WP. Negative Lifestyle Factors Specific to Aging Persons Living with HIV and Multimorbidity. J Int Assoc Provid AIDS Care 2024; 23:23259582241245228. [PMID: 39051608 PMCID: PMC11273731 DOI: 10.1177/23259582241245228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 02/28/2024] [Accepted: 03/18/2024] [Indexed: 07/27/2024] Open
Abstract
The primary goal of medical care during the pre-antiretroviral therapy (ART) era was to keep persons living with human immunodeficiency virus (HIV) alive, whereas since the advent of ART, the treatment objective has shifted to decreasing viral loads and infectiousness while increasing CD4+ T-cell counts and longevity. The health crisis, however, is in preventing and managing multimorbidity (ie, type 2 diabetes), which develops at a more accelerated or accentuated pace among aging persons living with HIV. Relative to the general population and age-matched uninfected adults, it may be more difficult for aging HIV-positive persons who also suffer from multimorbidity to improve negative lifestyle factors to the extent that their behaviors could support the prevention and management of diseases. With recommendations and a viable solution, this article explores the impact of negative lifestyle factors (ie, poor mental health, suboptimal nutrition, physical inactivity, alcohol use) on the health of aging individuals living with HIV.
Collapse
|
|
12
|
Vance DE, Fazeli PL, Azuero A, Khalidi S, Frank JS, Wadley VG, Raper JL, Pope CN, Jacob AE, Ball KK. Two-year clinical trial examining the effects of speed of processing training on everyday functioning in adults with human immunodeficiency virus-associated neurocognitive disorder (HAND) and borderline HAND in the U.S. Deep South: Findings of the Think Fast Study. APPLIED NEUROPSYCHOLOGY. ADULT 2023:1-14. [PMID: 37200482 PMCID: PMC10656361 DOI: 10.1080/23279095.2023.2209900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Many people living with human immunodeficiency virus (HIV) (PLWH) experience cognitive decline that impairs everyday functioning. Cognitive training approaches, such as speed of processing (SOP) training, may reduce the impact of HIV-Associated Neurocognitive Disorder (HAND) on everyday functioning. In this experimental design study called the Think Fast Study, 216 participants age 40 and older with HAND or borderline HAND were randomized to one of three groups: (1) 10 h of SOP training (n = 70); (2) 20 h of SOP training (n = 73); or (3) 10 h of Internet Navigation Control Training (a contact control group; n = 73). Participants completed several everyday functioning measures at baseline, posttest, and year 1 and year 2 follow ups, which included: (a) Modified Lawton and Brody Activities of Daily Living (ADL) Questionnaire; (b) Timed Instrumental Activities of Daily Living (TIADL) Test; (c) Patient's Assessment of Own Functioning (PAOFI); (d) Medication Adherence Questionnaire (MAQ); and (e) Medication Adherence Visual Analog Scale (VAS). Linear mixed-effect models and generalized estimating equation models were fitted to estimate between group differences at all follow-up time points. At follow-up timepoints, those in the 10-h and 20-h training groups had better scores on medication adherence measures (MAQ and VAS) than those in the control group, with effects (Cohen's d) ranging 0.13-0.41 for MAQ and 0.02-0.43 for VAS. In conclusion, SOP training improved some indicators of everyday functioning, specifically medication adherence; however, the therapeutic effects diminished over time. Implications for practice and research are posited.
