Associations between cognitive impairment and patient‐reported measures of physical/mental functioning in older people living with HIV

Underwood, Jonathan; Francesco, Davide De; Post, FA; Vera, Jaime H.; Williams, Ian; Boffito, Marta; Mallon, Patrick; Anderson, Jane; Sachikonye, Memory; Sabin, Caroline; Winston, Alan

doi:10.1111/hiv.12434

Cited by 25 publications

(56 citation statements)

References 18 publications

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“…Two other cohort studies have examined the association between answers to the EACS screening questions and NCI. The British Pharmacokinetic and Clinical Observations in People over Fifty (POPPY) study assessed cognitive function in 290 patients, with a median age of 57 years, using a computerized battery (CogState™, London, UK) and found a weak association between NCI, defined according to Frascati and other criteria, and patient‐reported outcome measures including answers to the EACS screening questions . The Dutch TREVI study examined cognitive function in 388 patients, with a mean age of 48 years, of whom 69 (17.8%) completed a neuropsychological assessment, and reported a sensitivity and specificity of 82% and 24%, respectively, for the EACS screening questions, which changed to 50 and 73% when used with the International HIV Dementia Scale .…”

Section: Discussionmentioning

confidence: 99%

How helpful are the European AIDS Clinical Society cognitive screening questions in predicting cognitive impairment in an aging, well‐treated HIV‐positive population?

Métral¹,

Nadin²,

Locatelli

et al. 2019

HIV Medicine

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ObjectivesDiagnosing neurocognitive impairment (NCI) in HIV infection requires time-consuming neuropsychological assessment. Screening tools are needed to identify when neuropsychological referral is indicated. We examined the positive and negative predictive values (PPVs and NPVs, respectively) of the three European AIDS Clinical Society (EACS) screening questions in identifying NCI. MethodsThe Neurocognitive Assessment in the Metabolic and Aging Cohort (NAMACO) study recruited patients aged ≥45 years enrolled in the Swiss HIV Cohort Study between 1 May 2013 and 30 November 2016. NAMACO participants (1) answered EACS screening questions, (2) underwent standardized neuropsychological assessment and (3) completed self-report forms [Center for Epidemiologic Studies Depression Scale (CES-D)] rating mood. NCI categories were defined using Frascati criteria. PPVs and NPVs of the EACS screening questions in identifying NCI categories were calculated. ResultsOf 974 NAMACO participants with complete EACS screening question data, 244 (25.1%) expressed cognitive complaints in answer to at least one EACS screening question, of whom 51.3% had NCI (26.1% HIV-associated and 25.2% related to confounding factors). The PPV and NPV of the EACS SHORT COMMUNICATION screening questions in identifying HIV-associated NCI were 0.35 and 0.7, respectively. Restricting analysis to NCI with functional impairment or related to confounding factors, notably depression, the NPV was 0.90. Expressing cognitive complaints for all three EACS screening questions was significantly associated with depression (P < 0.001). ConclusionsThe EACS screening questions had an NPV of 0.7 for excluding patients with HIV-associated NCI as defined by Frascati criteria. The PPV and NPV may improve if NCI diagnoses are based on new criteria.

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Section: Discussionmentioning

confidence: 99%

How helpful are the European AIDS Clinical Society cognitive screening questions in predicting cognitive impairment in an aging, well‐treated HIV‐positive population?

Métral¹,

Nadin²,

Locatelli

et al. 2019

HIV Medicine

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“…[7][8][9][10] In 290 PLWH over 50 years in Great Britain and Ireland and 97 seronegative controls, other patient-reported outcome measures, including depression, falls, sexual function, and general health, correlated poorly with cognitive impairment. 8 Thames et al 36 divided 107 HIV-positive patients into 4 groups, on the basis of whether they were impaired or unimpaired, and whether they were accurate or inaccurate in their selfassessment of this. Notably, only 38% were accurate, 33% were impaired but did not report a decline, and 25% reported a decline but did not have cognitive impairment.…”

Section: Discussionmentioning

confidence: 99%

“…[7][8][9][10] But even if symptoms are only weakly correlated with cognitive impairment, they are in some sense highly important to the patient. There are likely to be psychological and other factors underlying reported symptoms and understanding these factors may steer the clinician away from investigations such as brain imaging and lumbar puncture and toward the patients' more pertinent needs.…”

Section: Introductionmentioning

confidence: 99%

Self-Reported Decline in Everyday Function, Cognitive Symptoms, and Cognitive Function in People With HIV

