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Marquine MJ, Kamalyan L, Zlatar ZZ, Yassai-Gonzalez D, Perez-Tejada A, Umlauf A, Al-Rousan T, González V, Breton J, Guareña LA, Brody L, Cherner M, Ellis RJ, Zúñiga ML, Mungas DM, Moore RC, Moore DJ, Wojna V, Hall RK, Franklin DR, Heaton RK. Disparities in Metabolic Syndrome and Neurocognitive Function Among Older Hispanics/Latinos with Human Immunodeficiency Virus. AIDS Patient Care STDS 2024; 38:195-205. [PMID: 38662469 DOI: 10.1089/apc.2024.0043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024] Open
Abstract
Neurocognitive impairment and metabolic syndrome (MetS) are prevalent in persons with HIV (PWH). We examined disparities in HIV-associated neurocognitive function between Hispanic and non-Hispanic White older PWH, and the role of MetS in explaining these disparities. Participants included 116 community-dwelling PWH aged 50-75 years enrolled in a cohort study in southern California [58 Hispanic (53% Spanish speaking) and 58 age-comparable non-Hispanic White; overall group: age: M = 57.9, standard deviation (SD) = 5.7; education (years): M = 13, SD = 3.4; 83% male, 58% AIDS, 94% on antiretroviral therapy]. Global neurocognition was derived from T-scores adjusted for demographics (age, education, sex, ethnicity, language) on a battery of 10 cognitive tests. MetS was ascertained via standard criteria that considered central obesity, and fasting elevated triglycerides, low high-density lipoprotein cholesterol and elevated glucose, or medical treatment for these conditions. Covariates examined included sociodemographic, psychiatric, substance use and HIV disease characteristics. Compared with non-Hispanic Whites, Hispanics showed worse global neurocognitive function (Cohen's d = 0.56, p < 0.05) and had higher rates of MetS (38% vs. 56%, p < 0.05). A stepwise regression model including ethnicity and significant covariates showed Hispanic ethnicity was the sole significant predictor of worse global neurocognition (B = -3.82, SE = 1.27, p < 0.01). A model also including MetS showed that both Hispanic ethnicity (B = -3.39, SE = 1.31, p = 0.01) and MetS (B = -2.73, SE = 1.31, p = 0.04) were independently associated with worse neurocognition. In conclusion, findings indicate that increased MetS is associated with worse neurocognitive function in both Hispanic and non-Hispanic White older PWH, but does not explain neurocognitive disparities. MetS remains an important target for intervention efforts to ameliorate neurocognitive dysfunction among diverse older PWH.
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Affiliation(s)
- María J Marquine
- HIV Neurobehavioral Research Program, University of California San Diego, San Diego, California, USA
- Department of Psychiatry, Division of Geriatrics, Gerontology and Palliative Care, University of California San Diego, La Jolla, California, USA
- Department of Medicine, Division of Geriatrics, Gerontology and Palliative Care, University of California San Diego, La Jolla, California, USA
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
- Duke Center for the Study of Aging and Human Development, Duke University, Durham, North Carolina, USA
| | - Lily Kamalyan
- HIV Neurobehavioral Research Program, University of California San Diego, San Diego, California, USA
- Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California San Diego, San Diego, California, USA
| | - Zvinka Z Zlatar
- Department of Psychiatry, Division of Geriatrics, Gerontology and Palliative Care, University of California San Diego, La Jolla, California, USA
| | - David Yassai-Gonzalez
- HIV Neurobehavioral Research Program, University of California San Diego, San Diego, California, USA
| | - Alán Perez-Tejada
- HIV Neurobehavioral Research Program, University of California San Diego, San Diego, California, USA
| | - Anya Umlauf
- HIV Neurobehavioral Research Program, University of California San Diego, San Diego, California, USA
- Department of Psychiatry, Division of Geriatrics, Gerontology and Palliative Care, University of California San Diego, La Jolla, California, USA
| | - Tala Al-Rousan
- Herbert Wertheim School of Public Health, University of California San Diego, La Jolla, California, USA
| | - Verónica González
- Department of Medicine, Division of Geriatrics, Gerontology and Palliative Care, University of California San Diego, La Jolla, California, USA
| | - Jordana Breton
- HIV Neurobehavioral Research Program, University of California San Diego, San Diego, California, USA
- Department of Psychology, University of Texas at Austin, Austin, Texas, USA
| | - Lesley A Guareña
- HIV Neurobehavioral Research Program, University of California San Diego, San Diego, California, USA
- Department of Psychology, University of Arizona, Tucson, Arizona, USA
| | - Lilla Brody
- HIV Neurobehavioral Research Program, University of California San Diego, San Diego, California, USA
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Mariana Cherner
- HIV Neurobehavioral Research Program, University of California San Diego, San Diego, California, USA
- Department of Psychiatry, Division of Geriatrics, Gerontology and Palliative Care, University of California San Diego, La Jolla, California, USA
| | - Ronald J Ellis
- HIV Neurobehavioral Research Program, University of California San Diego, San Diego, California, USA
- Department of Psychiatry, Division of Geriatrics, Gerontology and Palliative Care, University of California San Diego, La Jolla, California, USA
- Department of Neurosciences, University of California San Diego, La Jolla, California, USA
| | - Maria Luisa Zúñiga
- School of Social Work, San Diego State University, San Diego, California, USA
| | - Dan M Mungas
- Department of Neurology, University of California Davis, Davis, California, USA
| | - Raeanne C Moore
- HIV Neurobehavioral Research Program, University of California San Diego, San Diego, California, USA
- Department of Psychiatry, Division of Geriatrics, Gerontology and Palliative Care, University of California San Diego, La Jolla, California, USA
| | - David J Moore
- HIV Neurobehavioral Research Program, University of California San Diego, San Diego, California, USA
- Department of Psychiatry, Division of Geriatrics, Gerontology and Palliative Care, University of California San Diego, La Jolla, California, USA
| | - Valerie Wojna
- Neurology Division, Department of Internal Medicine, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico
| | - Rasheeda K Hall
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
- Duke Center for the Study of Aging and Human Development, Duke University, Durham, North Carolina, USA
| | - Donald R Franklin
- HIV Neurobehavioral Research Program, University of California San Diego, San Diego, California, USA
- Department of Psychiatry, Division of Geriatrics, Gerontology and Palliative Care, University of California San Diego, La Jolla, California, USA
| | - Robert K Heaton
- HIV Neurobehavioral Research Program, University of California San Diego, San Diego, California, USA
- Department of Psychiatry, Division of Geriatrics, Gerontology and Palliative Care, University of California San Diego, La Jolla, California, USA
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Breton J, Watson CWM, Kamalyan L, Franklin D, Fazeli P, Umlauf A, Moore RC, Ellis R, Grant I, Heaton RK, Cherner M, Moore DJ, Marquine MJ. Neurocognition and its predictors in a linguistically and culturally diverse cohort of people with HIV. Clin Neuropsychol 2024:1-20. [PMID: 38588669 DOI: 10.1080/13854046.2024.2319900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 02/09/2024] [Indexed: 04/10/2024]
Abstract
Objective: HIV/AIDS disproportionately affects Black and Latino people in the United States, yet there is a lack of research on predictors of neurocognitive outcomes in these groups. We examined neurocognitive performance and its key predictors across White, Black, and Latino people with HIV (PWH). Method: Participants included 586 PWH of White, Black, and Latino (English- and Spanish-speaking) background. Neurocognition was assessed via demographically-adjusted Fluid Cognition Composite T-scores from the NIH-Toolbox cognition battery, and individual tests comprising this composite. Predictors examined included sociodemographic and HIV disease characteristics, and medical, psychiatric and substance comorbidities. Results: Compared to White PWH, English-speaking Latino PWH had lower T-scores on the Fluid Cognition Composite, as well as Flanker Inhibition and Picture Sequence Memory tests. While there were no other significant group differences on Fluid Cognition, both Latino PWH language groups performed worse than Black PWH on Flanker Inhibition, and Black PWH performed worse than White PWH on List Sorting. Separate multivariable linear regression models by ethnic/racial/language group showed that significant correlates of worse Fluid Cognition included depressive symptoms among White PWH; hepatitis C co-infection among Black PWH; hypertension among English-speaking Latino PWH; and higher estimated duration of HIV disease and depressive symptoms in Spanish-speaking Latino PWH. Conclusions: Findings suggest worse neurocognition among English-speaking Latino PWH compared to Whites. Predictors of neurocognitive function among PWH differ across ethnic/racial and language groups. Consideration of these HIV disease characteristics and comorbidities may be valuable in developing targeted culturally-relevant interventions aimed at ameliorating neurocognitive dysfunction among diverse PWH.
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Affiliation(s)
- Jordana Breton
- HIV Neurobehavioral Research Program, University of California San Diego, San Diego, CA, USA
- Department of Psychology, University of Texas at Austin, Austin, TX, USA
| | - Caitlin Wei-Ming Watson
- HIV Neurobehavioral Research Program, University of California San Diego, San Diego, CA, USA
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
- San Diego Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, San Diego, CA, USA
| | - Lily Kamalyan
- HIV Neurobehavioral Research Program, University of California San Diego, San Diego, CA, USA
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
- San Diego Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, San Diego, CA, USA
| | - Donald Franklin
- HIV Neurobehavioral Research Program, University of California San Diego, San Diego, CA, USA
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Pariya Fazeli
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Anya Umlauf
- HIV Neurobehavioral Research Program, University of California San Diego, San Diego, CA, USA
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Raeanne C Moore
- HIV Neurobehavioral Research Program, University of California San Diego, San Diego, CA, USA
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Ronald Ellis
- HIV Neurobehavioral Research Program, University of California San Diego, San Diego, CA, USA
- Department of Neurosciences, University of California San Diego, San Diego, CA, USA
| | - Igor Grant
- HIV Neurobehavioral Research Program, University of California San Diego, San Diego, CA, USA
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Robert K Heaton
- HIV Neurobehavioral Research Program, University of California San Diego, San Diego, CA, USA
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Mariana Cherner
- HIV Neurobehavioral Research Program, University of California San Diego, San Diego, CA, USA
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - David J Moore
- HIV Neurobehavioral Research Program, University of California San Diego, San Diego, CA, USA
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - María J Marquine
- Department of Medicine, University of California San Diego, San Diego, CA, USA
- Department of Medicine, Duke University, Durham, NC, USA
- Duke Center for the Study of Aging and Human Development, Duke University, Durham, NC, USA
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Guarña LA, Kamalyan L, Watson CWM, Karcher K, Umlauf A, Morgan E, Moore D, Ellis R, Grant I, Cherner M, Moore RC, Zlatar ZZ, Heaton RK, Marquine MJ. Emotional health and its association with neurocognition in Hispanic and non-Hispanic White people with HIV. J Int Neuropsychol Soc 2024; 30:56-66. [PMID: 37078464 PMCID: PMC10766342 DOI: 10.1017/s1355617723000188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/21/2023]
Abstract
OBJECTIVE Emotional functioning is linked to HIV-associated neurocognitive impairment, yet research on this association among diverse people with HIV (PWH) is scant. We examined emotional health and its association with neurocognition in Hispanic and White PWH. METHODS Participants included 107 Hispanic (41% primarily Spanish-speakers; 80% Mexican heritage/origin) and 216 White PWH (Overall age: M = 53.62, SD = 12.19; 86% male; 63% AIDS; 92% on antiretroviral therapy). Emotional health was assessed via the National Institute of Health Toolbox (NIHTB)-Emotion Battery, which yields T-scores for three factor-based summary scores (negative affect, social satisfaction, and psychological well-being) and 13 individual component scales. Neurocognition was measured via demographically adjusted fluid cognition T-scores from the NIHTB-cognition battery. RESULTS 27%-39% of the sample had problematic socioemotional summary scores. Hispanic PWH showed less loneliness, better social satisfaction, higher meaning and purpose, and better psychological well-being than Whites (ps <.05). Within Hispanics, Spanish-speakers showed better meaning and purpose, higher psychological well-being summary score, less anger hostility, but greater fear affect than English speakers. Only in Whites, worse negative affect (fear affect, perceived stress, and sadness) was associated with worse neurocognition (p <.05); and in both groups, worse social satisfaction (emotional support, friendship, and perceived rejection) was linked with worse neurocognition (p <.05). CONCLUSION Adverse emotional health is common among PWH, with subgroups of Hispanics showing relative strengths in some domains. Aspects of emotional health differentially relate to neurocogntition among PWH and cross-culturally. Understanding these varying associations is an important step towards the development of culturally relevant interventions that promote neurocognitive health among Hispanic PWH.
