Lower Frailty Is Associated with Successful Cognitive Aging Among Older Adults with HIV

Wallace, Lindsay; Ferrara, Maria; Garlassi, Sara; Kirkland, Susan; Theou, Olga; Zona, Stefano; Mussini, Cristina; Moore, David J.; Rockwood, Kenneth; Guaraldi, Giovanni

doi:10.1089/aid.2016.0189

Cited by 37 publications

(26 citation statements)

References 42 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…No consensus currently exists for an operational definition of frailty, and many have suggested that measures of mental health should be included [18]. Our findings support this suggestion, and are consistent with prior studies in HIV demonstrating an association between neuropsychiatric abnormality and frailty status [9,10]. Although the underlying mechanism of this association cannot be determined in our study, prior studies have demonstrated an association between motor abnormality (and with particular relevance to frailty, abnormal gait) and cognitive impairment, both in PLWH and HIV-negative populations [19][20][21].…”

Section: Discussionsupporting

confidence: 90%

“…In a functionally intact [i.e. without impairments in activities of daily living (ADL)] subsample from this clinic, cognitive status assessed by three neuropsychologic tests, and depressive symptom index was also correlated with frailty status [9]. In a sample from a tertiary care center in Mexico that excluded severe illnesses, such as COPD and advanced cardiac disease, frailty was related to functional cognitive impairments assessed with the NEUROPSI battery [10].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Frailty in medically complex individuals with chronic HIV

Morgello

Sherman

Ellis

et al. 2019

Aids

View full text Add to dashboard Cite

Sueiras i , for the NNTC Objectives: Multimorbidity and frailty are consequences of aging with HIV, yet not everyone with medical disease is frail. Our objective was to identify factors associated with frailty in a multimorbid HIV-infected cohort. Design: Analysis of a prospective, observational, longitudinal cohort. Methods: Three hundred and thirty-two participants in the medically advanced NNTC were categorized as frail, prefrail, or robust with the Fried Frailty Index. A series of logistic regression analyses (first univariate, then multivariable) were conducted to determine whether medical comorbidities, immunologic and virologic parameters, and/or neuropsychiatric variables predicted increased odds of frailty. Results: The mean number of medical comorbidities per participant was 2.7, mean CD4 þ T-cell count was 530 cells/ml, and 77% had undetectable HIV RNA in blood. Twenty-two percent were frail, 55% prefrail, and 23% robust. Significant predictors of frailty in multivariable analysis were cognitive diagnosis rendered by Frascati criteria, depressive symptoms, diabetes mellitus, chronic obstructive pulmonary disease (COPD), and sex. Men were less likely to be frail than women. Higher odds of frailty were seen with: symptomatic, but not asymptomatic, cognitive impairment (compared with cognitive normals); more depressive symptoms; diabetes mellitus; and COPD. Conclusion: Neuropsychiatric illness increased odds of being frail on a predominantly physical/motoric measure, but only when symptomatic. Lack of association with asymptomatic impairment may reflect the importance of functional limitation to frailty, or possibly a unique resilience phenotype. Understanding why sex and symptomatic neuropsychiatric illness are associated with frailty will be important in managing HIVassociated morbidity in aging populations.

show abstract

Section: Discussionsupporting

confidence: 90%

Section: Introductionmentioning

confidence: 99%

Frailty in medically complex individuals with chronic HIV

Morgello

Sherman

Ellis

et al. 2019

Aids

View full text Add to dashboard Cite

show abstract

“…The lack of significant cognitive decline is an encouraging finding; however, the accrual of motor dysfunction is worrisome. Motor dysfunction is part of many neurologic disorders of aging and has real impact on a person’s ability to age successfully and maintain independence (Wallace et al 2017). The combination of neuropsychological impairment, even if stable and relatively mild, with motor dysfunction may contribute to a frail HIV-infected aging population even in the setting of immune reconstitution and viral suppression.…”