Collapse
Affiliation(s)
- David E. Vance
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Pariya L. Fazeli
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Andres Azuero
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Sarah Khalidi
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Jennifer S. Frank
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Virginia G. Wadley
- School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - James L. Raper
- The 1917 (HIV/AIDS) Clinic, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Caitlin N. Pope
- Department of Health, Behavior & Society, University of Kentucky, Lexington, Kentucky, USA
| | - Alexandra E. Jacob
- UAB Department of Psychology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Karlene K. Ball
- UAB Department of Psychology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| |
Collapse
|
|
13
|
Vance D, Fazeli P, Azuero A, Frank JS, Wadley VG, Raper JL, Pope CN, Ball K. Can individualized-targeted computerized cognitive training improve everyday functioning in adults with HIV-associated neurocognitive disorder? APPLIED NEUROPSYCHOLOGY. ADULT 2023; 30:8-19. [PMID: 34000940 PMCID: PMC9881593 DOI: 10.1080/23279095.2021.1906678] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Half of people with human immunodeficiency virus (HIV) have HIV-associated neurocognitive disorder (HAND). Fortunately, cognitive training programs can improve function across cognitive domains, which may translate to everyday functioning. The Training on Purpose (TOPS) Study was designed to reverse HAND by targeting cognitive training to specific cognitive impairments that contributed to the diagnosis. A secondary aim of TOPS was to determine whether such cognitive training improved subjective and objective everyday functioning. In this two-group pre-post experimental design study, 109 adults with HAND were randomized to either: (1) a no-contact control group (no training) or (2) the Individualized-Targeted Cognitive Training group. Each participant received approximately 10 hours of cognitive training in two selected cognitive domains based on her/his individual baseline cognitive performance. Thus, 20 hours of individualized training on these two cognitive domains occurred over a course of 12 weeks in 1-2 hour sessions. Specific to the secondary aim of TOPS, measures of everyday functioning were administered before and after cognitive training to examine transfer effects. The analyses revealed that in general, speed of processing training produced benefits in everyday functioning as measured by the medication adherence visual analogue scale and the Timed Instrumental Activities of Daily Living test. Inconsistent findings were found for the other seven cognitive training protocols in either improving everyday functioning or reducing perceived everyday functioning; however, there may be other contributing factors that obscured such effects needing further research. This study demonstrated that some training protocols vary in efficacy in altering both objective and subjective everyday functioning ability.
Collapse
Affiliation(s)
- David Vance
- School of Nurisng, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Pariya Fazeli
- School of Nurisng, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Andres Azuero
- School of Nurisng, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jennifer S Frank
- School of Nurisng, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Virginia G Wadley
- School of Medicine, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - James L Raper
- School of Medicine, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Caitlin N Pope
- Graduate Center for Gerontology, University of Kentucky, Lexington, KY, USA
- Unit of Health, Behavior & Society, University of Kentucky, Lexington, KY, USA
| | - Karlene Ball
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA
| |
Collapse
|
|
14
|
Abstract
OBJECTIVE While life expectancies of people with HIV (PWH) have increased through the successes of antiretroviral treatment, cognitive impairment remains a pressing concern. Prevalence estimates vary worldwide as different definitions for cognitive impairment are used and resource availability differs across geographical settings. We aim to explore this heterogeneity and estimate the global cognitive impairment burden in PWH. DESIGN Systematic literature review and meta-analysis. METHODS We searched PubMed, Embase, SCOPUS, and Web of Science for studies reporting on cognitive impairment prevalence in PWH. Nine factors were investigated for their potential association with the prevalence using a univariate meta-analysis and a meta-regression: assessment method, geographical region, country income, exclusion criteria, study quality, age, sex, publication year, and sample size. RESULTS The literature search identified 8539 records, of which 225 were included. The adjusted prevalence was significantly lower in males than females. Across 44 countries, 12 assessment methods were used; the HIV-associated neurocognitive disorder/Frascati criteria, known for high false-positive rates, was employed in 44.4% of studies. The pooled cognitive impairment prevalence estimate in PWH, including asymptomatic cases, was 39.6% (95% confidence interval: 37.2-42.1%; range: 7-87%). The meta-regression explained 13.3% of between-study variation, with substantial residual heterogeneity ( I2 = 97.7%). CONCLUSION Lack of data from more than 70% of the world's countries, cohorts being unselected for symptoms in most research studies, and limitations of the HIV-associated neurocognitive disorder/Frascati criteria restrict the ability to accurately determine the global burden of cognitive impairment in PWH. More studies in low-resource settings and a standardized approach to assessing cognitive impairment, bridging research and clinical realms, are needed.
