Reliably Measuring Cognitive Change in the Era of Chronic HIV Infection and Chronic HIV-Associated Neurocognitive Disorders

Cysique, Lucette A; Casaletto, Kaitlin B.; Heaton, Robert K.

doi:10.1007/7854_2019_116

Cited by 14 publications

(24 citation statements)

References 70 publications

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“…demographics, as neurocognitive change is best measured using scores that do not remove reliable sources of variance in change over time (e.g., age) 27 .…”

Section: A C C E P T E Dmentioning

confidence: 99%

Cumulative Burden of Depression and Neurocognitive Decline Among Persons With HIV: A Longitudinal Study

Paolillo

Pasipanodya

Moore

et al. 2020

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Background: Higher cumulative burden of depression among people with HIV (PWH) is associated with poorer health outcomes; however, longitudinal relationships with neurocognition are unclear. This study examined hypotheses that among PWH: 1) higher cumulative burden of depression would relate to steeper declines in neurocognition, and 2) visit-to-visit depression severity would relate to neurocognition within persons. Setting: Data was collected at a university-based research center from 2002-2016.Methods: Participants included 448 PWH followed longitudinally. All participants had >1 visit (M=4.97; SD=3.53) capturing depression severity (Beck Depression Inventory-II) and neurocognition (comprehensive test battery). Cumulative burden of depression was calculated using an established method that derives weighted depression severity scores by time between visits and total time on study. Participants were categorized into low (67%), medium (15%), and high (18%) depression burden. Multilevel modeling examined between-and within-person associations between cumulative depression burden and neurocognition over time.Results: The high depression burden group demonstrated steeper global neurocognitive decline compared to the low depression burden group (b=-0.100, p=0.001); this was driven by declines in executive functioning, delayed recall, and verbal fluency. Within-person results showed that compared to visits when participants reported minimal depressive symptoms, their

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“…demographics, as neurocognitive change is best measured using scores that do not remove reliable sources of variance in change over time (e.g., age) 27 .…”

Section: A C C E P T E Dmentioning

confidence: 99%

Cumulative Burden of Depression and Neurocognitive Decline Among Persons With HIV: A Longitudinal Study

Paolillo

Pasipanodya

Moore

et al. 2020

JAIDS Journal of Acquired Immune Deficiency Syndromes

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“…These quadratic trajectories may also be more consistent with a regression to the mean phenomenon, whereby early declines in performance are followed by subsequent improvements toward baseline status, which in the present study reflected average or low levels of performance that were concordant with the CN and CI classifications, respectively. Survivor bias, an issue inherent to neuroHIV and aging research [53,54], may also partially explain this pattern under the assumption that individuals in Class 2 Quadratic Average and Class 3 Quadratic Low who experienced early neurocognitive declines dropped out of the study due to worsening disease. To help mitigate this possibility, we included auxiliary predictors of missing data, which did not significantly differ by latent trajectory groups.…”

Section: Discussionmentioning

confidence: 99%

“…The majority of longitudinal neurocognitive studies in PWH with chronic disease have focused on identifying individuals who exhibit poor/declining trajectories, but have not been designed for detection of an elite longitudinal subgroup. Cysique and colleagues noted in a recent review that these studies focused on decline significantly vary in length and operationalization of neurocognitive change [53], yet the most consistent observation is that the majority of PWH exhibit a stable/non-progressive neurocognitive trajectory while a smaller subgroup may experience a subtle yet systematic decline [53,55]. Only a handful of studies have explicitly focused on neurocognitive change within older groups of PWH (i.e., aged 50 or older), with support for amplified risk of neurocognitive decline compared to younger PWH and older HIV-seronegative adults [5,56].…”

Section: Discussionmentioning

confidence: 99%

Identification of Youthful Neurocognitive Trajectories in Adults Aging with HIV: A Latent Growth Mixture Model

et al. 2021

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Despite the neurocognitive risks of aging with HIV, initial cross-sectional data suggest a subpopulation of older people with HIV (PWH) possess youthful neurocognition (NC) characteristic of SuperAgers (SA). Here we characterize longitudinal NC trajectories of older PWH and their convergent validity with baseline SA status, per established SuperAging criteria in PWH, and baseline biopsychosocial factors. Growth mixture modeling (GMM) identified longitudinal NC classes in 184 older (age ≥ 50-years) PWH with 1–5 years of follow-up. Classes were defined using ‘peak-age’ global T-scores, which compare performance to a normative sample of 25-year-olds. 3-classes were identified: Class 1Stable Elite (n = 31 [16.8%], high baseline peak-age T-scores with flat trajectory); Class 2Quadratic Average (n = 100 [54.3%], intermediate baseline peak-age T-scores with u-shaped trajectory); Class 3Quadratic Low (n = 53 [28.8%], low baseline peak-age T-scores with u-shaped trajectory). Baseline predictors of Class 1Stable Elite included SA status, younger age, higher cognitive and physiologic reserve, and fewer subjective cognitive difficulties. This GMM analysis supports the construct validity of SuperAging in older PWH through identification of a subgroup with longitudinally-stable, youthful neurocognition and robust biopsychosocial health.

