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Browne S, Umlauf A, Moore DJ, Benson CA, Vaida F. User Experience of Persons Using Ingestible Sensor-Enabled Pre-Exposure Prophylaxis to Prevent HIV Infection: Cross-Sectional Survey Study. JMIR Mhealth Uhealth 2024; 12:e53596. [PMID: 38722201 PMCID: PMC11085042 DOI: 10.2196/53596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 02/26/2024] [Accepted: 04/01/2024] [Indexed: 05/12/2024] Open
Abstract
Background A digital health technology's success or failure depends on how it is received by users. objectives We conducted a user experience (UX) evaluation among persons who used the Food and Drug Administration-approved Digital Health Feedback System incorporating ingestible sensors (ISs) to capture medication adherence, after they were prescribed oral pre-exposure prophylaxis (PrEP) to prevent HIV infection. We performed an association analysis with baseline participant characteristics, to see if "personas" associated with positive or negative UX emerged. Methods UX data were collected upon exit from a prospective intervention study of adults who were HIV negative, prescribed oral PrEP, and used the Digital Health Feedback System with IS-enabled tenofovir disoproxil fumarate plus emtricitabine (IS-Truvada). Baseline demographics; urine toxicology; and self-report questionnaires evaluating sleep (Pittsburgh Sleep Quality Index), self-efficacy, habitual self-control, HIV risk perception (Perceived Risk of HIV Scale 8-item), and depressive symptoms (Patient Health Questionnaire-8) were collected. Participants with ≥28 days in the study completed a Likert-scale UX questionnaire of 27 questions grouped into 4 domain categories: overall experience, ease of use, intention of future use, and perceived utility. Means and IQRs were computed for participant total and domain subscores, and linear regressions modeled baseline participant characteristics associated with UX responses. Demographic characteristics of responders versus nonresponders were compared using the Fisher exact and Wilcoxon rank-sum tests. Results Overall, 71 participants were enrolled (age: mean 37.6, range 18-69 years; n=64, 90% male; n=55, 77% White; n=24, 34% Hispanic; n=68, 96% housed; and n=53, 75% employed). No demographic differences were observed in the 63 participants who used the intervention for ≥28 days. Participants who completed the questionnaire were more likely to be housed (52/53, 98% vs 8/10, 80%; P=.06) and less likely to have a positive urine toxicology (18/51, 35% vs 7/10, 70%; P=.08), particularly methamphetamine (4/51, 8% vs 4/10, 40%; P=.02), than noncompleters. Based on IQR values, ≥75% of participants had a favorable UX based on the total score (median 3.78, IQR 3.17-4.20), overall experience (median 4.00, IQR 3.50-4.50), ease of use (median 3.72, IQR 3.33-4.22), and perceived utility (median 3.72, IQR 3.22-4.25), and ≥50% had favorable intention of future use (median 3.80, IQR 2.80-4.40). Following multipredictor modeling, self-efficacy was significantly associated with the total score (0.822, 95% CI 0.405-1.240; P<.001) and all subscores (all P<.05). Persons with more depressive symptoms reported better perceived utility (P=.01). Poor sleep was associated with a worse overall experience (-0.07, 95% CI -0.133 to -0.006; P=.03). Conclusions The UX among persons using IS-enabled PrEP (IS-Truvada) to prevent HIV infection was positive. Association analysis of baseline participant characteristics linked higher self-efficacy with positive UX, more depressive symptoms with higher perceived utility, and poor sleep with negative UX.
