Apathy correlates with cognitive performance, functional disability, and HIV RNA plasma levels in HIV-positive individuals

Shapiro, Miriam E.; Mahoney, Jeannette R.; Zingman, Barry S.; Pogge, David L.; Verghese, Joe

doi:10.1080/13803395.2013.838941

Cited by 27 publications

(14 citation statements)

References 53 publications

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“…Here we propose that the ACC might be one of the key and early regions affected by HIV-disease, as suggested by a recent study (Garvey et al, 2014), and the manifestation of neuronal dysfunction in the ACC at a later stage may lead to a widespread cognitive decline, especially in the executive domain. Indeed, previous studies have suggested a significant correlation between apathy and cognitive performance in HIV+ individuals (Paul et al, 2005; Shapiro, Mahoney, Zingman, Pogge, & Verghese, 2013). …”

Section: Discussionmentioning

confidence: 95%

Behavioral and neuroimaging evidence for impaired executive function in “cognitively normal” older HIV-infected adults

et al. 2015

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The increased prevalence of HIV among adults >50 years underscores the importance of improving our understanding of mechanisms causing HIV-associated neurocognitive disorders (HAND). Identifying novel and non-invasive diagnostic predictors of HAND prior to clinical manifestation is critical to ultimately identifying means of preventing progression to symptomatic HAND. Here using a task-switching paradigm, in which subjects were cued (unpredictably) to perform a face-gender or a word-semantic task on superimposed face and word images, we examined the behavioral and neural profile of impaired cognitive control in older HIV+ adults (N=14, 9 HIV+). Functional magnetic resonance imaging (fMRI) and behavioral data were acquired while subjects were performing the face-gender or word-semantic task. We found that, despite comparable performance in standard neuropsychology tests that are designed to probe executive deficits, HIV infected participants were significantly slower than uninfected controls in adapting to change in task demand, and the behavioral impairments can be quantitatively related to difference in fMRI signal at the dorsal anterior cingulate cortex (ACC). Due to the limited sample size of this hypothesis generating study, we should take caution with these findings and future studies with a large and better matched sample size are needed. However, these rather novel findings in this study have a few important implications: first, the prevalence of cognitive impairments in HIV+ older adults might be even higher than previously proposed; secondly, ACC (in particularly its dorsal region) might be one of the key regions underlying cognitive impairments (in particularly executive functions) in HIV; and thirdly, it might be beneficial to adopt paradigms developed and validated in cognitive neuroscience to study HAND, as these techniques might be more sensitive to some aspects of HIV-associated neurocognitive impairments than standard neuropsychology tests.

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Section: Discussionmentioning

confidence: 95%

Behavioral and neuroimaging evidence for impaired executive function in “cognitively normal” older HIV-infected adults

et al. 2015

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“…In model 2, we additionally adjusted for age, sex, and education because apathy symptoms are influenced by these demographic characteristics. 1,3,4 Apathy has also been associated with poor health status and cognitive decline; 3,53–55 therefore, models 3 and 4 adjusted for summary illness index and cognitive functioning (FAS and Digit symbol coding), respectively. Associations are reported as hazard ratios (HR) with 95% confidence intervals (CI).…”

Section: Methodsmentioning

confidence: 99%

Symptoms of Apathy Independently Predict Incident Frailty and Disability in Community-Dwelling Older Adults

Ayers

Shapiro

Holtzer

et al. 2017

J. Clin. Psychiatry

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Objective Although depressive symptoms are widely recognized as a predictor of functional decline among older adults, little is known about the predictive utility of apathy in this population. We prospectively examined apathy symptoms as predictors of incident slow gait, frailty and disability among non-demented, community-dwelling older adults. Methods We examined two independent prospective cohort studies - the LonGenity study (N = 625, 53% women, mean age 75.2 years) and the Central Control of Mobility in Aging (CCMA) study (N = 312, 57% women, mean age 76.4 years). Individuals were recruited from 2008 to 2014. Apathy was assessed using 3 items from the Geriatric Depression Scale. Slow gait was defined as 1 standard deviation or more below age and sex-adjusted mean values, frailty was defined using the Cardiovascular Health Study criteria, and disability was assessed with a well-validated disability scale. Results The prevalence of apathy was 20% in LonGenity cohort and 26% in the CCMA cohort. The presence of apathy at baseline, independent of depressive symptoms (besides apathy), increased risk of developing incident slow gait (hazard ratio [HR] = 2.10; CI = 1.36–3.24; p = .001), frailty (HR = 2.86; CI = 1.96–4.16; p < .001), and disability (HR = 3.43; CI = 1.73–6.79; p < .001) in the pooled sample. These associations remained significant when accounting for demographics, medical illnesses, and cognitive function. Conclusions Apathy is associated with increased risk of developing slow gait, frailty, and disability, independent of other established risk factors, in non-demented older adults. Apathy should be screened as a potentially preventable cause of functional decline in clinical psychiatric settings.

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“…Though, this relationship was moderated by CD4 nadir, in that individuals with nadir CD4 levels ≥200, demonstrated a stronger association than those with nadir CD4 levels >200 [23]. Furthermore, higher levels of apathy have previously been associated with higher HIV RNA [24]. Finally, having a history of cocaine dependence has been associated with apathy, in PLWH and in HIV negative samples [7, 12, 25, 26].…”

Section: Introductionmentioning

confidence: 99%

Depression and Apathy Among People Living with HIV: Implications for Treatment of HIV Associated Neurocognitive Disorders

et al. 2014

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Depression and apathy are common among people living with HIV (PLWH). However, in PLWH, it is unclear whether depression and apathy are distinct conditions, which contribute to different patterns of disruption to cognitive processing and brain systems. Understanding these conditions may enable the development of prognostic indicators for HIV associated neurocognitive disorders (HAND). The present study examined substance use behavior and cognitive deficits, associated with depression and apathy, in 120 PLWH, using hierarchical regression analyses. Higher levels of depression were associated with a history of alcohol dependence and greater deficits in processing speed, motor and global cognitive functioning. Higher levels of apathy were associated with a history of cocaine dependence. It is recommended that PLWH get screened appropriately for apathy and depression, in order to receive the appropriate treatment, considering the comorbidities associated with each condition. Future research should examine the neurological correlates of apathy and depression in PLWH.

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Apathy correlates with cognitive performance, functional disability, and HIV RNA plasma levels in HIV-positive individuals

Cited by 27 publications

References 53 publications

Behavioral and neuroimaging evidence for impaired executive function in “cognitively normal” older HIV-infected adults

Behavioral and neuroimaging evidence for impaired executive function in “cognitively normal” older HIV-infected adults

Symptoms of Apathy Independently Predict Incident Frailty and Disability in Community-Dwelling Older Adults

Depression and Apathy Among People Living with HIV: Implications for Treatment of HIV Associated Neurocognitive Disorders

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