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Depression Tied to Worse Cognitive Function in MACS Men With or Without HIV
  6th International Workshop on HIV and Aging
October 5-6, 2015, Washington, DC
Mark Mascolini
Having a test-measured depressive phenotype made cognitive slowing more likely in men with or without HIV in the Multicenter AIDS Cohort Study (MACS) [1]. Depressed men with HIV did worse in one measure of cognition than depressed men without HIV.
Because HIV crosses the blood-brain barrier, noted MACS researchers who ran this study, it may play a part in both cognitive impairment and depression. They planned this analysis to address two hypotheses--that people with a depressive phenotype run a higher risk of cognitive impairment than people without that phenotype, and that people with HIV run a higher risk of cognitive slowing than people without HIV, especially if they have depression.
A team of MACS collaborators conducted this study in 927 men who have sex with men, 567 of them with HIV and 360 at risk of HIV infection. All study participants had at least 5 follow-up visits in MACS starting in 2000, and all completed twice-yearly tests to establish depressive phenotype and cognitive impairment. The researchers defined depressive phenotype as a Center for Epidemiologic Studies-Depression Scale (CES-D) score of 16 or higher on 3 consecutive tests. They used three tests to establish executive function and psychomotor speed--Trail-Making Tests A and B (TMT-A and TMT-B) and the Symbol Digit Modalities Test (SDMT). The investigators used linear random effects models adjusted for age, HIV status, race, education, and other variables to assess declining executive function or psychomotor speed with a depressive phenotype.
Of the 927 study participants, 335 (36%) had a depressive phenotype. Age did not differ significantly between those with versus without a depressive phenotype (average 38.4 versus 39.4). But men with a depressive phenotype included a larger proportion of nonwhites (67.8% versus 56.3%, P = 0.0006), a larger proportion with less than a college education (62.9% versus 52%, P = 0.0014), and larger proportions with 1, 2, 3, or more comorbidities (P < 0.001). Among 567 men with HIV, 227 (40%) had a depressive phenotype. Compared with HIV-positive men who did not have a depressive phenotype, those who did had a significantly higher viral load (average 32,642 versus 15,529 copies, P = 0.0246) but not a lower CD4 count.
Among all men studied, those with versus without a depressive phenotype took 8% longer on the TMT-A test and 12% longer on the TMT-B test, after adjustment for covariates. Among HIV-negative men, those with a depressive phenotype completed an average 1.84 fewer digit-symbol pairs on the SDMT. In a similar analysis limited to men with HIV, those with a depressive phenotype took 9% longer to complete TMT-A and 12% longer to complete TMT-B than men without a depressive phenotype. HIV-positive men with a depressive phenotype completed an average 4.31 fewer digit-symbol pairs on the SDMT.
The MACS team concluded that men with a depressive phenotype run a higher risk of cognitive slowing than men without a depressive phenotype and that depression has a stronger impact on men with than without HIV--but only on the SDMT, not on TMT-A or TMT-B. The results suggest slower psychomotor speed and worse executive function among men with depression.
A 2013 cross-sectional study in Portugal linked severe depressive symptoms with reduced cognitive function in women with HIV [2]. The three domains affected were attention, psychomotor speed, and construction. A cross-sectional study in the Hawaii Aging With HIV Cohort found evidence linking depression to impaired neuropsychological test performance in younger but not older people with HIV [3].
1. Armstrong NM, Surkan P, Gross AL, et al. Longitudinal association between depressive phenotype and cognitive impairment in men with and without HIV. 6th International Workshop on HIV and Aging. October 5-6, 2015, Washington, DC. Abstract 6.
2. Fialho RM, Pereira M, Mendonca N, Ouakinin S. Depressive symptoms and neurocognitive performance among HIV-infected women. Women Health. 2013;53:117-134. http://www.ncbi.nlm.nih.gov/pubmed/23517511
3. Shimizu SM, Chow DC, Valcour V, et al. The impact of depressive symptoms on neuropsychological performance tests in HIV-infected individuals: a study of the Hawaii Aging with HIV Cohort. World J AIDS. 2011;1:139-145. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3467015/