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Affiliation(s)
- Lesley A. Guarña
- Division of Geriatrics, Gerontology and Palliative Care, Department of Medicine, University of California San Diego, La Jolla, CA 92093-0662, USA
- HIV Neurobehavioral Research Program, University of California San Diego, 220 Dickinson Street, Suite B, San Diego, CA 92103-8231, USA
| | - Lily Kamalyan
- HIV Neurobehavioral Research Program, University of California San Diego, 220 Dickinson Street, Suite B, San Diego, CA 92103-8231, USA
- Department of Psychiatry, University of California San Diego, 9500 Gilman Dr. La Jolla, CA 92093, USA
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, 6363 Alvarado Court, Suite 103, San Diego, CA 92120, USA
| | - Caitlin Wei-Ming Watson
- HIV Neurobehavioral Research Program, University of California San Diego, 220 Dickinson Street, Suite B, San Diego, CA 92103-8231, USA
- Department of Psychiatry, University of California San Diego, 9500 Gilman Dr. La Jolla, CA 92093, USA
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, 6363 Alvarado Court, Suite 103, San Diego, CA 92120, USA
| | - Kayle Karcher
- Mentorship for Advancing Diversity in Undergraduate Research on Aging Program, University of California San Diego, 9500 Gilman Dr. La Jolla, CA, 920936, USA
| | - Anya Umlauf
- HIV Neurobehavioral Research Program, University of California San Diego, 220 Dickinson Street, Suite B, San Diego, CA 92103-8231, USA
- Department of Psychiatry, University of California San Diego, 9500 Gilman Dr. La Jolla, CA 92093, USA
| | - Erin Morgan
- HIV Neurobehavioral Research Program, University of California San Diego, 220 Dickinson Street, Suite B, San Diego, CA 92103-8231, USA
- Department of Psychiatry, University of California San Diego, 9500 Gilman Dr. La Jolla, CA 92093, USA
| | - David Moore
- HIV Neurobehavioral Research Program, University of California San Diego, 220 Dickinson Street, Suite B, San Diego, CA 92103-8231, USA
- Department of Psychiatry, University of California San Diego, 9500 Gilman Dr. La Jolla, CA 92093, USA
| | - Ronald Ellis
- HIV Neurobehavioral Research Program, University of California San Diego, 220 Dickinson Street, Suite B, San Diego, CA 92103-8231, USA
- Department of Psychiatry, University of California San Diego, 9500 Gilman Dr. La Jolla, CA 92093, USA
- Department of Neurosciences, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093-0662, USA
| | - Igor Grant
- HIV Neurobehavioral Research Program, University of California San Diego, 220 Dickinson Street, Suite B, San Diego, CA 92103-8231, USA
- Department of Psychiatry, University of California San Diego, 9500 Gilman Dr. La Jolla, CA 92093, USA
| | - Mariana Cherner
- HIV Neurobehavioral Research Program, University of California San Diego, 220 Dickinson Street, Suite B, San Diego, CA 92103-8231, USA
- Department of Psychiatry, University of California San Diego, 9500 Gilman Dr. La Jolla, CA 92093, USA
| | - Raeanne C. Moore
- HIV Neurobehavioral Research Program, University of California San Diego, 220 Dickinson Street, Suite B, San Diego, CA 92103-8231, USA
- Department of Psychiatry, University of California San Diego, 9500 Gilman Dr. La Jolla, CA 92093, USA
| | - Zvinka Z. Zlatar
- Department of Psychiatry, University of California San Diego, 9500 Gilman Dr. La Jolla, CA 92093, USA
| | - Robert K. Heaton
- HIV Neurobehavioral Research Program, University of California San Diego, 220 Dickinson Street, Suite B, San Diego, CA 92103-8231, USA
- Department of Psychiatry, University of California San Diego, 9500 Gilman Dr. La Jolla, CA 92093, USA
| | - María J. Marquine
- Division of Geriatrics, Gerontology and Palliative Care, Department of Medicine, University of California San Diego, La Jolla, CA 92093-0662, USA
- HIV Neurobehavioral Research Program, University of California San Diego, 220 Dickinson Street, Suite B, San Diego, CA 92103-8231, USA
- Department of Psychiatry, University of California San Diego, 9500 Gilman Dr. La Jolla, CA 92093, USA
- Departments of Medicine (Geriatrics Division) and Psychiatry, Duke University, Durham, NC, USA
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Xavier Hall CD, Okantey B, Meng Z, Sabuncu C, Lane B, Millender E, Queiroz A, Kim JH, Okada L, Gillespie A, Simoncini G, Barile J‘JP, Ma GX, Wong F‘FY. Examining biopsychosocial predictors of risk for cognitive impairment among a racially diverse sample of men who have sex with men living with HIV. Ther Adv Infect Dis 2024; 11:20499361241249657. [PMID: 38751756 PMCID: PMC11095190 DOI: 10.1177/20499361241249657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 04/08/2024] [Indexed: 05/18/2024] Open
Abstract
Background Cognitive decline among people living with HIV (PLWH) is growing concern as world populations become increasing older including higher proportions of PLWH. It is vitally important to understand psychosocial predictors of age-related cognitive decline men who have sex with men (MSM) living with HIV. Objectives The current study seeks to examine psychosocial risk factors the contribute to the risk of age-related cognitive impairment as measured by Cardiovascular Risk Factors, Aging, and Incidence of Dementia (CAIDE) score in a racially diverse sample of MSM living with HIV. Design The present analysis utilizes data from the baseline (n = 196) and 6-month follow-up (n = 135) time points of a longitudinal cohort study of PLWH. Methods Using a self-report survey, we examine the associations between psychosocial predictors (e.g. trauma, mental health, chronic pain, sleep disturbance, etc.) and risk of dementia using the CAIDE risk score. Analyses include linear and logistic regression. Results In adjusted model stress, chronic pain, Black racial identity, and having a sexual identity that is bisexual or another category are all positively associated with CAIDE scores. Childhood sexual abuse history was negatively associated with CAIDE scores indicating a protective effect. Sleep disorder has a positive association with CAIDE scores after adjusting for the baseline CAIDE scores. Conclusion These results indicate modifiable correlates of cognitive risk (stress and chronic pain). Interventions should seek to address these comorbid factors including the consideration of minority stress and stigma. Interventions should seek to reach Black and bisexual men living with HIV, including possible cultural tailoring to interventions and messaging. Lastly, future research should examine the impact of variation within childhood sexual abuse histories to better understand their association with cognitive impairment later in life. This may include considering the nature, severity, and potential treatment of trauma symptoms.
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Affiliation(s)
- Casey D. Xavier Hall
- Center of Population Sciences for Health Equity, College of Nursing, Florida State University, 2010 Levy Avenue, Innovation Park, Building B, Suite 3600, Tallahassee, FL 32310, USA
- College of Social Work, Florida State University, Tallahassee, FL, USA
| | - Beth Okantey
- Center of Population Sciences for Health Equity, College of Nursing, Florida State University, Tallahassee, FL, USA
- College of Social Work, Florida State University, Tallahassee, FL, USA
| | - Zhuo Meng
- Center of Population Sciences for Health Equity, College of Nursing, Florida State University, Tallahassee, FL, USA
- Department of Statistics, Florida State University, Tallahassee, FL, USA
| | - Crim Sabuncu
- Center of Population Sciences for Health Equity, College of Nursing, Florida State University, Tallahassee, FL, USA
- College of Social Work, Florida State University, Tallahassee, FL, USA
| | - Brittany Lane
- Center of Population Sciences for Health Equity, College of Nursing, Florida State University, Tallahassee, FL, USA
| | - Eugenia Millender
- Center of Population Sciences for Health Equity, College of Nursing, Florida State University, Tallahassee, FL, USA
- College of Social Work, Florida State University, Tallahassee, FL, USA
| | - Artur Queiroz
- Center of Population Sciences for Health Equity, College of Nursing, Florida State University, Tallahassee, FL, USA
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, USA
| | - Jung Hyo Kim
- Center of Population Sciences for Health Equity, College of Nursing, Florida State University, Tallahassee, FL, USA
- College of Social Work, Florida State University, Tallahassee, FL, USA
| | - Lorie Okada
- University of Hawaii, Manoa, Honolulu, HI, USA
| | - Avrum Gillespie
- Department of Medicine, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA
| | - Gina Simoncini
- Center of Asian Health, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA
- AIDS Healthcare Foundation Healthcare Center, Philadelphia, PA, USA
| | | | - Grace X. Ma
- Center of Asian Health, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA
- Department of Urban Health and Population Science, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA
| | - Frank ‘Frankie’ Y. Wong
- Center of Population Sciences for Health Equity, College of Nursing, Florida State University, Tallahassee, FL, USA
- College of Social Work, Florida State University, Tallahassee, FL, USA
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Beltran-Najera I, Thompson JL, Matchanova A, Woods SP. Racial differences in scores on the HIV Dementia Scale: mediating effects of literacy and screening utility among Black and White persons with HIV disease. AIDS Care 2023; 35:1724-1731. [PMID: 36314429 PMCID: PMC10148926 DOI: 10.1080/09540121.2022.2132373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 09/28/2022] [Indexed: 05/01/2023]
Abstract
There are many obstacles to screening for HIV-associated neurocognitive disorders (HAND), including the influence of various sociodemographic effects on screening measures. This study examined possible racial bias on the HIV Dementia Scale (HDS) in screening for HAND among 39 Black and 84 White persons living with HIV (PLWH). Black PLWH had significantly lower raw HDS scores than White PLWH, which was mediated by lower oral word reading scores. Nevertheless, HDS scores were comparably predictive of clinical HAND diagnoses for Black and White PLWH as determined by a comprehensive battery; overall, individuals who failed the HDS were three times as likely to have HAND as compared to those who performed within normal limits (sensitivity = .26, specificity = .94). Consistent with prior literature exploring race-group differences, findings suggest that lower scores among Black PLWH compared to White PLWH on a commonly-used screening measure for HAND are partly explained by reading scores, perhaps reflecting differences in educational quality and opportunities. However, race-group differences did not affect the classification accuracy of the HDS in detecting HAND, although overall diagnostic accuracy was modest in both groups. Future work should determine the optimal neurocognitive screening methods for Black PLWH and other under-represented ethnoracial groups.