Collapse
|
|
15
|
Cody SL, Miller GH, Fazeli PL, Wang G, Li W, Goodin BR, Vance DE. Preventing Neurocognitive Decline in Adults Aging with HIV: Implications for Practice and Research. J Alzheimers Dis 2023; 95:753-768. [PMID: 37599532 DOI: 10.3233/jad-230203] [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: 08/22/2023]
Abstract
Mild to moderate forms of neurocognitive impairment persist among people living with HIV (PLWH), despite being virally suppressed on antiretroviral therapy. PLWH are disproportionally impacted by physiological and psychosocial comorbidities compared to those without HIV. As adults live longer with HIV, the neurocognitive burden of physiological and psychosocial stressors can impair everyday functioning and may contribute to the development of neurodegenerative diseases such as Alzheimer's disease. This article outlines neurocognitive consequences of everyday stressors in PLWH. While some lifestyle factors can exacerbate inflammatory processes and promote negative neurocognitive health, novel interventions including the use of cannabinoids may be neuroprotective for aging PLWH who are at risk for elevated levels of inflammation from comorbidities. Studies of integrated neurocognitive rehabilitation strategies targeting lifestyle factors are promising for improving neurocognitive health, and may over time, reduce the risk of Alzheimer's disease in PLWH.
Collapse
Affiliation(s)
- Shameka L Cody
- Capstone College of Nursing, The University of Alabama, Tuscaloosa, AL, USA
| | - Gabe H Miller
- Department of Sociology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Pariya L Fazeli
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Ge Wang
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wei Li
- Department of Clinical and Diagnostic Sciences, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Burel R Goodin
- Department of Anesthesiology, Washington University Pain Center, Washington University, St. Louis, MO, USA
| | - David E Vance
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
| |
Collapse
|
|
16
|
Cognitive Intra-individual Variability in HIV: an Integrative Review. Neuropsychol Rev 2022; 32:855-876. [PMID: 34826006 PMCID: PMC9944348 DOI: 10.1007/s11065-021-09528-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 08/30/2021] [Indexed: 10/19/2022]
Abstract
Nearly 30-50% of people living with HIV experience HIV-Associated Neurocognitive Disorder (HAND). HAND indicates performance at least one standard deviation below the normative mean on any two cognitive domains. This method for diagnosing or classifying cognitive impairment has utility, however, cognitive intraindividual variability provides a different way to understand cognitive impairment. Cognitive intraindividual variability refers to the scatter in cognitive performance within repeated measures of the same cognitive test (i.e., inconsistency) or across different cognitive tests (i.e., dispersion). Cognitive intraindividual variability is associated with cognitive impairment and cognitive decline in various clinical populations. This integrative review of 13 articles examined two types of cognitive intraindividual variability in people living with HIV, inconsistency and dispersion. Cognitive intraindividual variability appears to be a promising approach to detect subtle cognitive impairments that are not captured by traditional mean-based neuropsychological testing. Greater intraindividual variability in people living with HIV has been associated with: 1) poorer cognitive performance and cognitive decline, 2) cortical atrophy, both gray and white matter volume, 3) poorer everyday functioning (i.e., driving simulation performance), specifically medication adherence, and 4) even mortality. This inspires future directions for research. First, greater cognitive intraindividual variability may reflect a greater task demand on executive control to harness and regulate cognitive control over time. By improving executive functioning through cognitive training, it may reduce cognitive intraindividual variability which could slow down cognitive decline. Second, cognitive intraindividual variability may be reconsidered in prior cognitive intervention studies in which only mean-based cognitive outcomes were used. It is possible that such cognitive interventions may actually improve cognitive intraindividual variability, which could have clinical relevance.