Section: Discussionmentioning

confidence: 99%

Motor function declines over time in human immunodeficiency virus and is associated with cerebrovascular disease, while HIV-associated neurocognitive disorder remains stable

et al. 2018

View full text Add to dashboard Cite

HIV-associated neurocognitive disorders (HAND) remain prevalent in the combined antiretroviral therapy (CART) era, especially the milder forms. Despite these milder phenotypes, we have shown that motor abnormalities persist and have quantified them with the HIV Dementia Motor Scale (HDMS). Our objectives were to replicate, in an independent sample, our prior findings that the HDMS is associated with cognitive impairment in HIV, while adding consideration of age-associated comorbidities such as cerebrovascular disease, and to examine the longitudinal trajectories of cognitive and motor dysfunction. We included all participants enrolled in the Manhattan HIV Brain Bank (MHBB) from January 2007 to May 2017 who had complete baseline data (N = 164). MHBB participants undergo standardized longitudinal assessments including documentation of comorbidities and medications, blood work, the HDMS, and neurocognitive testing. We found that motor dysfunction, cognitive impairment, and cerebrovascular disease were significantly associated with each other at baseline. Cerebrovascular disease independently predicted cognitive impairment in a multivariable model. Longitudinal analysis in a subset of 78 participants with ≥ 4 years of follow-up showed a stable cognition but declining motor function. We conclude that the HDMS is a valid measurement of motor dysfunction in HIV-infected patients and is associated with cognitive impairment and the presence of cerebrovascular disease. Cognitive impairment is mild and stable in CART-treated HIV; however, motor function declines over time, which may be related to the accrual of comorbidities such as cerebrovascular disease. Further research should examine the mechanisms underlying motor dysfunction in HIV and its clinical impact.

show abstract

“…While frailty's impact has provided new insights in prevention and treatment within AD, its effect on cognitive impairment among PLWH has been relatively unexplored. To date, we know that cross-sectionally, among PLWH, low frailty status is associated with the absence of cognitive impairment in older adults (Wallace et al, 2017) and that high frailty is associated with worse global neurocognitive functioning, verbal fluency, executive functioning, processing speed, and motor skills (Oppenheim et al, 2018).…”

Section: Introductionmentioning

confidence: 99%

Pre-frailty predicts cognitive decline at 2-year follow-up in persons living with HIV

et al. 2019

View full text Add to dashboard Cite

Both HIV disease and frailty syndrome are risk factors for neurocognitive impairment. Longitudinal research among individuals of the general population suggests that frailty predicts future cognitive decline; however, there is limited evidence for these longitudinal relationships among people living with HIV (PLWH). The current study evaluated and compared rates of cognitive decline over 2 years among HIV serostatus and frailty status groups. Participants included 50 PLWH and 60 HIV-uninfected (HIV−) participants who were evaluated at baseline and 2-year follow-up visits. Baseline frailty status (non-frail, pre-frail, and frail) was determined using fried frailty phenotype criteria. Neurocognitive functioning was measured using practice-effect corrected scaled scores derived from a comprehensive neuropsychological battery covering seven cognitive domains. Repeated measures analysis was used to estimate rates of global and domain-specific cognitive change from baseline to 2-year follow-up among each of six HIV/frailty status groups. Among PLWH, the pre-frail group demonstrated consistent declines in global cognitive functioning (B = − 0.029, p = 0.034), processing speed (B = − 0.047, p = 0.031), and motor functioning (B = − 0.048, p = 0.038). Among HIV− participants, pre-frail individuals also declined in global cognitive functioning and processing speed (ps ≤ 0.05). HIV− non-frail participants also declined in the cognitive domains of learning, delayed recall, and motor functioning; however, these declines appeared to be driven by relatively higher baseline scores among this group. Notably, 38% of PLWH changed in frailty status from baseline to follow-up, and those with stable pre-frailty demonstrated higher likelihood for cognitive decline; change in depressive symptoms did not relate to change in frailty status. Current findings highlight pre-frailty as an important clinical syndrome that may be predictive of cognitive decline among PLWH. Interventions to prevent or reduce frailty among vulnerable PLWH are needed to maintain optimal cognitive health.

show abstract

Lower Frailty Is Associated with Successful Cognitive Aging Among Older Adults with HIV

Cited by 37 publications

References 42 publications

Frailty in medically complex individuals with chronic HIV

Frailty in medically complex individuals with chronic HIV

Motor function declines over time in human immunodeficiency virus and is associated with cerebrovascular disease, while HIV-associated neurocognitive disorder remains stable

Pre-frailty predicts cognitive decline at 2-year follow-up in persons living with HIV

Contact Info

Product

Resources

About