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Medina LD, Henry S, Torres S, MacDonald B, Strutt AM. The Measurement of Acculturation in Neuropsychological Evaluations of Hispanic/Latino Individuals across the Lifespan: A Scoping Review of the Literature. Arch Clin Neuropsychol 2023; 38:365-386. [PMID: 36988392 PMCID: PMC10132785 DOI: 10.1093/arclin/acac114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/27/2022] [Indexed: 03/30/2023] Open
Abstract
OBJECTIVE Acculturation has been linked to health outcomes in Hispanics/Latinos (H/Ls). However, there is equivocal evidence of a relationship between acculturation and neuropsychological outcomes. Various factors limit the ability to subject the evidence to systematic/meta-analytic review. We sought to examine the current state of the literature in the context of H/Ls and neuropsychology and describe the various limitations of measuring acculturation across the lifespan. METHOD Applying a scoping review approach, we identified unique stand-alone (e.g., questionnaires) measures of acculturation. We focused on psychometric (e.g., internal consistency) and other characteristics (e.g., language, structure/format) and description of the validation samples (e.g., cultural background/country of origin). RESULTS A total of 40 unique acculturation measures were identified. Measures spanned various domains (e.g., language proficiency, food preference, music choice), and relied heavily on linguistic behavioral characteristics. Internal consistency varied from unacceptable to clinically acceptable ranges. Variable approaches to development and validation were reported. Validation samples varied from 22 to 2,048 respondents (median = 380), most of which represented a general adult population. Only eight measures were validated for use in pediatric populations; none were developed specifically for use with older adults. CONCLUSIONS Published measures are outdated, evidence highly variable psychometric and methodological weaknesses, and lack a lifespan perspective. Several themes in the types of items considered elemental to the acculturative process are revealed and findings are summarized via an "ABC" framework, categorizing items as antecedents, behaviors, and consequent acculturative changes, that lends itself to clinical and research settings.
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Affiliation(s)
- Luis D Medina
- Department of Psychology, University of Houston, Houston, TX, USA
- Department of Psychiatry & Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Samantha Henry
- Department of Neurology, Section of Neuropsychology, Baylor College of Medicine, Houston, TX, USA
| | - Stephanie Torres
- Department of Psychology, University of Houston, Houston, TX, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, TX, USA
| | - Beatriz MacDonald
- Department of Pediatrics, Section of Psychology, Baylor College of Medicine, Houston, TX, USA
| | - Adriana M Strutt
- Department of Psychiatry & Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
- Department of Neurology, Section of Neuropsychology, Baylor College of Medicine, Houston, TX, USA
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Jimenez DE, Weinstein ER, Batsis J. You gotta walk the walk to talk the talk: protocol for a feasibility study of the Happy Older Latino Adults (HOLA) health promotion intervention for older HIV-positive Latino men. Pilot Feasibility Stud 2023; 9:32. [PMID: 36855194 PMCID: PMC9972624 DOI: 10.1186/s40814-023-01262-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 02/14/2023] [Indexed: 03/02/2023] Open
Abstract
BACKGROUND Older Latinos living with the human immunodeficiency virus (HIV) have been disproportionately affected by the epidemic and experience compounded health disparities that have deepened over time. These health disparities are largely related to lifestyle and are either preventable or amenable to early detection or intervention. Despite existing resources to deliver an intervention to reduce this compounded health disparity, there is little information on the effects of health promotion interventions on indices of cardiometabolic risk in midlife and older Latinos living with HIV. The Happy Older Latinos are Active (HOLA) intervention is an innovative health promotion program that is uniquely tailored to meet the diverse needs and circumstances of older Latinos with HIV. The goal of this manuscript is to describe the protocol of a feasibility study of the HOLA health promotion intervention for older HIV-positive Latino men. METHODS/DESIGN HOLA, which is informed by Behavioral Activation and Social Learning theory is a community health worker (CHW)-led, multicomponent, health promotion intervention consisting of: (1) a social and physical activation session; (2) a moderately intense group walk led by a CHW for 45 min, 3×/week for 16 weeks; (3) pleasant events (e.g., going to brunch with friends) scheduling. Eighteen community dwelling Latinos living with HIV aged 50+ will be recruited for this feasibility study adapting the HOLA intervention. Participants will be assessed at three time points (baseline, post-intervention, and 3 months post-intervention) on measures of cardiometabolic risk factors (waist circumference, dyslipidemia, hypertension, and glucose), psychosocial functioning, and health-related quality of life. CONCLUSIONS If HOLA can be delivered successfully by CHWs, then the scalability, accessibility, and potential for dissemination is increased. Additionally, this study will inform feasibility and identify modifications needed in the design of a larger hypothesis testing study. TRIAL REGISTRATION Clinicaltrials.gov Identifier: NCT03839212. Date of Registration: 8 February, 2019.
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Affiliation(s)
- Daniel E Jimenez
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, USA.
| | | | - John Batsis
- Division of Geriatric Medicine, Department of Medicine and Department of Nutrition, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, USA
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8
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Njie-Carr VPS, Zhu S, Stafford KA, Tong W, Plankey M, Sharma A, Milam J, Cohen M, Diaz MM, Rubtsova AA, Fischl MA, Konkle-Parker D, Gustafson D, Rubin LH. Intersectionality of Socioecological Factors Associated With Cognitive Function Among Older Women With HIV in the United States: A Structural Equation Model Analysis Using Data From the Women's Interagency HIV Study. J Assoc Nurses AIDS Care 2023; 34:83-95. [PMID: 36656093 PMCID: PMC10079306 DOI: 10.1097/jnc.0000000000000376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
ABSTRACT Increased life expectancy of people with HIV has health implications including the intersection of the long-term use of antiretroviral treatment, inflammatory events, and age-related immunosenescence. In a cross-sectional study utilizing using the Socio-Eecological Model, we identified pathways of cognitive function (CF) among 448 women with HIV, 50 years and older. A structural equation model showed the direct effects of mood (β = -0.25, p < .01), comorbidities (β = --0.13, p < .05), race (β = --0.13, p < .05), and abuse (β = 0.27, p < .001) on the latent variable CF. Substance and alcohol use, depressive symptoms, cigarette smoking, and the number of comorbidities are important considerations when designing interventions utilizing using a multi-level and intersectional lens to maximize positive CF outcomes.
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Affiliation(s)
| | - Shijun Zhu
- School of Nursing, University of Maryland, Baltimore, Maryland, USA
| | | | - Weiqun Tong
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Michael Plankey
- Division of Infectious Diseases, School of Medicine, Georgetown University, Washington, District of Columbia, USA
| | - Anjali Sharma
- Department of Medicine, College of Medicine, Albert Einstein University Bronx, New York, USA
| | - Joel Milam
- Department of Epidemiology and Biostatistics, Program in Public Health, Susan & Henry Samueli College of Health Sciences, University of California Irvine, Irvine, California, USA
| | - Mardge Cohen
- Boston Health Care for the Homeless Program, Chicago, Illinois, USA
| | - Monica M. Diaz
- Department of Neurology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Anna A. Rubtsova
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Margaret A. Fischl
- School of Medicine, University of Miami Health Systems, Miami, Florida, USA
| | - Deborah Konkle-Parker
- Schools of Nursing, Medicine, and Population Health Sciences, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Deborah Gustafson
- Department of Neurology, SUNY Downstate Health Sciences University, Brooklyn, New York, USA
| | - Leah H. Rubin
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
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9
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Mindt MR, Ashford MT, Zhu D, Cham H, Aaronson A, Conti C, Deng X, Alaniz R, Sorce J, Cypress C, Griffin P, Flenniken D, Camacho M, Fockler J, Truran D, Mackin RS, Hill C, Weiner MW, Byrd D, Turner Ii RW, Nosheny RL. The Community Engaged Digital Alzheimer's Research (CEDAR) Study: A Digital Intervention to Increase Research Participation of Black American Participants in the Brain Health Registry. J Prev Alzheimers Dis 2023; 10:847-856. [PMID: 37874107 PMCID: PMC10598330 DOI: 10.14283/jpad.2023.32] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
Abstract
BACKGROUND Although Black/African American older adults bear significant inequities in prevalence, incidence, and outcomes of Alzheimer's disease and related dementias, they are profoundly under-included in Alzheimer's Disease research. Community-Engaged Research (e.g., equitable community/science partnerships) is an evidence-based approach for improving engagement of underrepresented populations into Alzheimer's Disease research, but has lacked scalability to the national level. As internet use among older adults from underrepresented populations continues to grow, internet-based research shows promise as a feasible, valid approach to engagement and longitudinal assessment. The Community Engaged Digital Alzheimer's Research (CEDAR) study utilizes a community-engaged research approach to increase the engagement and research participation of Black/African American adults in the Brain Health Registry (BHR) and Alzheimer Disease clinical research. OBJECTIVES To describe the methods and evaluate the feasibility of the CEDAR culturally-informed digital platform within BHR. DESIGN All Black/African American participants in BHR were invited to enroll in CEDAR and to consider serving on a newly convened Community-Scientific Partnership Board to guide the study. The community board guided the development a culturally-informed cadre of engagement materials and strategies to increase research participation. Engagement strategies included incentives for study task completion, culturally-informed communications (e.g., landing page, emails and social media), resources about brain health, and video and written testimonials by CEDAR participants. SETTING BHR, an Internet-based registry and cohort. PARTICIPANTS BHR participants self-identifying as Black/African American were invited to enroll. All participants who signed an online informed consent document were enrolled. MEASUREMENTS We report the number of participants invited, enrolled, completed tasks, and volunteered to join the community board. We compared the demographics, cognitive profile, and baseline BHR task completion rates between CEDAR participants and all those invited to join the study. RESULTS Of 3738 invited, 349 (9.34%) enrolled in CEDAR. 134 (37% of CEDAR participants) volunteered to join the community board, of which 19 were selected for the community board. Compared to those invited, the CEDAR cohort had a higher percentage of female participants (84.5%) and a lower percentage of participants who identify as belonging to more than one ethnocultural group (21.8%). Compared to those did not enroll in CEDAR, those enrolled in CEDAR had a higher percentage of participants completing all BHR tasks (22%) and a higher percentage of participants completing at least one cognitive test (76%). Those enrolled in CEDAR also had a higher percentage of participants having an enrolled study partner (18%). CONCLUSIONS A culturally-informed Community-Engaged Research approach, including a remotely-convened community board, to engagement of Black/African American participants in an online research registry is feasible. This approach can be adapted for use in various clinical studies and other settings. Future studies will evaluate the effectiveness of the engagement strategies.
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Affiliation(s)
- M R Mindt
- Rachel Nosheny, 4150 Clement Street, 114M, San Francisco, CA. 94121, USA, Telephone: 415-221-4810, Email address: Fax number: 415-221-4810
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10
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Bernard C, Font H, Diallo Z, Ahonon R, Tine JM, Abouo FN, Tanon A, Messou E, Seydi M, Dabis F, Dartigues JF, de Rekeneire N. Factors associated with verbal fluency in older adults living with HIV in West Africa: A longitudinal study. Trop Med Int Health 2023; 28:35-42. [PMID: 36398852 PMCID: PMC9812871 DOI: 10.1111/tmi.13830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Verbal fluency decline, observed both in aging and HIV infection, has been related to lower quality of life. This study aimed to evaluate the factors associated with categorical fluency in people living with HIV (PLHIV) aged ≥60 years living in West Africa. METHODS In this longitudinal study, PLHIV aged ≥60 years, on antiretroviral therapy (ART) for ≥6 months were included in three clinics (two in Côte d'Ivoire, one in Senegal) participating in the West Africa International epidemiological Databases to Evaluate AIDS (IeDEA) collaboration. Categorical fluency was evaluated with the Isaacs Set Test at 60 s at baseline and 2 years later. Factors associated with verbal fluency baseline performance and annual rates of changes were evaluated using multivariate linear regression models. RESULTS Ninety-seven PLHIV were included with 41 of them (42%) having a 2-year follow-up visit. The median age was 64 (62-67), 45.4% were female, and 89.7% had an undetectable viral load. The median annual change in categorical fluency scores was -0.9 (IQR: -2.7 to 1.8). Low baseline categorical fluency performance and its decline were associated with older age and being a female. Low educational level was associated with low baseline categorical fluency performance but not with its decline. Categorical fluency decline was also associated with marital status and hypertension. CONCLUSIONS Among older West African PLHIV, usual socio-demographic variables and hypertension were the main factors associated with low categorical fluency performance and/or its decline. Interventions that focus on supporting cardiometabolic health are highly recommended to prevent cognitive disorders in PLHIV.