Laverick

Haddow

Daskalopoulou

et al. 2017

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Background: We determined factors associated with self-reported decline in activities of daily living (ADLs) and symptoms of cognitive impairment in HIV positive adults in 5 European clinics.Methods: HIV+ adults underwent computerized and pen-and-paper neuropsychological tests and questionnaires of cognitive symptoms and ADLs. We considered cognitive function in 5 domains, psychosocial factors, and clinical parameters as potentially associated with symptoms. Separate regression analyses were used to determine factors associated with a decline in ADL (defined as selfreported decline affecting $2 ADLs and attributed to cognitive difficulties) and self-reported frequency of symptoms of cognitive impairment. We also estimated the diagnostic accuracy of both questionnaires as tests for cognitive impairment.

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“…HIV-associated neurocognitive disorder (HAND) ranges from asymptomatic to HIV-associated dementia (HAD) (Day et al, 1992;Maj et al, 1994;Nakazato et al, 2014;Robertson et al, 2011). The prevalence of HAD on the severe end of the spectrum has declined with antiretroviral therapy (ART) (Baker et al, 2015;Gates & Cysique, 2016), but mild to moderate cognitive deficits in HIV remain an issue (Manji, Jager, & Winston, 2013;Underwood et al, 2017;Vivithanaporn et al, 2010). Accelerated loss of brain tissue, specifically, in frontal and sensorimotor neocortices, thalamus, and hippocampus-related to disease duration and CD4 nadir (Cohen et al, 2010;Pfefferbaum et al, 2014)-may represent a risk factor for premature cognitive compromise if not dementia (Ances, Ortega, Vaida, Heaps, & Paul, 2012;Pfefferbaum et al, 2014;Pfefferbaum et al, 2018;Sanford et al, 2018).…”

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confidence: 99%

“…Recently, a method for segmentation of the thalamic nuclei from structural MRI has been proposed that was validated against manual segmentation guided by the Morel atlas . Based on the extant literature, we hypothesized that thalamic nuclei AV and MD would be smaller in AUD and HIV relative to control individuals and relate to performance on tasks of explicit memory (e.g., Pergola et al, 2012;Van der Werf et al, 2003).…”

mentioning

confidence: 99%

Sensitivity of ventrolateral posterior thalamic nucleus to back pain in alcoholism and CD4 nadir in HIV

Zahr

Sullivan

Pohl

et al. 2019

Human Brain Mapping

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Volumes of thalamic nuclei are differentially affected by disease‐related processes including alcoholism and human immunodeficiency virus (HIV) infection. This MRI study included 41 individuals diagnosed with alcohol use disorders (AUD, 12 women), 17 individuals infected with HIV (eight women), and 49 healthy controls (24 women) aged 39 to 75 years. A specialized, high‐resolution acquisition protocol enabled parcellation of five thalamic nuclei: anterior [anterior ventral (AV)], posterior [pulvinar (Pul)], medial [mediodorsal (MD)], and ventral [including ventral lateral posterior (VLp) and ventral posterior lateral (VPl)]. An omnibus mixed‐model approach solving for volume considered the “fixed effects” of nuclei, diagnosis, and their interaction while covarying for hemisphere, sex, age, and supratentorial volume (svol). The volume by diagnosis interaction term was significant; the effects of hemisphere and sex were negligible. Follow‐up mixed‐model tests thus evaluated the combined (left + right) volume of each nucleus separately for effects of diagnosis while controlling for age and svol. Only the VLp showed diagnoses effects and was smaller in the AUD (p = .04) and HIV (p = .0003) groups relative to the control group. In the AUD group, chronic back pain (p = .008) and impaired deep tendon ankle reflex (p = .0005) were associated with smaller VLp volume. In the HIV group, lower CD4 nadir (p = .008) was associated with smaller VLp volume. These results suggest that the VLp is differentially sensitive to disease processes associated with AUD and HIV.

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Associations between cognitive impairment and patient‐reported measures of physical/mental functioning in older people living with HIV

Cited by 25 publications

References 18 publications

How helpful are the European AIDS Clinical Society cognitive screening questions in predicting cognitive impairment in an aging, well‐treated HIV‐positive population?

How helpful are the European AIDS Clinical Society cognitive screening questions in predicting cognitive impairment in an aging, well‐treated HIV‐positive population?

Self-Reported Decline in Everyday Function, Cognitive Symptoms, and Cognitive Function in People With HIV

Sensitivity of ventrolateral posterior thalamic nucleus to back pain in alcoholism and CD4 nadir in HIV

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