Relationships Among Apathy, Depression, and Cognitive Impairment in HIV/AIDS

Journal of Clinical Epidemiology

Atkinson

et al. 2001

118

Treatment advances such as the advent of highly active antiretroviral therapy (HAART) have translated into greater life expectancy for HIV-infected individuals, which will ultimately result in a "graying" of the HIV/AIDS epidemic. In addition, older individuals are engaging in a higher rate of high risk behaviors than had been previously expected. As such, study of older HIV-infected patients, including study of the psychiatric and neurocognitive aspects of the disease, appears highly indicated. Epidemiological studies have demonstrated that HIV infection is associated with higher rates of several psychological/psychiatric disorders when compared to general population base rates. There is also a rich literature that has documented the adverse neurocognitive effects of HIV infection, ranging from subtle cognitive complaints to frank dementia, among younger adults. Although it has been hypothesized that older age may potentiate the deleterious effects of HIV infection, little is actually known, however, regarding the incidence, prevalence, course, and clinical features of HIVassociated psychiatric and cognitive dysfunction among older adults. This article provides an overview of the epidemiology and clinical manifestations of HIV-associated cognitive and psychiatric disorder across the age spectrum, with particular focus on what is known regarding the interaction of advancing age and HIV infection. Future directions for research are suggested, including basic epidemiologic study of incidence and prevalence rates of neurodisease among older HIV-infected adults as well as investigations designed to determine whether the nature, severity, course, or treatment of such disorders differs among older versus younger patients.

Section: Other Neuropsychiatric Disordersmentioning

confidence: 99%

Neuropsychiatric aspects of HIV infection among older adults

Hinkin

Journal of Clinical Epidemiology

Atkinson

et al. 2001

118

“…It is possible that depression and anxiety symptomatology may relate to other neural systems affected by HIV that were not measured in the current study, although other work evaluating primary neuropsychological domains have thus far not found that to be the case (Castellon et al, 1998;Grant et al, 1993;Hinkin et al, 1992;Mapou et al, 1993;Perdices et al, 1992;Rabkin et al, 2000). Alternatively, these psychiatric features may be more related to psychological and psychosocial factors (Perdices et al, 1992).…”

Section: Discussionmentioning

confidence: 75%

“…Castellon et al (1998) found prominent symptoms of apathy to be associated with working memory deficits in HIV-positive individuals and, in a second study, found that prominent irritability and apathy were highly related to poorer performance on those neuropsychological tasks most dependent upon executive functioning . In contrast, Rabkin et al (2000) found that apathy was not related to performances across several neuropsychological domains, including frontal systems, in HIVseropositive (HIV+) individuals. The authors concluded that the absence of a significant relationship between cognition and apathy indicated that apathy may not represent a direct CNS affect of HIV infection, and they called for a reconsideration of the relationship between apathy and cognitive impairment in HIV infection.…”

Section: Introductionmentioning

confidence: 87%

“…Several studies demonstrated a lack of relationship between depression and neuropsychological decrements in HIV-infected individuals (Castellon et al, 1998;Grant et al, 1993;Hinkin et al, 1992;Rabkin et al, 2000). Similarly, studies suggest that anxiety is not related to poor neuropsychological performances (Mapou et al, 1993;Perdices et al, 1992), but has been found to be associated with psychological and psychosocial symptoms (Perdices et al, 1992).…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Relationship between psychiatric status and frontal–subcortical systems in HIV-infected individuals

Cole

J. Inter. Neuropsych. Soc.

Perkins

et al. 2007

Human immunodeficiency virus (HIV)-infected adults frequently evidence both neurocognitive and psychiatric dysfunction. It was hypothesized that apathy and irritability, but not anxiety and depression, are related to HIV effects on frontal-subcortical systems. This hypothesis was evaluated by determining the degree to which these psychiatric features are associated with neurocognitive functioning that is dependent upon frontal-subcortical circuitry and, therefore, thought to be sensitive to the central nervous system effects of HIV. Rating scales assessing irritability, apathy, depression, and anxiety and a dual-task paradigm were administered to 189 HIV-seropositive (HIV+) and 53 HIV-seronegative participants. Deficits in dual-task performance and greater anxiety, depression, apathy, and irritability were observed in HIV+ participants. Simultaneous multivariate regression and communality analyses revealed that only apathy and irritability were associated with dual-task performance in HIV+ participants. Thus, these findings suggest that apathy and irritability, but not depression and anxiety, are likely associated with the effects of HIV on frontal-subcortical circuitry.

“…While our findings and those from the laboratory of Bungener and Jouvent converge, further study is needed, including the use of more direct markers of CNS function (e.g., neuroimaging or CSF viral load). Further empirical scrutiny of these constructs may be particularly indicated given the findings of a recent study by Rabkin et al (2000), which failed to find an association between apathy and neurocognitive performance in a sample of HIV-infected subjects.…”

mentioning

confidence: 99%

Neuropsychiatric alterations and neurocognitive performance in HIV/AIDS: A response to C. Bungener and R. Jouvent

Hinkin

Myers

2001

J Int Neuropsychol Soc

The findings reported in the Letter to the Editor authored by Bungener and Jouvent are consistent with results we have presented here (Castellon et al., 2000) and again underscore the importance of considering the potentially multifactorial nature of depression in many neurologic diseases/disorders. We have suggested, although the idea is hardly a new one, that depression in HIV/AIDS can be secondary to any of multiple potential etiologies. For example, it may be a direct central nervous system (CNS) consequence of infection (i.e., neurochemical and/or neuropathological changes), a result of increased exposure to social, medical, and financial stressors secondary to living with HIV, a reaction to multiple losses (e.g., bereavement, loss of instrumental capacity), or be an admixture of multiple etiological factors. The phenomenology of this disruption of mood, motivation, and affect may differ as a function of etiology/pathophysiology. We believe that a prominent amotivation/apathy syndrome may be a more pure manifestation of the CNS effects of HIV-1 infection than is the more heterogeneous construct of depression and therefore more closely associated with other putative measures of CNS integrity (e.g., neurocognitive performance).