Collapse
|
|
17
|
Etesami MS, Saboury N, Mohraz M, SeyedAlinaghi S, Jones DL, Vance DE, Habibi Asgarabad M. Immediate and Long-Term Effects of a Computerized Cognitive Rehabilitation Therapy on Cognitive Function in People Living with HIV in Iran: A Single-Blind Two-Arm Parallel Randomized Controlled Trial. J Assoc Nurses AIDS Care 2022; 33:505-522. [PMID: 35878047 DOI: 10.1097/jnc.0000000000000339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Up to 50% of people with HIV (PWH) experience neurocognitive impairments (NCIs) that can interfere with everyday functioning and reduce quality of life. To address this problem, this study examined the immediate and long-term efficacy of computerized cognitive rehabilitation therapy (CCRT) on cognitive function in PWH in Tehran, Iran. Thirty PWH with NCI engaged in 24 biweekly 90-min CCRT sessions. A control group of 30 PWH and NCI received treatment-as-usual, but no CCRT. The cognitive rehabilitation protocol focused on attention, visual memory, nonverbal learning, and planning. Pretest, posttest, and follow-up cognitive measurements showed that the designed CCRT protocol was effective in improving performance in selected cognitive domains along with the global neurocognitive performance scores of PWH. These findings suggest that this CCRT protocol be considered as part of a treatment plan to address cognitive impairment for PWH. Implications for clinical practice and research are provided.
Collapse
Affiliation(s)
- Maede Sadat Etesami
- Maede Sadat Etesami, MSc, is a Clinical Psychologist and Researcher, Iranian Research Center for HIV/AIDS (IRCHA), Imam Khomeini Hospital Complex; Health Promotion Research Center, Iran University of Medical Sciences; Center of Excellence in Cognitive Neuropsychology, Institute for Cognitive and Brain Sciences, Shahid Beheshti University, Tehran, Iran. Nadia Saboury, MSc, is a Psychologist, Department of Psychology, Faculty of Humanities, University of Science and Culture, Tehran, Iran. Minoo Mohraz, MD, MPH, is a Professor, Iranian Research Center for HIV/AIDS (IRCHA), Department of Infectious Diseases, Imam Khomeini Hospital Complex, Tehran, Iran. SeyedAhmad SeyedAlinaghi, MD, PhD, MPhil, is an Associate Professor and Senior Medical Researcher, Iranian Research Center for HIV/AIDS (IRCHA), Iranian Institute for Reduction of High-Risk Behaviors, Tehran University of Medical Sciences, Tehran, Iran. Deborah L. Jones, PhD, is a Professor, Department of Psychiatry & Behavioral Sciences, University of Miami Miller School of Medicine, Miami, Florida, USA. David E. Vance, PhD, MGS, is a Professor, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA. Mojtaba Habibi Asgarabad, PhD, is an Assistant Professor, Health Promotion Research Center, Iran University of Medical Sciences, Tehran, Iran; Department of Health Psychology, School of Behavioral Sciences and Mental Health (Tehran Institute of Psychiatry), Iran University of Medical Sciences; Center of Excellence in Cognitive Neuropsychology, Institute for Cognitive and Brain Sciences, Shahid Beheshti University, Tehran, Iran; and Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | | | | | | | | | | | | |
Collapse
|
|
18
|
Vance DE, Lee Y, Batey DS, Li W, Chapman Lambert C, Nakkina SR, Anderson JN, Triebel K, Byun JY, Fazeli PL. Emerging directions of cognitive aging with HIV: practice and policy implications for social work. JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2022; 65:476-494. [PMID: 34511048 DOI: 10.1080/01634372.2021.1978028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 09/01/2021] [Accepted: 09/04/2021] [Indexed: 06/13/2023]
Abstract
Cognitive impairments have been endemic to the HIV epidemic since its beginning and persist to this day. These impairments are attributed to HIV-induced neuroinflammation, the long-term effects of combination antiretroviral therapy, lifestyle factors (e.g., sedentary behavior, substance use), neuro-comorbidities (e.g., depression), age-associated comorbidities (e.g., heart disease, hypertension), and others causes. Normal aging and lifestyle also contribute to the development of cognitive impairment. Regardless of the etiology, such cognitive impairments interfere with HIV care (e.g., medication adherence) and everyday functioning (e.g., driving safely, financial management). With more than half of people with HIV (PWH) 50 years and older, and ~45% of all PWH meeting the criteria for HIV-Associated Neurocognitive Disorder (HAND), those aging PWH are more vulnerable for developing cognitive impairment. This article provides an update to a social work model to identify and monitor PWH for cognitive impairment. Within this update, the state of the science on protecting brain health and cognitive reserve within the context of neuroHIV is also presented. From this, implications for practice and policy to promote successful cognitive functioning in older PWH are provided.
