Post-traumatic stress is associated with verbal learning, memory, and psychomotor speed in HIV-infected and HIV-uninfected women

Abstract

The prevalence of post-traumatic stress disorder (PTSD) is higher among HIV-infected (HIV+) women compared with HIV-uninfected (HIV−) women, and deficits in episodic memory are a common feature of both PTSD and HIV infection. We investigated the association between a probable PTSD diagnosis using the PTSD Checklist-Civilian (PCL-C) version and verbal learning and memory using the Hopkins Verbal Learning Test in 1004 HIV+ and 496 at-risk HIV− women. HIV infection was not associated with a probable PTSD diagnosis (17 % HIV+, 16 % HIV−; p=0.49) but was associated with lower verbal learning (p<0.01) and memory scores (p<0.01). Irrespective of HIV status, a probable PTSD diagnosis was associated with poorer performance in verbal learning (p<0.01) and memory (p<0.01) and psychomotor speed (p<0.001). The particular pattern of cognitive correlates of probable PTSD varied depending on exposure to sexual abuse and/or violence, with exposure to either being associated with a greater number of cognitive domains and a worse cognitive profile. A statistical interaction between HIV serostatus and PTSD was observed on the fine motor skills domain (p= 0.03). Among women with probable PTSD, HIV− women performed worse than HIV+ women on fine motor skills (p=0.01), but among women without probable PTSD, there was no significant difference in performance between the groups (p= 0.59). These findings underscore the importance of considering mental health factors as correlates to cognitive deficits in women with HIV.

Aging and Neurocognitive Functioning in HIV-Infected Women: a Review of the Literature Involving the Women’s Interagency HIV Study

“…13,27 This point is particularly germane as women, worldwide, comprise most of those infected with HIV. 28 Unfortunately, most studies that examine HIV-related neurocognitive impairment primary have focused on men or on small samples of women, which prevents the ability to reliably extrapolate what the cognitive aging profile in HIV-infected women may be.…”

Monocyte Activation Is Associated With Worse Cognitive Performance in HIV-Infected Women With Virologic Suppression

“…Briefly, they are the Hopkins Verbal Learning TestRevised, the Stroop Task test, the Trail Making test ( parts A and B), the Symbol Digit Modalities Test, the Letter Fluency (F, A, S) test, the Letter Number Sequencing test, the Semantic Fluency (animals) test, and the Grooved Pegboard test. Raw individual test scores were adjusted on the basis of values from a larger sample of HIV-uninfected WIHS women [21,[30][31][32][33][34][35] and transformed into z scores. All outcome measures for timed tests (the Trail Making, Stroop Task, and Grooved Pegboard tests) were skewed and therefore log transformed before the creation of z scores.…”

Perceived and posttraumatic stress is associated with decreased learning, memory, and fluency in HIV-infected women

“…PTSD symptoms were measured with the PTSD Checklist-Civilian version (PCL-C), a 17-item measure of PTSD symptoms (re-experiencing, avoidance, hyperarousal) as defined by DSM-IV [23] . As in our previous work [13] , probable PTSD was defined as meeting DSM-IV symptom criteria in the previous month (≥1 B item—re-experiencing, ≥3 C items—avoidance, & ≥2 D items—arousal) and the total severity score >44. Depressive symptoms were measured with the Center for Epidemiological Studies Depression (CES-D) scale.…”

“…Given our previous cross-sectional results [12, 14] , we hypothesized that the negative effect of PRFs on cognition would be greater in the context of HIV. Moreover, given our cross-sectional findings, we expected that perceived stress and post-traumatic stress would exacerbate HIV-associated cognitive compromise particularly for verbal memory and this relationship would become stronger over time [13, 17, 18] .…”