Effects of HIV on executive function and verbal fluency in Cameroon

Abstract

HIV-associated neurocognitive disorders (HAND) are frequently associated with impaired executive function and verbal fluency. Given limited knowledge concerning HAND in Sub-Saharan-Africa and lack of Cameroonian adult neuropsychological (NP) test norms, we administered four executive function [Halstead Category Test (HCT), Wisconsin Card Sorting Test (WCST), Color Trails-II (CTT2), and Stroop Color-Word-Interference (SCWT)] and three verbal fluency (Category, Action, and Letter Fluency) tests to 742 adult Cameroonians (395 HIV−, 347 HIV+). We developed demographically-corrected NP test norms and examined the effects of HIV and related variables on subjects’ executive function and verbal fluency. HIV+ subjects had significantly lower T-scores on CTT2 (P = 0.005), HCT (P = 0.032), WCST (P < 0.001); lower executive function composite (P = 0.002) and Action Fluency (P = 0.03) T-scores. ART, viremia, and CD4 counts did not affect T-scores. Compared to cases harboring other viral subtypes, subjects harboring HIV-1 CRF02_AG had marginally higher CTT2 T-scores, significantly higher SCWT (P = 0.015) and executive function (P = 0.018) T-scores. Thus, HIV-1 infection in Cameroon is associated with impaired executive function and some aspects of verbal fluency, and viral genotype influenced executive function. We report the first normative data for assessing executive function and verbal fluency in adult Cameroonians and provide regression-based formulas for computing demographically-adjusted T-scores. These norms will be useful for investigating HIV/AIDS and other diseases affecting cognitive functioning in Cameroon.

Attention/Working Memory, Learning and Memory in Adult Cameroonians: Normative Data, Effects of HIV Infection and Viral Genotype

“…The effect sizes for individual NP tests and domain T-scores in our studies are in the same ranges as effect sizes observed in some large US cohort studies (Maki et al, 2015;Rubin et al, 2015). The proportion of cases in this study with impairment based on individual tests or domain T-scores (17-23%) is in line with our previous findings (Kanmogne et al, 2018;Kanmogne et al, 2010;Njamnshi et al, 2009;Njamnshi et al, 2008) and some previously reported prevalence of HAND in Nigeria (21.5%) (Yusuf et al, 2017) and South Africa (23%) (Joska, Fincham, Stein, Paul, & Seedat, 2010). However, these are much lower than HAND prevalence reported among HIV-infected adults in other studies in Nigeria, China, and India (26-28%) (Jumare et al, 2019;Royal et al, 2012); South Africa (36-53%) (Joska et al, 2011;Mogambery, Dawood, Wilson, & Moodley, 2017), Botswana (37-38%) (Lawler et al, 2011), Zambia (34-35%) (Kabuba et al, 2017), Uganda (38-64%) (Nakku, Kinyanda, & Hoskins, 2013;Sacktor et al, 2019;Yechoor et al, 2016), and the United States (36-45%) (Heaton et al, 2015).…”

“…Data showed no difference in learning or memory based on HIV genotype but compared to subjects infected with AG-Plus and non-AG HIV-1, subjects infected with AG viruses had higher functioning on the overall composite attention/WM T-scores. Therefore, previous findings of reduced inflammation with AG viruses and Tat.AG (Bhargavan & Kanmogne, 2018;Woollard et al, 2014) may be associated with less impairment in executive function (Kanmogne et al, 2018) and reduced deficits in attention/ WM among subjects harboring AG viruses, compared to subjects infected with other HIV genotypes. Our subsequent studies will determine whether there is a correlation between viral genotype, systemic inflammation, and risk of other NCIs in these subjects.…”

“…Comparative analyses of T-scores of PLWH who had low (<350 cells/μl) and higher (≥350 cells/μl) CD4 counts showed no significant differences between those with low and higher CD4 count on attention/WM, learning, or memory (Table 6). Analyses of the viral PR, RT, gag, env, tat, and nef sequences showed a high genetic diversity (Acharya, Fonsah, Mbanya, Njamnshi, & Kanmogne et al, 2019;Kanmogne et al, 2018;Teto et al, 2016;Teto et al, 2017). These patients were predominantly infected with HIV-1 CRF02_AG (AG) (59-71.6%), but there were also individuals infected with non-CRF02_AG viruses (non-AG) or viruses that had CRF02_AG genotype in some of the six gene regions analyzed and different genotypes in other gene regions (AG-Plus).…”

Selective Estrogen Receptor β Agonists: a Therapeutic Approach for HIV-1 Associated Neurocognitive Disorders

“…At the most basic level, HIV-1 seropositive individuals (Minassian et al 2013) display prominent alterations in preattentive processes (sensorimotor gating); deficits which have been translationally modeled across multiple biological systems used to model HAND (e.g., HIV-1 Tg rat: Moran et al 2013, McLaurin et al 2017; stereotaxic injections of HIV-1 viral proteins: Fitting et al 2006aFitting et al , 2006b; gp120 transgenic mice: Henry et al 2014, Bachis et al 2016; Tat transgenic mice: Paris et al 2015). Alterations in the core components of cognitive function, including key components of both representational knowledge (e.g., attention, long-term episodic memory) and executive function (e.g., flexibility, inhibition), have also been reported in clinical (e.g., Heaton et al 2011;Maki et al 2015;Kanmogne et al 2018) and preclinical (e.g., Lashomb et al 2009;Moran et al 2014;Repunte-Canonigo et al 2014;McLaurin et al 2018McLaurin et al , 2019a studies. Given the componential relationship between neurocognitive functions, examining the effect of SE on the core components of cognitive function (i.e., preattentive processes, stimulus-response learning, sustained attention, and selective attention) will provide one critical test of its therapeutic potential for HAND in the post-cART era.…”

Effects of HIV infection, antiretroviral therapy, and immune status on the speed of information processing and complex motor functions in adult Cameroonians

“…www.nature.com/scientificreports/ Stroop color naming and word reading speed 40 . The Stroop test was administered over 45 s as we previously described 30 , with scores consisting of the total number of words read and total number of colors correctly identified and named. This test measures cognitive processing, mental speed and mental control.…”