Collapse
Affiliation(s)
- David E Vance
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Yookyong Lee
- Department of Social Work, College of Arts and Sciences, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - David Scott Batey
- Department of Social Work, College of Arts and Sciences, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Wei Li
- Department of Clinical and Diagnostic Sciences, School of Health Professions, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | | | - Sai Rashmi Nakkina
- College of Arts and Science, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Joseph N Anderson
- School of Medicine, Department of Neurology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Kristen Triebel
- School of Medicine, Department of Neurology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Jun Y Byun
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Pariya L Fazeli
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
| |
Collapse
|
|
19
|
Risk Factors of Cognitive Decline in Older Caregivers With HIV: An Emerging Hypothesis. J Assoc Nurses AIDS Care 2022; 33:676-681. [PMID: 35878046 DOI: 10.1097/jnc.0000000000000349] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
ABSTRACT People with HIV (PWH) are living longer and healthier lives; thanks to combination antiretroviral therapy. As many PWH age, they find themselves providing care to family members and friends, just as their counterparts without HIV. The literature indicates that becoming a caregiver creates conditions that compromise one's cognitive function. Additionally, nearly 45% of all PWH experience HIV-associated neurocognitive disorder and are already vulnerable to cognitive impairment due to HIV, aging, and accompanying health conditions, and lifestyle factors. Given what is known, we assert that caregivers with HIV, especially as they age, are at additional risk for developing cognitive impairments. The purpose of this commentary was to briefly examine the juxtaposition between cognitive vulnerability of caregiving and the cognitive vulnerability of aging with HIV. Potential factors contributing to impaired cognition include stress, lack of social support, stigma, lifestyle, and comorbidities. Implications for clinical practice and research are provided.
Collapse
|
|
20
|
Zanella I, Zacchi E, Fornari C, Fumarola B, Antoni MD, Zizioli D, Quiros-Roldan E. An exploratory pilot study on the involvement of APOE, HFE, C9ORF72 variants and comorbidities in neurocognitive and physical performance in a group of HIV-infected people. Metab Brain Dis 2022; 37:1569-1583. [PMID: 35353274 PMCID: PMC8964929 DOI: 10.1007/s11011-022-00975-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 03/24/2022] [Indexed: 11/18/2022]
Abstract
Cognitive decline of aging is modulated by chronic inflammation and comorbidities. In people with HIV-infection (PWH) it may also be affected by HIV-induced inflammation, lifestyle and long-term effects of antiretroviral therapies (ART). The role of genetics in the susceptibility to HIV-associated neurocognitive disorders (HAND) is not fully understood. Here we explored the possible relations among variants in 3 genes involved in inflammation and neurodegenerative disorders (APOE: ε2/ε3/ε4; HFE: H63D; C9ORF72: hexanucleotide expansions ≥ 9 repeats), cognitive/functional impairment (MiniMental State Examination MMSE, Clock Drawing Test CDT, Short Physical Performance Battery SPPB), comorbidities and HIV-related variables in a cohort of > 50 years old PWH (n = 60) with at least 10 years efficient ART. Patients with diabetes or hypertension showed significantly lower MMSE (p = .031) or SPPB (p = .010) scores, respectively, while no relations between HIV-related variables and cognitive/functional scores were observed. Patients with at least one APOEε3 allele had higher CDT scores (p = .019), APOEε2/ε4 patients showing the lowest scores in all tests. Patients with HFE-H63D variant showed more frequently hypertriglyceridemia (p = .023) and those harboring C9ORF72 expansions > 9 repeats had higher CD4+-cell counts (p = .032) and CD4% (p = .041). Multiple linear regression analysis computed to verify possible associations among cognitive/functional scores and all variables further suggested positive association between higher CDT scores and the presence of at least one APOEε3 allele (2,2; 95% CI [0,03 0,8]; p = .037), independent of other variables, although the model did not reach the statistical significance (p = .14). These data suggest that in PWH on efficient ART cognitive abilities and physical performances may be partly associated with comorbidities and genetic background. However, further analyses are needed to establish whether they could be also dependent and influenced by comorbidities and genetic background.