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Affiliation(s)
- Charlotte Bernard
- University of Bordeaux, National Institute for Health and Medical Research (INSERM) UMR 1219, Research Institute for Sustainable Development (IRD) EMR 271, Bordeaux Population Health Centre, Bordeaux, France
| | - Hélène Font
- University of Bordeaux, National Institute for Health and Medical Research (INSERM) UMR 1219, Research Institute for Sustainable Development (IRD) EMR 271, Bordeaux Population Health Centre, Bordeaux, France
| | - Zélica Diallo
- Service des maladies infectieuses et tropicales, CHU Treichville, Abidjan, Côte d'Ivoire
| | - Richard Ahonon
- Centre de prise en charge de recherche et de formation (CePReF), Yopougon Attié Hospital, Abidjan, Côte d'Ivoire
| | | | | | - Aristophane Tanon
- Service des maladies infectieuses et tropicales, CHU Treichville, Abidjan, Côte d'Ivoire
| | - Eugène Messou
- Centre de prise en charge de recherche et de formation (CePReF), Yopougon Attié Hospital, Abidjan, Côte d'Ivoire
| | - Moussa Seydi
- Service des maladies infectieuses et tropicales, CHNU de Fann, Dakar, Senegal
| | - François Dabis
- University of Bordeaux, National Institute for Health and Medical Research (INSERM) UMR 1219, Research Institute for Sustainable Development (IRD) EMR 271, Bordeaux Population Health Centre, Bordeaux, France
| | - Jean-François Dartigues
- University of Bordeaux, National Institute for Health and Medical Research (INSERM) UMR 1219, Research Institute for Sustainable Development (IRD) EMR 271, Bordeaux Population Health Centre, Bordeaux, France
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11
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Paul RH, Cho K, Belden A, Carrico AW, Martin E, Bolzenius J, Luckett P, Cooley SA, Mannarino J, Gilman JM, Miano M, Ances BM. Cognitive Phenotypes of HIV Defined Using a Novel Data-driven Approach. J Neuroimmune Pharmacol 2022; 17:515-525. [PMID: 34981318 PMCID: PMC10364465 DOI: 10.1007/s11481-021-10045-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 12/13/2021] [Indexed: 01/13/2023]
Abstract
The current study applied data-driven methods to identify and explain novel cognitive phenotypes of HIV. Methods: 388 people with HIV (PWH) with an average age of 46 (15.8) and median plasma CD4+ T-cell count of 555 copies/mL (79% virally suppressed) underwent cognitive testing and 3T neuroimaging. Demographics, HIV disease variables, and health comorbidities were recorded within three months of cognitive testing/neuroimaging. Hierarchical clustering was employed to identify cognitive phenotypes followed by ensemble machine learning to delineate the features that determined membership in the cognitive phenotypes. Hierarchical clustering identified five cognitive phenotypes. Cluster 1 (n=97) was comprised of individuals with normative performance on all cognitive tests. The remaining clusters were defined by impairment on action fluency (Cluster 2; n=46); verbal learning/memory (Cluster 3; n=73); action fluency and verbal learning/memory (Cluster 4; n=56); and action fluency, verbal learning/memory, and tests of executive function (Cluster 5; n=114). HIV detectability was most common in Cluster 5. Machine learning revealed that polysubstance use, race, educational attainment, and volumes of the precuneus, cingulate, nucleus accumbens, and thalamus differentiated membership in the normal vs. impaired clusters. The determinants of persistent cognitive impairment among PWH receiving suppressive treatment are multifactorial nature. Viral replication after ART plays a role in the causal pathway, but psychosocial factors (race inequities, substance use) merit increased attention as critical determinants of cognitive impairment in the context of ART. Results underscore the need for comprehensive person-centered interventions that go beyond adherence to patient care to achieve optimal cognitive health among PWH.
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Affiliation(s)
- Robert H Paul
- Department of Psychological Sciences, University of Missouri Saint Louis, Missouri, Saint Louis, US. .,Missouri Institute of Mental Health, University of Missouri Saint Louis, Missouri, Saint Louis, US.
| | - Kyu Cho
- Missouri Institute of Mental Health, University of Missouri Saint Louis, Missouri, Saint Louis, US
| | - Andrew Belden
- Missouri Institute of Mental Health, University of Missouri Saint Louis, Missouri, Saint Louis, US
| | - Adam W Carrico
- Department of Public Health, University of Miami School of Medicine, Coral Gables, Florida, US
| | - Eileen Martin
- Department of Psychiatry, Rush University School of Medicine, Chicago, Illinois, US
| | - Jacob Bolzenius
- Missouri Institute of Mental Health, University of Missouri Saint Louis, Missouri, Saint Louis, US
| | - Patrick Luckett
- Department of Neurology, Washington University, Saint Louis, Missouri, US
| | - Sarah A Cooley
- Department of Neurology, Washington University, Saint Louis, Missouri, US
| | - Julie Mannarino
- Missouri Institute of Mental Health, University of Missouri Saint Louis, Missouri, Saint Louis, US
| | - Jodi M Gilman
- Center for Addiction Medicine, Harvard Medical School/Massachusetts General Hospital, Boston, Massachusetts, US
| | - Mariah Miano
- Department of Communication Sciences and Disorders, Northern Arizona University, Flagstaff, Arizona, US
| | - Beau M Ances
- Department of Neurology, Washington University, Saint Louis, Missouri, US
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12
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Watson CWM, Kamalyan L, Tang B, Hussain MA, Cherner M, Mindt MR, Byrd DA, Franklin DR, Collier AC, Clifford DB, Gelman B, Morgello S, McCutchan JA, Ellis RJ, Grant I, Heaton RK, Marquine MJ. Ethnic/Racial Disparities in Longitudinal Neurocognitive Decline in People With HIV. J Acquir Immune Defic Syndr 2022; 90:97-105. [PMID: 35081558 PMCID: PMC8986565 DOI: 10.1097/qai.0000000000002922] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 07/19/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND To examine longitudinal neurocognitive decline among Latino, non-Latino Black, and non-Latino White people with HIV (PWH) and factors that may explain ethnic/racial disparities in neurocognitive decline. METHODS Four hundred ninety nine PWH (13.8% Latino, 42.7% Black, 43.5% White; baseline age: M = 43.5) from the CNS HIV Anti-Retroviral Therapy Effects Research (CHARTER) study completed neurocognitive, neuromedical, and laboratory assessments every 6-12 months with up to 5 years of follow-up. Longitudinal neurocognitive change was determined via published regression-based norms. Survival analyses investigated the relationship between ethnicity/race and neurocognitive change, and baseline and time-dependent variables that may explain ethnic/racial disparities in neurocognitive decline, including socio-demographic, HIV-disease, medical, psychiatric, and substance use characteristics. RESULTS In Cox proportional hazard models, hazard ratios for neurocognitive decline were increased for Latino compared with White PWH (HR = 2.25, 95% CI = 1.35 to 3.73, P = 0.002), and Latino compared with Black PWH (HR = 1.86, 95% CI = 1.14 to 3.04, P = 0.013), with no significant differences between Black and White PWH (P = 0.40). Comorbidities, including cardiometabolic factors and more severe neurocognitive comorbidity classification, accounted for 33.6% of the excess hazard for Latino compared with White PWH, decreasing the hazard ratio associated with Latino ethnicity (HR = 1.83, 95% CI = 1.06 to 3.16, P = 0.03), but did not fully account for elevated risk of decline. CONCLUSIONS Latino PWH may be at higher risk of early neurocognitive decline compared with Black and White PWH. Comorbidities accounted for some, but not all, of this increased risk among Latino PWH. Future research examining institutional, sociocultural, and biomedical factors, including structural discrimination and age-related biomarkers, may further explain the observed disparities.
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Affiliation(s)
| | | | - Bin Tang
- University of California, San Diego, San Diego, CA
| | | | | | | | | | | | - Ann C. Collier
- University of Washington School of Medicine, Seattle, WA
| | | | | | | | | | | | - Igor Grant
- University of California, San Diego, San Diego, CA
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13
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Jimenez DE, Weinstein ER, Batsis JA. "Me Dieron Vida": The Effects of a Pilot Health Promotion Intervention to Reduce Cardiometabolic Risk and Improve Behavioral Health among Older Latinos with HIV. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:2667. [PMID: 35270360 PMCID: PMC8910201 DOI: 10.3390/ijerph19052667] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 02/15/2022] [Accepted: 02/19/2022] [Indexed: 02/05/2023]
Abstract
There are significant gaps in knowledge about the synergistic and disparate burden of health disparities associated with cardiovascular health issues, poorer mental health outcomes, and suboptimal HIV-care management on the health of older Latinos living with HIV (OLLWH). This pilot study sought to evaluate the feasibility and acceptability of an innovative application of an already established health-promotion intervention-Happy Older Latinos are Active (HOLA)-among this marginalized population. Eighteen self-identified Latino men with an undetectable HIV viral load and documented risk of cardiometabolic disease participated in this study. Although the attrition rate of 22% was higher than expected, participants attended 77% of the sessions and almost 95% of the virtual walks. Participants reported high satisfaction with the intervention, as evident by self-report quantitative (CSQ-8; M = 31, SD = 1.5) and qualitative metrics. Participants appreciated bonding with the community health worker and their peers to reduce social isolation. Results indicate that the HOLA intervention is an innovative way of delivering a health promotion intervention adapted to meet the diverse needs and circumstances of OLLWH, is feasible and acceptable, and has the potential to have positive effects on the health of OLLWH.
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Affiliation(s)
- Daniel E. Jimenez
- Department of Psychiatry, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | | | - John A. Batsis
- Division of Geriatric Medicine, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC 27599, USA;
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599, USA
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14
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Crook CL, Savin MJ, Byrd D, Summers AC, Guzman VA, Morris EP, Tureson K, Aghvinian M, Cham H, Mindt MR. The neurocognitive effects of a past cannabis use disorder in a diverse sample of people living with HIV. AIDS Care 2021; 33:1482-1491. [PMID: 32951441 PMCID: PMC10310357 DOI: 10.1080/09540121.2020.1822504] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Accepted: 09/07/2020] [Indexed: 12/11/2022]
Abstract
People living with HIV (PLWH) report higher rates of cannabis use than the general population, a trend likely to continue in light of recent policy changes and the reported therapeutic benefits of cannabis for PLWH. Therefore, it is important to better understand cannabis-associated effects on neurocognition, especially as PLWH are at heightened risk for neurocognitive impairment. This study aimed to elucidate the effects of a past cannabis use disorder on current neurocognition in a diverse sample of PLWH. This cross-sectional study included 138 PLWH (age M(SD) = 47.28(8.06); education M(SD) = 12.64(2.73); 73% Male; 71% Latinx) who underwent neuropsychological, DSM-diagnostic, and urine toxicology evaluations. One-way ANCOVAs were conducted to examine effects of a past cannabis use disorder (CUD+) on tests of attention/working memory, processing speed, executive functioning, verbal fluency, learning, memory, and motor ability. Compared to the past CUD- group, the past CUD+ group performed significantly better on tests of processing speed, visual learning and memory, and motor ability (p's < .05). Findings suggest PLWH with past cannabis use have similar or better neurocognition across domains compared to PLWH without past use.
