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Older Age and Neurocognitive Function in the Multi-Center AIDS Cohort Study
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Reported by Jules Levin
CROI 2013
K. Goodkin1, E. Miller2, C. Cox3, S. Reynolds3, D. Ostrow4, O. Selnes5, E. Martin6, N. Sacktor5, J. Becker7, for the Multi-Center AIDS Cohort Study
AIDS Healthcare Foundation, Los Angeles, CA, US1; University of California at Los Angeles, Los Angeles, CA, US2; Johns Hopkins School of Public Health, Baltimore, MD, US3; University of Chicago, Chicago, IL, US4; Johns Hopkins School of Medicine, Baltimore, MD, US5; University of Illinois at Chicago, Chicago, IL, US6; and University of Pittsburgh, Pittsburgh, PA, US7
Abstract
Background: Despite increasing numbers of research studies on aging, HIV disease and cognitive function, the extent to which HIV disease moderates the relationship between chronological age and cognitive functioning has remained unclear. The purpose of the present study was to examine this question in a large sample with extensive, longitudinal follow-up and a high level of control for other factors known to influence cognitive function.
Methods: Data from 5,086 participants in the Multicenter AIDS Cohort Study were used in this study: 2,278 were HIV infected (20,477 visits), and 2,808 were HIV seronegative (27,409 visits). Dependent variables included measures of cognitive functions from five domains: executive functions, information processing speed, working memory, episodic memory, and motor functions. Covariates in the models included ethnicity, education, household income, body mass index, body weight, depressed mood, antiretroviral therapy period, diabetes, hypertension, psychotropic medication use, and measures of pain and fatigue. History of infection with hepatitis C andB viruses were controlled for, as were a history of cigarette smoking, alcohol/substance use, and the duration of HIV infection (in a sub-sample).
Results: Older age was significantly associated with poor performance in all cognitive domains, after controlling for HIV disease stage. HIV Stage was significantly associated with NP outcome in all cognitive domains, independent of the effects of age. Clinical AIDS was associated with poorer performance in every case. Most important was the observation of a significant interaction between age and HIV disease stage in the episodic memory and motor function domains, after controlling for duration of HIV infection. Longer duration of HIV infection was associated with better function in each of these domains.
Conclusion: Based on these longitudinal data, we tentatively conclude that HIV disease severity shows a synergistic effect on the association between aging and cognitive function in the areas of episodic memory and motor function. The positive association between duration of infection and these cognitive functions suggests the possibility of a survivor bias, which needs to be addressed in all studies of this kind.
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