Collapse
Affiliation(s)
- Isabella Zanella
- Department of Molecular and Translational Medicine, University of Brescia, 25123, Brescia, Italy.
- Clinical Chemistry Laboratory, Cytogenetics and Molecular Genetics Section, Diagnostic Department, ASST Spedali Civili Di Brescia, 25123, Brescia, Italy.
| | - Eliana Zacchi
- Department of Clinical and Experimental Sciences, University of Brescia, 25123, Brescia, Italy
- Division of Infectious and Tropical Diseases, ASST Spedali Civili Di Brescia, 25123, Brescia, Italy
| | - Chiara Fornari
- Department of Clinical and Experimental Sciences, University of Brescia, 25123, Brescia, Italy
- Division of Infectious and Tropical Diseases, ASST Spedali Civili Di Brescia, 25123, Brescia, Italy
| | - Benedetta Fumarola
- Department of Clinical and Experimental Sciences, University of Brescia, 25123, Brescia, Italy
- Division of Infectious and Tropical Diseases, ASST Spedali Civili Di Brescia, 25123, Brescia, Italy
| | - Melania Degli Antoni
- Department of Clinical and Experimental Sciences, University of Brescia, 25123, Brescia, Italy
- Division of Infectious and Tropical Diseases, ASST Spedali Civili Di Brescia, 25123, Brescia, Italy
| | - Daniela Zizioli
- Department of Molecular and Translational Medicine, University of Brescia, 25123, Brescia, Italy
| | - Eugenia Quiros-Roldan
- Department of Clinical and Experimental Sciences, University of Brescia, 25123, Brescia, Italy
- Division of Infectious and Tropical Diseases, ASST Spedali Civili Di Brescia, 25123, Brescia, Italy
| |
Collapse
|
|
21
|
Vance DE, Pope CN, Fazeli PL, Azuero A, Frank JS, Wadley VG, Raper JL, Byun JY, Ball KK. A Randomized Clinical Trial on the Impact of Individually Targeted Computerized Cognitive Training on Quality of Life Indicators in Adults With HIV-Associated Neurocognitive Disorder in the Southeastern United States. J Assoc Nurses AIDS Care 2022; 33:295-310. [PMID: 34864757 DOI: 10.1097/jnc.0000000000000316] [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] [Indexed: 11/27/2022]
Abstract
ABSTRACT HIV-associated neurocognitive disorder (HAND) is experienced by 30% to 50% of people living with HIV (PLWH), potentially affecting their quality of life (QoL). In the Training on Purpose Study, we investigated whether targeted cognitive training can improve QoL in PLWH with HAND. Using a two-group experimental design, we randomized 109 adults with HAND to either (a) the Individualized-Targeted Cognitive Training group or (b) a no-contact control group. Those in the training group were assigned 10 hr of cognitive training per two selected cognitive domains (20 hr total) for which impairment was observed. Overall, two patterns emerged. First, significant improvements in measures of everyday cognitive complaints, depression, and mental health were consistently observed after the completion of many cognitive training protocols. Second, immediate and delayed spatial learning and memory training resulted in more significant indicators of QoL improvements compared with the other cognitive domain trainings. The findings suggest that some types of cognitive training may have advantages over others in improving aspects of QoL.