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Affiliation(s)
- Cara L Crook
- Department of Psychology, Fordham University, New York, NY, USA
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Micah J Savin
- Department of Psychology, Fordham University, New York, NY, USA
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Desiree Byrd
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Psychology, Queens College and The Graduate Center, CUNY, Queens, NY, USA
| | - Angela C Summers
- Department of Psychology, Fordham University, New York, NY, USA
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Vanessa A Guzman
- Department of Psychology, Fordham University, New York, NY, USA
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Emily P Morris
- Department of Psychology, University of Michigan, Ann Arbor, MI, USA
| | - Kayla Tureson
- Department of Psychology, University of Southern California, Los Angeles, CA, USA
| | - Maral Aghvinian
- Department of Psychology, Fordham University, New York, NY, USA
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Heining Cham
- Department of Psychology, Fordham University, New York, NY, USA
| | - Monica Rivera Mindt
- Department of Psychology, Fordham University, New York, NY, USA
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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15
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Naveed Z, Fox HS, Wichman CS, May P, Arcari CM, Meza J, Totusek S, Baccaglini L. Development of a Nomogram-Based Tool to Predict Neurocognitive Impairment Among HIV-positive Charter Participants. Open AIDS J 2021. [DOI: 10.2174/1874613602115010052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background:
Despite the widespread use of combination antiretroviral therapy (cART), HIV-associated neurocognitive impairment (NCI) persists in people living with HIV (PLWH). Studies have generated inconsistent results regarding etiological factors for NCI in PLWH. Furthermore, a user-friendly and readily available predictive tool is desirable in clinical practice to screen PLWH for NCI.
Objective:
This study aimed to identify factors associated with NCI using a large and diverse sample of PLWH and build a nomogram based on demographic, clinical, and behavioral variables.
Methods:
We performed Bayesian network analysis using a supervised learning technique with the Markov Blanket (MB) algorithm. Logistic regression was also conducted to obtain the adjusted regression coefficients to construct the nomogram.
Results:
Among 1,307 participants, 21.6% were neurocognitively impaired. During the MB analysis, age provided the highest amount of mutual information (0.0333). Logistic regression also showed that old age (>50 vs. ≤50 years) had the strongest association (OR=2.77, 95% CI=1.99-3.85) with NCI. The highest possible points on the nomogram were 626, translated to a nomogram-predicted probability of NCI to be approximately 0.95. The receiver operating characteristic (ROC) curve's concordance index was 0.75, and the nomogram's calibration plot exhibited an excellent agreement between observed and predicted probabilities.
Conclusion:
The nomogram used variables that can be easily measured in clinical settings and, thus, easy to implement within a clinic or web-interface platform. The nomogram may help clinicians screen for patients with a high probability of having NCI and thus needing a comprehensive neurocognitive assessment for early diagnosis and appropriate management.
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16
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Bernard C, Font H, Diallo Z, Ahonon R, Tine JM, Abouo FN, Tanon A, Messou E, Seydi M, Dabis F, Dartigues JF, de Rekeneire N. Effects of Age, Level of Education and HIV Status on Cognitive Performance in West African Older Adults: The West Africa IeDEA Cohort Collaboration. AIDS Behav 2021; 25:3316-3326. [PMID: 34050826 DOI: 10.1007/s10461-021-03309-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2021] [Indexed: 12/28/2022]
Abstract
An in-depth understanding of the impact of aging, cognitive reserve, and HIV status on cognitive function is needed in older West African adults. Ninety-nine HIV-negative and 334 HIV-positive adults aged ≥ 50 years were enrolled in three clinics (Senegal and Côte d'Ivoire) participating in the IeDEA West Africa collaboration. All subjects underwent the Free and Cued Selective Reminding Test (FCSRT) and the Isaacs Set Test (IST). Age (both linear and quadratic), education level, and HIV status effects on Z-scores were assessed using multivariate linear regression models. Interactions between HIV status and age or educational level were tested. In the present cohort of older West African adults, the role of age and educational level on episodic memory and verbal fluency was observed without revealing an interaction between HIV status and age effect. As age had quadratic effects, older HIV-positive adults should not be considered as a unique group irrespective of their age. Low-educated HIV-positive patients had the lowest verbal fluency performance compared to others. Further studies are needed to duplicate these results. In clinical settings, screening and adapted programs focusing on improving cognition in those patients are needed.
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17
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Waldrop D, Irwin C, Nicholson WC, Lee CA, Webel A, Fazeli PL, Vance DE. The Intersection of Cognitive Ability and HIV: A Review of the State of the Nursing Science. J Assoc Nurses AIDS Care 2021; 32:306-321. [PMID: 33449578 PMCID: PMC8091162 DOI: 10.1097/jnc.0000000000000232] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
ABSTRACT Neurocognitive problems have been endemic to the HIV epidemic since its beginning. Four decades later, these problems persist, but currently, they are attributed to HIV-induced inflammation, the long-term effects of combination antiretroviral therapy, lifestyle (i.e., physical activity, drug use), psychiatric, and age-associated comorbidities (i.e., heart disease, hypertension). In many cases, persons living with HIV (PLWH) may develop cognitive problems as a function of accelerated or accentuated normal aging and lifestyle rather than HIV itself. Nonetheless, such cognitive impairments can interfere with HIV care, including medication adherence and attending clinic appointments. With more than half of PLWH 50 years and older, and 30%-50% of all PLWH meeting the criteria for HIV-associated neurocognitive disorder, those aging with HIV may be more vulnerable to developing cognitive problems. This state of the science article provides an overview of current issues and provides implications for practice, policy, and research to promote successful cognitive functioning in PLWH.
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Affiliation(s)
- Drenna Waldrop
- Drenna Waldrop, PhD, is a Professor and Assistant Dean for Research Operations & Training, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA. Crista Irwin, BSN, RN, is a PhD Student, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA. W. Chance Nicholson, PhD, MSN, PMHNP-BC, is a Nurse Practitioner and Assistant Professor, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA. Cheryl A. Lee, BSN, RN, is a PhD Student, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA. Allison Webel, PhD, RN, FAAN, is an Associate Professor, Frances Bolton School of Nursing, Case Western University, Cleveland, Ohio, USA. Pariya L. Fazeli, PhD, is an Associate Professor, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA. David E. Vance, PhD, MGS, is a Professor, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Crista Irwin
- Drenna Waldrop, PhD, is a Professor and Assistant Dean for Research Operations & Training, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA. Crista Irwin, BSN, RN, is a PhD Student, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA. W. Chance Nicholson, PhD, MSN, PMHNP-BC, is a Nurse Practitioner and Assistant Professor, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA. Cheryl A. Lee, BSN, RN, is a PhD Student, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA. Allison Webel, PhD, RN, FAAN, is an Associate Professor, Frances Bolton School of Nursing, Case Western University, Cleveland, Ohio, USA. Pariya L. Fazeli, PhD, is an Associate Professor, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA. David E. Vance, PhD, MGS, is a Professor, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - W. Chance Nicholson
- Drenna Waldrop, PhD, is a Professor and Assistant Dean for Research Operations & Training, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA. Crista Irwin, BSN, RN, is a PhD Student, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA. W. Chance Nicholson, PhD, MSN, PMHNP-BC, is a Nurse Practitioner and Assistant Professor, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA. Cheryl A. Lee, BSN, RN, is a PhD Student, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA. Allison Webel, PhD, RN, FAAN, is an Associate Professor, Frances Bolton School of Nursing, Case Western University, Cleveland, Ohio, USA. Pariya L. Fazeli, PhD, is an Associate Professor, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA. David E. Vance, PhD, MGS, is a Professor, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Cheryl A. Lee
- Drenna Waldrop, PhD, is a Professor and Assistant Dean for Research Operations & Training, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA. Crista Irwin, BSN, RN, is a PhD Student, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA. W. Chance Nicholson, PhD, MSN, PMHNP-BC, is a Nurse Practitioner and Assistant Professor, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA. Cheryl A. Lee, BSN, RN, is a PhD Student, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA. Allison Webel, PhD, RN, FAAN, is an Associate Professor, Frances Bolton School of Nursing, Case Western University, Cleveland, Ohio, USA. Pariya L. Fazeli, PhD, is an Associate Professor, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA. David E. Vance, PhD, MGS, is a Professor, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Allison Webel
- Drenna Waldrop, PhD, is a Professor and Assistant Dean for Research Operations & Training, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA. Crista Irwin, BSN, RN, is a PhD Student, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA. W. Chance Nicholson, PhD, MSN, PMHNP-BC, is a Nurse Practitioner and Assistant Professor, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA. Cheryl A. Lee, BSN, RN, is a PhD Student, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA. Allison Webel, PhD, RN, FAAN, is an Associate Professor, Frances Bolton School of Nursing, Case Western University, Cleveland, Ohio, USA. Pariya L. Fazeli, PhD, is an Associate Professor, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA. David E. Vance, PhD, MGS, is a Professor, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Pariya L. Fazeli
- Drenna Waldrop, PhD, is a Professor and Assistant Dean for Research Operations & Training, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA. Crista Irwin, BSN, RN, is a PhD Student, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA. W. Chance Nicholson, PhD, MSN, PMHNP-BC, is a Nurse Practitioner and Assistant Professor, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA. Cheryl A. Lee, BSN, RN, is a PhD Student, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA. Allison Webel, PhD, RN, FAAN, is an Associate Professor, Frances Bolton School of Nursing, Case Western University, Cleveland, Ohio, USA. Pariya L. Fazeli, PhD, is an Associate Professor, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA. David E. Vance, PhD, MGS, is a Professor, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - David E. Vance
- Drenna Waldrop, PhD, is a Professor and Assistant Dean for Research Operations & Training, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA. Crista Irwin, BSN, RN, is a PhD Student, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA. W. Chance Nicholson, PhD, MSN, PMHNP-BC, is a Nurse Practitioner and Assistant Professor, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA. Cheryl A. Lee, BSN, RN, is a PhD Student, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA. Allison Webel, PhD, RN, FAAN, is an Associate Professor, Frances Bolton School of Nursing, Case Western University, Cleveland, Ohio, USA. Pariya L. Fazeli, PhD, is an Associate Professor, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA. David E. Vance, PhD, MGS, is a Professor, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Tureson K, Byrd DA, Guzman V, Summers AC, Morris EP, Mindt MR. The impact of sociocultural factors on prospective memory performance in HIV+ Latinx adults. Neuropsychology 2021; 35:411-422. [PMID: 34043391 PMCID: PMC10284210 DOI: 10.1037/neu0000732] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE Prospective memory (PM), a salient component of neurocognitive functioning for people living with HIV (PLH), is necessary for planning and coordinating health-related behaviors and instrumental tasks of daily living. However, little is known regarding the impact of sociocultural factors on PM in diverse populations, particularly Latinx PLH. The aim of this study was to examine ethnic group differences and sociocultural factors related to PM. METHOD The sample of 127 PLH (91 Latinx and 36 non-Latinx white) completed measures of quality of education, socioeconomic status (SES), and a validated PM measure, the Memory for Intentions Screening Test (MIST). The Latinx group also completed a bicultural acculturation measure. RESULTS Results revealed the Latinx and the non-Latinx white groups did not significantly differ in overall MIST performance (all p > .05). In the entire sample, better quality of education was associated with better MIST performance (all p < .05). Within the Latinx group, higher Latinx acculturation was associated with worse MIST performance (p = .02), whereas higher U.S. acculturation was associated with better MIST performance at a trend level (p = .07). Multivariate regressions revealed quality of education and Latinx acculturation significantly predicted MIST performance and PM errors (all p < .05). SES was not related to the MIST (all p > .10). CONCLUSIONS In sum, clinicians must take sociocultural factors into consideration when working with Latinx PLH, as these factors influence cognitive functions (i.e., PM) vital to health-related behaviors. Integrating culturally-informed psychoeducation into care plans is an imperative first step. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Affiliation(s)
- Kayla Tureson
- Department of Psychology, University of Southern California, Los Angeles, CA
| | - Desiree A. Byrd
- Department of Psychology, Queens College, Queens, NY
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Vanessa Guzman
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY
- Department of Psychology, Fordham University, Bronx, NY
| | - Angela C. Summers
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY
- Department of Psychology, Fordham University, Bronx, NY
| | - Emily P. Morris
- Department of Psychology, University of Michigan, Ann Arbor, MI
| | - Monica Rivera Mindt
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY
- Department of Psychology, Fordham University, Bronx, NY
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Morris EP, Byrd D, Summers AC, Tureson K, Guzman V, Crook CL, Mindt MR. Depressive Symptoms Differentially Predict Neurocognition in Latinx and Non-Hispanic White People Living with HIV. J Int Neuropsychol Soc 2021; 27:249-260. [PMID: 32967753 PMCID: PMC7969352 DOI: 10.1017/s1355617720000855] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES Depression is common in people living with HIV (PLWH) and can contribute to neurocognitive dysfunction. Depressive symptoms in PLWH are often measured by assessing only cognitive/affective symptoms. Latinx adults, however, often express depressive symptoms in a somatic/functional manner, which is not typically captured in assessments of depression among PLWH. Given the disproportionate burden of HIV that Latinx adults face, examining whether variations in expressed depressive symptoms differentially predict neurocognitive outcomes between Latinx and non-Hispanic white PLWH is essential. METHODS This cross-sectional study included 140 PLWH (71% Latinx; 72% male; mean (M) age = 47.1 ± 8.5 years; M education = 12.6 ± 2.9 years) who completed a comprehensive neurocognitive battery, Wechsler Test of Adult Reading (WTAR), and Beck Depression Inventory-II (BDI-II). Neurocognitive performance was measured using demographically adjusted T-scores. BDI-II domain scores were computed for the Fast-Screen (cognitive/affective items) score (BDI-FS) and non-FS score (BDI-NFS; somatic/functional items). RESULTS Linear regressions revealed that the BDI-NFS significantly predicted global neurocognitive function and processing speed in the Latinx group (p < .05), such that higher physical/functional symptoms predicted worse performance. In the non-Hispanic white group, the cognitive/affective symptoms significantly predicted processing speed (p = .02), with more symptoms predicting better performance. Interaction terms of ethnicity and each BDI sub-score indicated that Latinx participants with higher cognitive/affective symptoms performed worse on executive functioning. CONCLUSIONS Depressive symptoms differentially predict neurocognitive performance in Latinx and non-Hispanic white PLWH. These differences should be considered when conducting research and intervention among the increasingly culturally and ethnically diverse population of PLWH.
