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"Successful Cognitive Aging" in Only One Fifth of US HIV Group 50 or Older
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4th International Workshop on HIV and Aging, October 30-31, 2013, Baltimore
Mark Mascolini
Only one fifth of HIV-positive people 50 or older met criteria for successful cognitive aging in a 300-person comparison of younger and older people with and without HIV infection [1]. In contrast, almost 50% of the younger HIV-negative group and one third of the older HIV-negative group met successful cognitive aging criteria. Cognitive reserve (higher premorbid intelligence related to education and occupation) appeared to play a protective role throughout adult life, but especially in older adults with HIV.
Neurocognitive decline and subjective neurocognitive complaints can affect daily functioning, health-related quality of life, and emotional well-being in people with and without HIV. To measure rates of successful cognitive aging and factors that may promote it, researchers from the University of California, San Diego (UCSD) compared neurocognitive parameters in 70 HIV-positive people 40 and younger, 107 HIV-positive people 50 and older, 48 younger HIV-negative people, and 77 older HIV-negative people.
Study participants underwent comprehensive assessment of neuropsychological, psychiatric, medical, and health-related quality-of-life functioning. The UCSD team defined successful cognitive aging and absence of neurocognitive deficits (SCA-ANDS) as "absence of both performance-based neurocognitive deficits and self-reported symptoms."
Ages in the younger and older HIV groups averaged 32.8 and 56.2, compared with 31.2 and 56.2 in the younger and older HIV-negative groups (P < 0.001). Respective proportions of women in those four groups were 15.7%, 16.8%, 33.3%, and 28.6% (P = 0.03), and respective proportions of Caucasians were 40.0%, 68.2%, 43.8%, and 66.2% (P < 0.001).
Proportions of participants with affective disorder were 72.9% and 69.2% in the younger and older HIV groups and 29.2% and 45.5% in the younger and older non-HIV groups (P < 0.001). Respective proportions with alcohol dependence were 44.3%, 27.1%, 31.3%, and 31.2% (P < 0.001). The younger and older HIV groups had estimated HIV infection durations averaging 8.0 and 17.6 years (P < 0.001).
Statistical analysis controlling for all clinical variables that differed between groups found decreasing prevalence of successful cognitive aging with age and HIV status. Almost half of the younger HIV-negative group (48%) met criteria for SCA-ANDS, compared with 35% of the older HIV-negative group, 34% of the younger HIV-positive group, and 19% of the older HIV-positive group (P < 0.05).
Among younger HIV-positive people, five factors were associated with successful cognitive aging--higher premorbid cognitive reserve, Caucasian race, shorter duration of HIV infection, and no history of alcohol dependence or affective disorders. Among older people with HIV, only higher premorbid cognitive reserve was associated with successful cognitive aging.
In both younger and older people with HIV, successful cognitive aging was a strong independent predictor of aspects of mental health-related quality of life but not physical quality of life.
The researchers proposed that age and HIV infection have additive adverse effects on successful cognitive aging. "Higher levels of cognitive reserve may play an important protective role in SCA-ANDS across the lifespan," they observed, "particularly among older persons living with HIV." The UCSD team suggested that interventions aimed at improving and maintaining cognitive reserve "to bolster successful cognitive aging" throughout life may protect against neurocognitive disorders and promote mental well-being. They called for longitudinal studies to chart the course of successful cognitive aging throughout life and to further identify predictors and "neurobiological underpinnings."
Reference
1. Moore RC, Fazeli PL, Jeste DV, et al. Successful cognitive aging and health-related quality of life in younger and older adults infected with HIV. 4th International Workshop on HIV and Aging, October 30-31, 2013, Baltimore. Abstract 4.
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