Collapse
Affiliation(s)
- David E Vance
- David E. Vance, PhD, MGS, is a Professor, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA. Caitlin N. Pope, PhD, is an Assistant Professor, Department of Health, Behavior, and Society, College of Public Health, University of Kentucky, Lexington, Kentucky, USA. Pariya L. Fazeli, PhD, is an Associate Professor, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA. Andres Azuero, PhD, is a Professor, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA. Jennifer S. Frank, PhD, is a Neuropsychologist/Instructor, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA. Virginia G. Wadley, PhD, is a Professor Emerita, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA. James L. Raper, PhD, JD, CRNP, is a Professor and Director of the 1917 (HIV/AIDS) Clinic, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA. Jun Y. Byun, MSN, RN, is a PhD Student, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA. Karlene K. Ball, PhD, is a Professor, Department of Psychology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | | | | | | | | | | | | | | | | |
Collapse
|
|
22
|
Perceived Improvement and Satisfaction With Training After Individualized-Targeted Computerized Cognitive Training in Adults With HIV-Associated Neurocognitive Disorder Living in Alabama: A Descriptive Cross-sectional Study. J Assoc Nurses AIDS Care 2022; 33:581-586. [PMID: 35363623 DOI: 10.1097/jnc.0000000000000333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
|
23
|
Fazeli PL, Woods SP, Lambert CC, Li W, Hopkins CN, Vance DE. Differential Associations Between BDNF and Memory Across Older Black and White Adults With HIV Disease. J Acquir Immune Defic Syndr 2022; 89:129-135. [PMID: 34629411 PMCID: PMC8752478 DOI: 10.1097/qai.0000000000002831] [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: 06/28/2021] [Accepted: 09/27/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Brain-derived neurotrophic factor (BDNF) shows consistent associations with memory across many clinical populations, including dementia. Less is understood about the association between BDNF and memory functioning in people living with HIV (PWH). METHODS A sample of 173 adults aged 50+ (n = 100 HIV+ and n = 73 HIV seronegative) completed a comprehensive neurobehavioral assessment and blood draw. Linear regressions predicting memory domains (learning, delayed recall, and recognition) were conducted including race (White vs. Black/African American), HIV status, BDNF, and their interactions. RESULTS For learning and delayed recall, significant (P < 0.05) main effects for race and interactions for BDNF x race and HIV status x race were found, whereas for recognition, only a BDNF x race interaction emerged. In adjusted models, BDNF x race interactions remained for learning and delayed recall. To determine effect size, correlations were conducted between BDNF and memory domains stratified by HIV serostatus and race, and small-medium associations between BDNF and learning and delayed recall (rho = 0.29, P < 0.01; rho = 0.22, P = 0.045), but no recognition (rho = 0.12, P = 0.29) were found among Black/African American PWH. BDNF was not significantly associated with memory domains in White PWH or either HIV- sample. Follow-up analyses showed BDNF-memory specificity, such that race X BDNF interactions did not emerge for other cognitive domains. CONCLUSIONS While limited by cross-sectional design among a small sample, particularly of White individuals, results indicate that BDNF may serve as a promising biomarker reflecting memory functioning in PWH, particularly Black/African Americans. Further work is needed to replicate findings and determine mechanisms for racial differences in BDNF associations with memory.
