Diabetes and cognitive decline in a French cohort of patients infected with HIV-1

Abstract

Objective: We investigated the relationship of diabetes and prediabetes with cognitive performances, assessed through raw test and z scores and according to neurocognitive impairment (NCI) classification in a cohort of individuals infected with HIV. Methods:The ANRS CO3 Aquitaine cohort is a prospective hospital-based cohort of HIV-1-infected patients under routine clinical management in 6 public hospitals in southwestern France. Between 2007 and 2009, an ancillary study consisted of a neuropsychological battery of 10 tests at baseline and 2-year follow-up. The severity of NCI (normal, asymptomatic, mild, HIV dementia) was assessed according to international guidelines.Results: At baseline (400 patients, 33 with prediabetes, 39 with diabetes), in cross-sectional multivariable analyses, patients with diabetes performed significantly worse on 9 neuropsychological tests that assessed memory, executive functions, attention, psychomotor speed, language, and manual dexterity. Participants with prediabetes had worse performances compared with those who had normal glycemia in 5 tests. The longitudinal analysis of the association between glycemia status at baseline and change in cognitive performances over 2-year follow-up (n 5 283) suggested that patients with diabetes also showed a slightly higher decline on 5 of the 10 tests, those involving executive functions and memory functioning. Glycemia status at baseline was not significantly associated with NCI severity in cross-sectional (p 5 0.44) and longitudinal (p 5 0.64) analyses. Conclusions:In this hospital-based cohort of people living with HIV, diabetes, but not the other cardiovascular risk factors, is associated with worse cognitive performances in several cognitive domains and with larger decline in fewer domains over the short term.

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

“…12,13 This has crucial implications for the interpretation of longitudinal studies in which the risk of change from ANI to MND is measured, such as the United States CHARTER cohort, 39 the Canadian OHTN Cohort, 6 and the French Aquitaine cohort. 40 For example, in the Ottawa cohort, depression was a major risk factor for change from ANI to MND. 6 Because self-reported functional impairment is associated with depression, change from ANI to MND does not always indicate decline in neurocognitive abilities.…”

“…30 Each cognitive test was converted to an age-, sex-, and education-standardized Z-score using normative mean values and SD. Normative data for the computerized tests were provided by Cogstate from Europe, United States of America, South East Asia, and Australia/New Zealand, frequencymatched for age (18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42)(43)(44)(45)(46)(47)(48)(49)(50), and 51+ years; minimum cell size n = 145), sex (157 female, 377 male), and education (university/further education, n = 243, or secondary school, n = 291). The normative population excluded individuals with clinical or functional impediments to test performance, and subsets of these data had been used previously to measure cognitive function in HIV+ adults.…”

HIV-associated neurocognitive disorder

“…[47] Diabetes with its known accelerated vascular disease is associated with earlier cognitive dysfunction. [48,49] Cohort studies continue to find substantial impact of cardiovascular associated factors affecting cognition, suggesting that this will be one of best areas of concentration to decrease cognitive impairment. [4,50]…”

Risk Factors of Asymptomatic Neurocognitive Impairment in People Living with HIV in an Indian Cohort

“…18 Diabetes has also been linked to greater cognitive decline a French cohort of HIV patients. 19 Our previous study has shown that CIMT is linked to protease inhibitor based ART regiemes. 20 Previous studies have shown that age, especially > 50 years, increases risk of HAND.…”