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Affiliation(s)
- Emily P. Morris
- University of Michigan Department of Psychology, Ann Arbor, MI
| | - Desiree Byrd
- Icahn School of Medicine at Mount Sinai Department of Neurology, New York, NY
- Icahn School of Medicine at Mount Sinai Department of Psychiatry, New York, NY
- Queens College, City University of New York Department of Psychology, Flushing, NY
| | - Angela C. Summers
- Icahn School of Medicine at Mount Sinai Department of Neurology, New York, NY
- Fordham University Department of Psychology, New York, NY
| | - Kayla Tureson
- University of Southern California Department of Psychology, Los Angeles, CA
| | - Vanessa Guzman
- Department of Neurology, Columbia University Medical Center, New York, NY, USA
| | - Cara L. Crook
- Icahn School of Medicine at Mount Sinai Department of Neurology, New York, NY
- Fordham University Department of Psychology, New York, NY
| | - Monica Rivera Mindt
- Icahn School of Medicine at Mount Sinai Department of Neurology, New York, NY
- Icahn School of Medicine at Mount Sinai Department of Psychiatry, New York, NY
- Fordham University Department of Psychology, New York, NY
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20
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Mindt MR, Marquine MJ, Aghvinian M, Paredes AM, Kamalyan L, Suárez P, Heaton A, Scott TM, Gooding A, Diaz-Santos M, Umlauf A, Taylor MJ, Fortuny LAI, Heaton RK, Cherner M. The Neuropsychological Norms for the U.S.-Mexico Border Region in Spanish (NP-NUMBRS) Project: Overview and considerations for life span research and evidence-based practice. Clin Neuropsychol 2021; 35:466-480. [PMID: 32727283 PMCID: PMC8725610 DOI: 10.1080/13854046.2020.1794046] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Revised: 05/26/2020] [Accepted: 06/05/2020] [Indexed: 12/18/2022]
Abstract
OBJECTIVE This paper summarizes the findings of the Neuropsychological Norms for the U.S.-Mexico Border Region in Spanish (NP-NUMBRS) Project and offers a roadmap for future research. METHODS The NP-NUMBRS project represents the largest and most comprehensive co-normed neuropsychological battery to date for native Spanish-speaking healthy adults from the U.S. (California/Arizona)-Mexico borderland region (N = 254; ages 19-60 years). These norms provide demographic adjustments for tests across numerous domains (i.e., verbal fluency, processing speed, attention/working memory, executive function, episodic memory [learning and delayed recall], visuospatial, and fine motor skills). CONCLUSIONS This project: 1) shows that the NP-NUMBRS norms consistently outperformed previously published norms for English-speaking non-Hispanic (White and African-American) adults in identifying impairment; 2) explores the role of Spanish-English bilingualism in test performance; and 3) provides support for the diagnostic validity of these norms in detecting HIV-associated neurocognitive impairment. Study limitations include the limited assessment of sociocultural variables and generalizability (e.g., other Latina/o populations, age limit [19 - 60 years]). Future research is needed to: 1) investigate these norms with U.S.-dwelling Spanish-speakers of non-Mexican heritage and other clinical subpopulations; 2) expand coverage of cognitive domains (e.g. language, visuospatial); 3) develop large normative datasets for children and older Latina/o populations; 4) examine how sociocultural factors impact performance (e.g., bilingualism, acculturation); 5) investigate these norms' diagnostic and ecological validity; and 6) develop norms for neurocognitive change across time. It is hoped that the NP-NUMBRS norms will aid researchers and clinicians working with U.S.-dwelling Spanish-speakers from the U.S.-Mexico borderland to conduct research and evidence-based neuropsychological evaluations in a more culturally responsive and ethical manner.
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Affiliation(s)
- Monica Rivera Mindt
- Department of Psychology & Latin American Latino Studies Institute, Fordham University, New York City, NY, USA
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - María J. Marquine
- Department of Psychiatry, University of California, San Diego, CA, USA
| | - Maral Aghvinian
- Department of Psychology & Latin American Latino Studies Institute, Fordham University, New York City, NY, USA
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | | | - Lily Kamalyan
- Department of Psychiatry, University of California, San Diego, CA, USA
| | - Paola Suárez
- Hispanic Neuropsychiatric Center of Excellence - Cultural Neuropsychology Program, Semel Institute for Neuroscience & Human Behavior, Department of Psychiatry & Biobehavioral Sciences, University of California, Los Angeles, CA, USA
| | - Anne Heaton
- Department of Psychiatry, University of California, San Diego, CA, USA
| | - Travis M. Scott
- Department of Psychology & Latin American Latino Studies Institute, Fordham University, New York City, NY, USA
- VA Palo Alto Health Care System, Sierra Pacific MIRECC, Palo Alto, CA, USA
| | - Amanda Gooding
- Department of Psychiatry, University of California, San Diego, CA, USA
| | - Mirella Diaz-Santos
- Hispanic Neuropsychiatric Center of Excellence - Cultural Neuropsychology Program, Semel Institute for Neuroscience & Human Behavior, Department of Psychiatry & Biobehavioral Sciences, University of California, Los Angeles, CA, USA
| | - Anya Umlauf
- Department of Psychiatry, University of California, San Diego, CA, USA
| | - Michael J. Taylor
- Department of Psychiatry, University of California, San Diego, CA, USA
| | | | - Robert K. Heaton
- Department of Psychiatry, University of California, San Diego, CA, USA
| | - Mariana Cherner
- Department of Psychiatry, University of California, San Diego, CA, USA
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21
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Kamalyan L, Hussain MA, Diaz MM, Umlauf A, Franklin DR, Cherner M, Mindt MR, Fortuny LAI, Grant I, Heaton RK, Marquine MJ. Neurocognitive impairment in Spanish-speaking Latinos living with HIV in the US: Application of the neuropsychological norms for the US-Mexico border region in Spanish (NP-NUMBRS). Clin Neuropsychol 2021; 35:433-452. [PMID: 31847711 PMCID: PMC7453430 DOI: 10.1080/13854046.2019.1701084] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Revised: 11/01/2019] [Accepted: 11/29/2019] [Indexed: 02/07/2023]
Abstract
Objective Latinos in the US are at increased risk for HIV-associated neurocognitive impairment (NCI). Most studies of US Latinos living with HIV have included primarily English-speakers only. We investigated the rate, pattern, and correlates of HIV-associated NCI in native Spanish-speaking Latinos living in the US near the Mexican border. Methods Participants included 407 native Spanish-speaking Latinos (Age: M = 37.65, SD = 10.0; Education: M = 10.75, SD = 4.1; 53% male): 153 persons living with HIV (PLWH; 56% AIDS) and 254 healthy controls. All participants completed comprehensive neuropsychological assessments in Spanish. Raw neuropsychological test scores from seven domains were converted to demographically-adjusted T-scores using norms developed with healthy controls. Global and domain NCI were defined per established criteria. Among PLWH we applied norms developed for non-Hispanic (NH) Whites and Blacks, and investigated correlates of global NCI, including HIV disease characteristics and psychiatric comorbidities. Results Utilizing population specific norms, rates of global NCI were significantly higher among PLWH (39%) than healthy controls (17%), comparable to previously published rates. In contrast, rates of global NCI in the same group of PLWH were significantly different when NH White norms (63%, p < 0.0001) and NH Black norms were used (18%, p < 0.0001). Among PLWH without a history of lifetime substance use disorder, more years of antiretroviral exposure were significantly associated with decreased rates of global NCI. Conclusions Present findings lend support to the validity of newly developed norms for native Spanish-speakers living near the US-Mexico border, and underscore the importance of utilizing appropriate norms to accurately identify HIV-associated NCI.