Collapse
Affiliation(s)
- Pariya L. Fazeli
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL
| | | | | | - Wei Li
- School of Health Professions, University of Alabama at Birmingham, Birmingham, AL
| | - Cierra N. Hopkins
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL
| | - David E. Vance
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL
| |
Collapse
|
|
24
|
Psychosocial Mechanisms of Self-rated Successful Aging with HIV: A Structural Equation Model. AIDS Behav 2021; 25:2875-2885. [PMID: 34115265 DOI: 10.1007/s10461-021-03340-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/05/2021] [Indexed: 02/06/2023]
Abstract
This study tested a conceptual psychosocial model of self-rated successful aging (SRSA) with HIV. Our sample (n = 356) included older women living with HIV (OWLH): average age 56.5 years, 73% Black. SRSA was assessed using a research-based 10-point scale (higher scores = better outcomes). We conducted adjusted structural equation modeling. The global model included two latent variables-protective attributes (composite of positive psychosocial factors: resilience, personal mastery, optimism, spirituality) and psychological distress (composite of negative psychosocial factors: anxiety, depression, loneliness, internalized HIV-related stigma). The model showed good fit (χ2(58) = 76, p = 0.06; RMSEA = 0.03; CFI = 0.99). Increased protective attributes were associated with improved SRSA both directly and mediated by improved coping with stress. While psychological distress did not have a direct effect on SRSA, it was indirectly associated with worsened SRSA via diminished protective attributes and via decreased coping with stress. Findings suggest the need for interventions enhancing positive and mitigating negative psychosocial factors in OWLH.
Collapse
|
|
25
|
Parallels Between NeuroHIV and NeuroCOVID-19: Considerations for a Post-COVID-19 Era. J Assoc Nurses AIDS Care 2021; 32:e55-e59. [PMID: 35137724 PMCID: PMC8384133 DOI: 10.1097/jnc.0000000000000265] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
|
|
26
|
Robinson JJ, Walker T, Hopkins C, Bradley B, McKie P, Frank JS, Pope CN, Fazeli PL, Vance DE. Driving habits, cognition, and health-related quality of life in middle-aged and older adults with HIV. APPLIED NEUROPSYCHOLOGY. ADULT 2021; 30:492-502. [PMID: 34379556 PMCID: PMC9639014 DOI: 10.1080/23279095.2021.1960530] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Cognitive impairment is known to increase with aging in people living with HIV (PLWH). Impairment in cognitive domains required for safe driving may put PLWH at risk for poor driving outcomes, decreased mobility, and health-related quality of life (HRQoL). This study described the driving behaviors of middle-aged and older PLWH and examined correlations between driving behaviors and cognitive functioning (Aim 1), and driving behaviors and HRQoL domains (Aim 2). A sample of 260 PLWH ages 40 and older completed a comprehensive assessment including a battery of cognitive tests, an HRQoL measure, and a measure of self-reported driving habits. Associations between driving habits, cognitive function, and HRQoL domains were examined. While 212 (81.54%) participants reported currently driving, only 166 (63.85%) possessed a driver's license. Several significant correlations emerged between driving habits and both cognitive and HRQoL variables, with a general pattern suggesting that current greater driving exposure was associated with better cognitive functioning and HRQoL. Given consistent associations that emerged between the social functioning HRQoL domain and several driving habits, multivariable regression was conducted to examine the unique association between an index of greater driving exposure (i.e., days driven per week) and social functioning, adjusting for potential confounders (race, income, education, depression, and global cognition). Results showed that more days driven per week was a significant, independent correlate of higher social functioning. Understanding the factors underlying driving behaviors in PLWH may contribute to interventions to promote better mobility and improved access to care.
Collapse
Affiliation(s)
- Josiah J Robinson
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Tess Walker
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Cierra Hopkins
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Brittany Bradley
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Peggy McKie
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Jennifer S Frank
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Caitlin N Pope
- Graduate Center for Gerontology, University of Kentucky, Lexington, KY, United States
- University of Kentucky, Health, Behavior & Society, Lexington, KY, United States
| | - Pariya L Fazeli
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, United States
| | - David E Vance
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, United States
| |
Collapse
|