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“…The inclusion criteria for individuals with HIV-1 Infection were (i) a diagnosis of HIV-1 Infection in the asymptomatic stage; (ii) age ranging between 18 and 58 y/o (to control any potential age-related cognitive immaturity or decline) [24]; (iii) the completion of at least two years of elementary school; (iv) a maximum time since HIV diagnosis of 9 years (considering nine years is the maximum period HIV-1 infected individuals can remain asymptomatic) [40]; and (v) no history of alcohol and/or drug use, neurological, neuropsychological, and/or psychopathological disorders before HIV-1 diagnosis. The target population is primarily of low socioeconomic status, making it more vulnerable to develop HAND [19]. On the other hand, the control group accomplished the same criteria but was not infected with HIV.…”

Section: Subjectsmentioning

confidence: 99%

“…More recently, batteries such as the Western Neuropsychological Test Battery of the HIV Neurobehavioral Research Center [11], and a battery developed by Brazilian researchers [17] are available. Although these comprehensive batteries are more sensible than screening tests [11,18], the lack of access to them in environments with limited resources [19] increases the need to develop screening tools and short assessment protocols that facilitate HAND detection [20,21]. Some of these screening instruments include the Mini-mental State Examination (MMSE) (scrutinized for its low sensitivity) [8,9], the HIV Dementia Scale (HDS) [22], and the International HIV Dementia Scale (IHDS) [23] (with limited performance especially for the diagnosis of MND) [18,24,25], the Cognitive Assessment Tool-Rapid version (CAT-rapid) (with borderline sensitivity and low specificity) [8], the Montreal Cognitive Assessment (MOCA, with acceptable sensitivity but low specificity) [8], and the CogState computerized battery (with a sensitivity of 76% and specificity of 71%, when compared to full neuropsychological testing) [21].…”

Section: Introductionmentioning

confidence: 99%

Utility of a Short Neuropsychological Protocol for Detecting HIV-Associated Neurocognitive Disorders in Patients with Asymptomatic HIV-1 Infection

et al. 2021

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Human Immunodeficiency Virus type 1 (HIV-1) infection is a chronic disease that affects ~40 million people worldwide. HIV-associated neurocognitive disorders (HAND) are common in individuals with HIV-1 Infection, and represent a recent public health problem. Here we evaluate the performance of a recently proposed short protocol for detecting HAND by studying 60 individuals with HIV-1-Infection and 60 seronegative controls from a Caribbean community in Barranquilla, Colombia. The short evaluation protocol used significant neuropsychological tests from a previous study of asymptomatic HIV-1 infected patients and a group of seronegative controls. Brief screening instruments, i.e., the Mini-mental State Examination (MMSE) and the International HIV Dementia Scale (IHDS), were also applied. Using machine-learning techniques, we derived predictive models of HAND status, and evaluated their performance with the ROC curves. The proposed short protocol performs exceptionally well yielding sensitivity, specificity, and overall prediction values >90%, and better predictive capacity than that of the MMSE and IHDS. Community-specific cut-off values for HAND diagnosis, based on the MMSE and IHDS, make this protocol suitable for HAND screening in individuals from this Caribbean community. This study shows the effectivity of a recently proposed short protocol to detect HAND in individuals with asymptomatic HIV-1-Infection. The application of community-specific cut-off values for HAND diagnosis in the clinical setting may improve HAND screening accuracy and facilitate patients’ treatment and follow-up. Further studies are needed to assess the performance of this protocol in other Latin American populations.

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Reliably Measuring Cognitive Change in the Era of Chronic HIV Infection and Chronic HIV-Associated Neurocognitive Disorders

Cited by 14 publications

References 70 publications

Cumulative Burden of Depression and Neurocognitive Decline Among Persons With HIV: A Longitudinal Study

Cumulative Burden of Depression and Neurocognitive Decline Among Persons With HIV: A Longitudinal Study

Identification of Youthful Neurocognitive Trajectories in Adults Aging with HIV: A Latent Growth Mixture Model

Utility of a Short Neuropsychological Protocol for Detecting HIV-Associated Neurocognitive Disorders in Patients with Asymptomatic HIV-1 Infection

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