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Affiliation(s)
- Lily Kamalyan
- Department of Psychiatry, HIV Neurobehavioral Research Program, University of California, San Diego
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology
| | - Mariam A. Hussain
- Department of Psychiatry, HIV Neurobehavioral Research Program, University of California, San Diego
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology
| | - Monica M. Diaz
- Department of Neurosciences, University of California, San Diego
| | - Anya Umlauf
- Department of Psychiatry, HIV Neurobehavioral Research Program, University of California, San Diego
| | - Donald R. Franklin
- Department of Psychiatry, HIV Neurobehavioral Research Program, University of California, San Diego
| | - Mariana Cherner
- Department of Psychiatry, HIV Neurobehavioral Research Program, University of California, San Diego
| | - Monica Rivera Mindt
- Department of Psychology & Latin American Latino Studies Institute, Fordham University and Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Igor Grant
- Department of Psychiatry, HIV Neurobehavioral Research Program, University of California, San Diego
| | - Robert K. Heaton
- Department of Psychiatry, HIV Neurobehavioral Research Program, University of California, San Diego
| | - María J. Marquine
- Department of Psychiatry, HIV Neurobehavioral Research Program, University of California, San Diego
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Cruz LN, Weinberger AH, Shuter J, Lee CJ. Wisconsin Card Sorting Task-64 performance among HIV+ Black/African American and Latinx adults compared to normative samples and by sociocultural and health variables. APPLIED NEUROPSYCHOLOGY-ADULT 2020; 29:816-828. [PMID: 32985252 DOI: 10.1080/23279095.2020.1813142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Many people living with HIV experience cognitive impairment, and HIV disproportionately affects racial/ethnic minority groups. Independent of HIV, racial/ethnic minority individuals perform worse than White individuals on cognitive tasks, even after accounting for education. Our goals were to (1) compare WCST-64 scores between HIV+ Black/African American (Black/AA) (n = 45) and Latinx (n = 41) urban-dwelling adults; (2) compare our total sample to the WCST-64 manual's normative (N) and clinical normative (CN) groups; and (3) explore relationships between WCST-64 performance and sociocultural/health variables. In our sample, employment (12%), mean annual income (<$10,000), and mean education (<12 years) were low, while mean medication adherence rates were high for both Black/AA (90%) and Latinx (87%). WCST-64 scores were similar between groups (p > .05). Percentages of "below average" and "mildly impaired" scores in our sample were higher than the N group, and similar to the CN group. Lifetime heroin use, dementia, and longer HIV illness duration were significantly associated with worse WCST-64 performance (ps < .05). The observed low scores in our asymptomatic sample are likely due to the intersectionality of sociocultural and medical burden, highlighting complexities in interpreting neuropsychological data in real-world HIV+ clinics. Executive deficits are linked to poorer outcomes, and routine cognitive screening may be clinically indicated.
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Affiliation(s)
- Lisa N Cruz
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY, USA
| | - Andrea H Weinberger
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY, USA.,Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Jonathan Shuter
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA.,AIDS Center and Division of Infectious Diseases, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Christine J Lee
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY, USA.,Department of Psychiatry, Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA
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Cultural Neuropsychology Considerations in the Diagnosis of HIV-Associated Neurocognitive Disorders. Curr Top Behav Neurosci 2020; 50:193-223. [PMID: 32157665 DOI: 10.1007/7854_2019_121] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/15/2023]
Abstract
Human Immunodeficiency Virus Type-I (HIV) is a health disparities issue that affects culturally and linguistically diverse (CALD) and underrepresented minority populations to a greater degree than non-Hispanic white populations. Neurologically speaking, CALD populations experience worse HIV-related health outcomes, which are exacerbated by inadequate neurocognitive measures, poor normative samples, and the complex interplay of sociocultural factors that may affect test interpretation. Although cross-cultural neuropsychologists are working diligently to correct this gap in the literature, currently, studies examining neurocognitive outcomes among CALD populations are sparse. The most well-studied CALD groups are of African American/Black and Latinx adults in the US, and the chapter therefore focuses on these studies. There is more limited work among other populations in the US, such as Asians, Native Hawaiians, Pacific Islanders, and American Indians/Alaskan Natives, and even fewer studies for many CALD populations outside of the US. For example, HIV neuropsychology data is rare or nonexistent in the First Peoples of Australia and Indigenous People of Canada. It is often not adequately reported in Europe for the migrant populations within those countries or other world regions that have historically large multicultural populations (e.g., South America, Caribbean countries, Asia, and Africa). Therefore, this chapter reviews HIV-related health disparities faced by CALD populations with focus on North American research where it has been specifically studied, with particular attention given to disparities in HIV-Associated Neurocognitive Disorders (HAND). International data was also included for research with focus on First Peoples of Australia and Indigenous People of Canada. The chapter also examines other sociocultural and health factors, including global and regional (e.g., rural versus urban) considerations, migration, and gender. Further, guidelines for incorporating sociocultural consideration into assessment and interpretation of neurocognitive data and HAND diagnosis when working with HIV-positive CALD populations that would be relevant internationally are provided.
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Tan YW, Burgess GH, Green RJ. The effects of acculturation on neuropsychological test performance: A systematic literature review. Clin Neuropsychol 2020; 35:541-571. [DOI: 10.1080/13854046.2020.1714740] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Yi Wen Tan
- Department of Neuroscience, Psychology and Behaviour, University of Leicester, Leicester, United Kingdom
| | - Gerald H. Burgess
- Salomons Institute for Applied Psychology Canterbury, Christ Church University, Canterbury, United Kingdom
| | - Robin J. Green
- Department of Neuroscience, Psychology and Behaviour, University of Leicester, Leicester, United Kingdom
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Peripheral Blood Mitochondrial DNA Copy Number Obtained From Genome-Wide Genotype Data Is Associated With Neurocognitive Impairment in Persons With Chronic HIV Infection. J Acquir Immune Defic Syndr 2019; 80:e95-e102. [PMID: 30531306 DOI: 10.1097/qai.0000000000001930] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Mitochondrial DNA (mtDNA) copy number varies by cell type and energy demands. Blood mtDNA copy number has been associated with neurocognitive function in persons without HIV. Low mtDNA copy number may indicate disordered mtDNA replication; high copy number may reflect a response to mitochondrial dysfunction. We hypothesized that blood mtDNA copy number estimated from genome-wide genotyping data is related to neurocognitive impairment (NCI) in persons with HIV. METHODS In the CNS HIV Antiretroviral Therapy Effects Research (CHARTER) study, peripheral blood mtDNA copy number was obtained from genome-wide genotyping data as a ratio of mtDNA single-nucleotide polymorphism probe intensities relative to nuclear DNA single-nucleotide polymorphisms. In a multivariable regression model, associations between mtDNA copy number and demographics, blood cell counts, and HIV disease and treatment characteristics were tested. Associations of mtDNA copy number with the global deficit score (GDS), GDS-defined NCI (GDS ≥ 0.5), and HIV-associated neurocognitive disorder (HAND) diagnosis were tested by logistic regression, adjusting for potential confounders. RESULTS Among 1010 CHARTER participants, lower mtDNA copy number was associated with longer antiretroviral therapy duration (P < 0.001), but not with d-drug exposure (P = 0.85). mtDNA copy number was also associated with GDS (P = 0.007), GDS-defined NCI (P < 0.001), and HAND (P = 0.002). In all analyses, higher mtDNA copy number was associated with poorer cognitive performance. CONCLUSIONS Higher mtDNA copy number estimated from peripheral blood genotyping was associated with worse neurocognitive performance in adults with HIV. These results suggest a connection between peripheral blood mtDNA and NCI, and may represent increased mtDNA replication in response to mitochondrial dysfunction.
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Chow FC, Makanjuola A, Wu K, Berzins B, Kim KYA, Ogunniyi A, Ellis RJ, Robertson K, Tassiopoulos K, Taiwo BO. Physical Activity Is Associated With Lower Odds of Cognitive Impairment in Women but Not Men Living With Human Immunodeficiency Virus Infection. J Infect Dis 2019; 219:264-274. [PMID: 30137500 DOI: 10.1093/infdis/jiy503] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 08/16/2018] [Indexed: 11/13/2022] Open
Abstract
Background Cardiovascular comorbidities are risk factors for human immunodeficiency virus (HIV)-associated cognitive impairment. Given differences in cardiometabolic risk profiles between women and men with HIV, we investigated whether associations between cardiometabolic risk factors and prevalent cognitive impairment differ by sex. Methods Separate logistic regression models were constructed for women and men at entry into a prospective study of older persons with HIV (PWH) to assess the association of cardiometabolic and other risk factors with cognitive impairment. Results Of 988 participants, 20% were women. Women had higher total cholesterol (194 vs 186 mg/dL; P = .027), hemoglobin A1c (5.9% vs 5.7%; P = .003), and body mass index (30.8 vs 27.4 kg/m2; P < .001) compared with men, and were less physically active (43% vs 55%; P = .005). In a multivariable model, physical activity was associated with lower odds of cognitive impairment in women (odds ratio, 0.35 [95% confidence interval, .15-.80]; P = .013) but not men. Conclusions Physical activity may have a greater positive impact on cognitive health in women than in men with HIV. This finding should be confirmed in studies examining the longitudinal association between physical activity and incident cognitive impairment in PWH and the effect of interventions that increase physical activity on cognitive impairment in women with HIV.
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Affiliation(s)
- Felicia C Chow
- Weill Institute for Neuroscience, University of California, San Francisco.,Department of Neurology and Division of Infectious Diseases, University of California, San Francisco
| | | | - Kunling Wu
- Center for Biostatistics in AIDS Research, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Baiba Berzins
- Division of Infectious Diseases and Center for Global Health
| | - Kwang-Youn A Kim
- Department of Preventive Medicine, Northwestern University, Chicago, Illinois
| | - Adesola Ogunniyi
- Department of Medicine (Neurology), University of Ibadan, Nigeria
| | - Ronald J Ellis
- Departments of Neurosciences and Psychiatry, University of California, San Diego
| | - Kevin Robertson
- Department of Neurology, University of North Carolina, Chapel Hill
| | - Katherine Tassiopoulos
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
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Impact of glycemic status on longitudinal cognitive performance in men with and without HIV infection. AIDS 2018; 32:1849-1860. [PMID: 29746300 DOI: 10.1097/qad.0000000000001842] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVES To determine the relationship between glycemic status and cognitive performance in men living with HIV (MLWH) and without HIV infection. DESIGN A prospective HIV/AIDS cohort study in four US cities between 1999 and 2016. METHODS Glycemic status was categorized as normal glucose, impaired fasting glucose, controlled diabetes mellitus and uncontrolled diabetes mellitus at each semiannual visit. Cognitive performance was evaluated using nine neuropsychological tests which measure attention, constructional ability, verbal learning, executive functioning, memory and psychomotor speed. Linear mixed models were used to assess the association between glycemic status and cognition. RESULTS Overall, 900 MLWH and 1149 men without HIV were included. MLWH had significantly more person-visits with impaired fasting glucose (52.1 vs. 47.9%) and controlled diabetes mellitus (58.2 vs. 41.8%) than men without HIV (P < 0.05). Compared with men with normal glucose, men with diabetes mellitus had significantly poorer performance on psychomotor speed, executive function and verbal learning (all P < 0.05). There was no difference in cognition by HIV serostatus. The largest effect was observed in individuals with uncontrolled diabetes mellitus throughout the study period, equivalent to 16.5 and 13.4 years of aging on psychomotor speed and executive function, respectively, the effect of which remained significant after adjusting for HIV-related risk factors. Lower CD4+ nadir was also associated with worse cognitive performance. CONCLUSION Abnormalities in glucose metabolism were more common among MLWH than men without HIV and were related to impaired cognitive performance. Metabolic status, along with advanced age and previous immunosuppression, may be important predictors of cognition in the modern antiretroviral therapy era.
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Abstract
OBJECTIVES Human immunodeficiency virus (HIV) disproportionately affects Hispanics/Latinos in the United States, yet little is known about neurocognitive impairment (NCI) in this group. We compared the rates of NCI in large well-characterized samples of HIV-infected (HIV+) Latinos and (non-Latino) Whites, and examined HIV-associated NCI among subgroups of Latinos. METHODS Participants included English-speaking HIV+ adults assessed at six U.S. medical centers (194 Latinos, 600 Whites). For overall group, age: M=42.65 years, SD=8.93; 86% male; education: M=13.17, SD=2.73; 54% had acquired immunodeficiency syndrome. NCI was assessed with a comprehensive test battery with normative corrections for age, education and gender. Covariates examined included HIV-disease characteristics, comorbidities, and genetic ancestry. RESULTS Compared with Whites, Latinos had higher rates of global NCI (42% vs. 54%), and domain NCI in executive function, learning, recall, working memory, and processing speed. Latinos also fared worse than Whites on current and historical HIV-disease characteristics, and nadir CD4 partially mediated ethnic differences in NCI. Yet, Latinos continued to have more global NCI [odds ratio (OR)=1.59; 95% confidence interval (CI)=1.13-2.23; p<.01] after adjusting for significant covariates. Higher rates of global NCI were observed with Puerto Rican (n=60; 71%) versus Mexican (n=79, 44%) origin/descent; this disparity persisted in models adjusting for significant covariates (OR=2.40; CI=1.11-5.29; p=.03). CONCLUSIONS HIV+ Latinos, especially of Puerto Rican (vs. Mexican) origin/descent had increased rates of NCI compared with Whites. Differences in rates of NCI were not completely explained by worse HIV-disease characteristics, neurocognitive comorbidities, or genetic ancestry. Future studies should explore culturally relevant psychosocial, biomedical, and genetic factors that might explain these disparities and inform the development of targeted interventions. (JINS, 2018, 24, 163-175).
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Vance D, Fazeli P, Shacka J, Nicholson W, McKie P, Raper J, Azuero A, Wadley V, Ball K. Testing a Computerized Cognitive Training Protocol in Adults Aging With HIV-Associated Neurocognitive Disorders: Randomized Controlled Trial Rationale and Protocol. JMIR Res Protoc 2017; 6:e68. [PMID: 28446421 PMCID: PMC5422019 DOI: 10.2196/resprot.6625] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Revised: 10/20/2016] [Accepted: 10/22/2016] [Indexed: 12/26/2022] Open
Abstract
Background HIV-associated neurocognitive disorders occur in nearly 50% of adults with HIV. Such disorders can interfere with everyday functioning such as driving and medication adherence. Therefore, cognitive interventions are needed to address such neurocognitive disorders as well as improve everyday functioning, especially as people age with HIV. Objective This article reports and discusses the overall rationale and development of speed of processing training, a computerized Internet cognitive training program, to improve this specific neurocognitive ability as well as everyday functioning and quality of life in adults aging with HIV. Although this protocol has been shown to improve speed of processing, everyday functioning, and quality of life in healthy, community-dwelling older adults in the advanced cognitive training in vital elderly (ACTIVE) study, its efficacy in adults aging with HIV has not been established. Nevertheless, such a cognitive intervention is particularly germane as 52%-59% of adults with HIV experience HIV-associated neurocognitive disorders (HAND), and both the frequency and severity of such disorders may increase with advancing age. Methods The description of this longitudinal randomized controlled trial covers the following: (1) rationale for speed of processing training in this clinical population, (2) overview of overall study design, (3) eligibility criteria and HAND, (4) intervention dosage, (5) assessment battery, and (6) examination of biomarkers. Results The project was funded in April 2016 and enrolment is on-going. The first results are expected to be submitted for publication in 2020. Conclusions Similar novel cognitive intervention approaches are suggested as they may be of value to those with HAND and may utilize similar features of this current randomized controlled trial (RCT) protocol to examine their therapeutic efficacy. Trial Registration ClinicalTrials.gov NCT02758093; https://clinicaltrials.gov/ct2/show/NCT02758093 (Archived by Webcite at http://www.webcitation.org/6p8C5fBCX)
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Affiliation(s)
- David Vance
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Pariya Fazeli
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, United States
| | - John Shacka
- Department of Pharmacology & Toxicology, University of Alabama at Birmingham, Birmingham, AL, United States
| | - William Nicholson
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Peggy McKie
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, United States
| | - James Raper
- School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Andres Azuero
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Virginia Wadley
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Karlene Ball
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, United States
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Patton SM, Wang Q, Hulgan T, Connor JR, Jia P, Zhao Z, Letendre SL, Ellis RJ, Bush WS, Samuels DC, Franklin DR, Kaur H, Iudicello J, Grant I, Kallianpur AR. Cerebrospinal fluid (CSF) biomarkers of iron status are associated with CSF viral load, antiretroviral therapy, and demographic factors in HIV-infected adults. Fluids Barriers CNS 2017; 14:11. [PMID: 28427421 PMCID: PMC5399327 DOI: 10.1186/s12987-017-0058-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Accepted: 04/01/2017] [Indexed: 02/06/2023] Open
Abstract
Background HIV-associated neurocognitive disorder (HAND) remains common, despite antiretroviral therapy (ART). HIV dysregulates iron metabolism, but cerebrospinal fluid (CSF) levels of iron and iron-transport proteins in HIV-infected (HIV+) persons are largely unknown. The objectives of this study were to characterize CSF iron-related biomarkers in HIV+ adults and explore their relationships to known predictors of HAND. Methods We quantified total iron, transferrin and heavy-chain (H)-ferritin by immunoassay in CSF sampled by lumbar puncture in 403 HIV+ participants in a multi-center, observational study and evaluated biomarker associations with demographic and HIV-related correlates of HAND [e.g., age, sex, self-reported race/ethnicity, ART, and detectable plasma virus and CSF viral load (VL)] by multivariable regression. In a subset (N = 110) with existing CSF: serum albumin (QAlb) measurements, QAlb and comorbidity severity were also included as covariates to account for variability in the blood–CSF-barrier. Results Among 403 individuals (median age 43 years, 19% women, 56% non-Whites, median nadir CD4+ T cell count 180 cells/µL, 46% with undetectable plasma virus), men had 25% higher CSF transferrin (median 18.1 vs. 14.5 µg/mL), and 71% higher H-ferritin (median 2.9 vs. 1.7 ng/mL) than women (both p-values ≤0.01). CSF iron was 41% higher in self-reported Hispanics and 27% higher in (non-Hispanic) Whites than in (non-Hispanic) Blacks (median 5.2 and 4.7 µg/dL in Hispanics and Whites, respectively, vs. 3.7 µg/dL in Blacks, both p ≤ 0.01); these findings persisted after adjustment for age, sex, and HIV-specific factors. Median H-ferritin was 25% higher (p < 0.05), and transferrin 14% higher (p = 0.06), in Whites than Blacks. Transferrin and H-ferritin were 33 and 50% higher, respectively, in older (age > 50 years) than in younger persons (age ≤ 35 years; both p < 0.01), but these findings lost statistical significance in subset analyses that adjusted for QAlb and comorbidity. After these additional adjustments, associations were observed for CSF iron and transferrin with race/ethnicity as well as CSF VL, for transferrin with sex and ART, and for H-ferritin with plasma virus detectability and significant comorbidity (all p < 0.05). Conclusions CSF iron biomarkers are associated with demographic factors, ART, and CSF VL in HIV+ adults. Future studies should investigate a role for CNS iron dysregulation, to which an altered blood-CSF barrier may contribute, in HAND. Electronic supplementary material The online version of this article (doi:10.1186/s12987-017-0058-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Stephanie M Patton
- Department of Neurosurgery, Penn State Hershey Medical Center, 500 University Drive, Mailbox H110, Hershey, PA, 17033, USA.
| | - Quan Wang
- Department of Biomedical Informatics, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Todd Hulgan
- Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - James R Connor
- Department of Neurosurgery, Penn State Hershey Medical Center, 500 University Drive, Mailbox H110, Hershey, PA, 17033, USA
| | - Peilin Jia
- School of Biomedical Informatics, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Zhongming Zhao
- School of Biomedical Informatics, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Scott L Letendre
- Department of Medicine, University of California-San Diego, San Diego, CA, USA
| | - Ronald J Ellis
- Department of Neurology, University of California-San Diego, San Diego, CA, USA
| | - William S Bush
- Department of Epidemiology and Biostatistics, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - David C Samuels
- Department of Molecular Physiology and Biophysics, Vanderbilt University, Nashville, TN, USA
| | - Donald R Franklin
- Department of Medicine, University of California-San Diego, San Diego, CA, USA
| | - Harpreet Kaur
- Genomic Medicine Institute, Cleveland Clinic/Lerner Research Institute, Cleveland, OH, USA
| | - Jennifer Iudicello
- Department of Psychiatry, University of California-San Diego, San Diego, CA, USA
| | - Igor Grant
- Department of Psychiatry, University of California-San Diego, San Diego, CA, USA
| | - Asha R Kallianpur
- Genomic Medicine Institute, Cleveland Clinic/Lerner Research Institute, Cleveland, OH, USA.,Department of Molecular Medicine, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA
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Miller TR, Weiss JJ, Bräu N, Dieterich DT, Stivala A, Rivera-Mindt M. Greater decline in memory and global neurocognitive function in HIV/hepatitis C co-infected than in hepatitis C mono-infected patients treated with pegylated interferon and ribavirin. J Neurovirol 2017; 23:260-272. [PMID: 27896573 PMCID: PMC5334364 DOI: 10.1007/s13365-016-0494-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Revised: 09/21/2016] [Accepted: 10/20/2016] [Indexed: 12/18/2022]
Abstract
The human immunodeficiency virus (HIV), hepatitis C virus (HCV), and the treatment of HCV with pegylated interferon and ribavirin (IFN/RBV) have been associated with neurocognitive and psychiatric abnormalities. The goal of this research was to prospectively evaluate neurocognitive functioning among a group of HCV mono-infected and HIV/HCV co-infected patients during the first 24 weeks of IFN/RBV treatment while accounting for practice effects, normal variations in change over time, and variations in IFN/RBV treatment exposure. Forty-four HCV mono-infected and 30 HIV/HCV co-infected patients were enrolled in a prospective study of patients beginning on IFN/RBV for chronic HCV infection. Patients were administered a depression inventory, a measure of fatigue, a structured psychiatric interview, and a neurocognitive battery at baseline and 24 weeks after initiation of treatment. Analyses were conducted to explore possible associations between neurocognitive functioning and the following: HIV/HCV co-infection vs. HCV mono-infection, IFN and RBV treatment exposure, psychiatric status, liver disease stage, and other medical characteristics. At baseline, there were no significant differences between the two groups' neuropsychiatric or neurocognitive function other than the mono-infected group had significantly higher reports of fatigue (p = 0.033). Over the course of 24 weeks of treatment after controlling for practice effects, the HIV/HCV co-infected patients experienced significantly greater declines in memory (t(56) = 2.14, p = 0.037) and global neurocognitive functioning (t(53) = 2.28, p = 0.027). In a well-characterized sample of mono-infected and co-infected patients, it appears that persons with HIV/HCV co-infection are potentially more vulnerable to neurocognitive sequalae during HCV treatment.
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Affiliation(s)
- Theodore R Miller
- Department of Medicine, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, PO Box 1087, New York, NY, 10029, USA
- Yale School of Nursing, 400 West Campus Drive, Orange, CT, 06477, USA
| | - Jeffrey J Weiss
- Department of Medicine, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, PO Box 1087, New York, NY, 10029, USA.
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY, 10029, USA.
| | - Norbert Bräu
- Department of Medicine, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, PO Box 1087, New York, NY, 10029, USA
- Infectious Disease Section, Bronx Veterans Affairs Medical Center, 130 W. Kingsbridge Road, Bronx, New York, NY, 10468, USA
| | - Douglas T Dieterich
- Department of Medicine, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, PO Box 1087, New York, NY, 10029, USA
| | - Alicia Stivala
- Department of Medicine, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, PO Box 1087, New York, NY, 10029, USA
| | - Monica Rivera-Mindt
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY, 10029, USA
- Psychology Department, Fordham University, DE 340, 441 E. Fordham Road, Bronx, NY, 10458, USA
- Department of Neurology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY, 10029, USA
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