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Affiliation(s)
- Sara Browne
- Division of Infectious Diseases and Global Public Health, University of California San Diego, San Diego, CA, United States
- Specialists in Global Health, Encinitas, CA, United States
| | - Anya Umlauf
- Department of Psychiatry, University of California San Diego, San Diego, CA, United States
| | - David J Moore
- Department of Psychiatry, University of California San Diego, San Diego, CA, United States
| | - Constance A Benson
- Division of Infectious Diseases and Global Public Health, University of California San Diego, San Diego, CA, United States
| | - Florin Vaida
- Department of Family Medicine and Public Health, University of California San Diego, San Diego, CA, United States
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Browne SH, Vaida F, Umlauf A, Kim J, DeYoung P, Owens RL. Performance of a commercial smart watch compared to polysomnography reference for overnight continuous oximetry measurement and sleep apnea evaluation. J Clin Sleep Med 2024. [PMID: 38652502 DOI: 10.5664/jcsm.11178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
STUDY OBJECTIVES To evaluate the accuracy and precision of continuous overnight oxygen saturation (SpO2) measurement by a commercial wrist device (WD) incorporating high-grade sensors, and investigate WD estimation of sleep-disordered breathing by quantifying overnight oxygen desaturation index (ODI) compared to polysomnography (PSG) ODI and apnea-hypopnea index (AHI) with and without sleep questionnaire data, to assess WD ability to detect obstructive sleep apnea (OSA) and determine its severity. METHODS Participants completed sleep questionnaires, had a WD (Samsung Galaxy Watch 4) placed on their wrist, and underwent attending, in-lab overnight PSG (Nihon Kohden) with pulse oximetry probe secured either to a finger or ear lobe. PSG data was scored by a single experienced registered PSG technologist. Statistical analysis included demographic characteristics, continuous SpO2 measurement WD vs PSG root mean square error (RMSE) with Bland Altman plot and linear regression associations. Predictive models for PSG ODI and AHI severity were built using logistic regression with probability cutoffs determined via receiver operating curve (ROC) characteristics. RESULTS The 51 participants analyzed had median age of 49 (range 22-78) years, 66.7% were male, with median body mass index (BMI) 28.1 (range 20.1, 47.3) kg/m2 with race/ethnicity distribution of 49.0% Caucasian, 25.5% Hispanic, 9.8% African-American, 9.8% Asian, and 5.9% Middle Eastern. WD vs PSG continuous SpO2 measurement in percentage points demonstrated bias of 0.91 (CI95 0.38, 1.45), standard deviation 2.37 (CI95 2.36, 2.38), and RMSE 2.54 (CI95 2.34, 2.73). WD area under the curve (AUC) ROC characteristics for predicting PSG were 0.882 ODI>15/h, 0.894 AHI>30/h, 0.800 AHI>15/h, and 0.803 AHI>5/h. WD plus select sleep questionnaire AUCs for predicting PSG were 0.943 AHI>30/h, 0.868 AHI>15/h, and 0.863 AHI>5/h. CONCLUSIONS The WD conducted reliable overnight continuous SpO2 monitoring with RMSE <3% vs PSG. Predictive models of PSG AHI based on WD measurements alone, or plus sleep questionnaires, demonstrated excellent to outstanding discrimination for OSA identification and severity. Longitudinal WD use should be evaluated promptly based on WD potential to improve accessibility and accuracy of OSA testing, as well as support treatment follow-up.
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Affiliation(s)
- Sara H Browne
- Department of Medicine, University of California San Diego (UCSD), La Jolla, CA
- Specialists in Global Health
| | - Florin Vaida
- Herbert Wertheim School of Public Health & Human Longevity Science, UCSD, La Jolla, CA
| | - Anya Umlauf
- Department of Psychiatry, UCSD, La Jolla, CA
| | - Jeffrey Kim
- Department of Medicine, University of California San Diego (UCSD), La Jolla, CA
- Specialists in Global Health
| | - Pamela DeYoung
- Department of Medicine, University of California San Diego (UCSD), La Jolla, CA
| | - Robert L Owens
- Department of Medicine, University of California San Diego (UCSD), La Jolla, CA
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Grant I, Krupitsky E, Vetrova M, Umlauf A, Heaton RK, Hauger RL, Toussova O, Franklin DR, Letendre SL, Woody G, Blokhina E, Lioznov D, Zvartau E. Effects of Opioid Withdrawal on Psychobiology in People Living with HIV. Viruses 2024; 16:92. [PMID: 38257791 PMCID: PMC10818595 DOI: 10.3390/v16010092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 12/20/2023] [Accepted: 12/21/2023] [Indexed: 01/24/2024] Open
Abstract
OBJECTIVE Many persons with opioid use disorders (OUDs) have HIV disease and experience clinically significant stress after they enroll in abstinence-based treatment and undergo medically assisted withdrawal. We examined whether opioid withdrawal affects virologic control, inflammatory markers, cognition, and mood in persons with an OUD and HIV, and explored whether measures of withdrawal stress, such as activation of the HPA axis, contribute to alterations in immune function, cognition, and mood. METHOD AND PARTICIPANTS Study participants were 53 persons with HIV who were admitted for OUD treatment at the City Addiction Hospital in Saint Petersburg, Russian Federation. Participants were examined at admission, at the anticipated peak of withdrawal 3 to 7 days after the last day of a clonidine-based withdrawal process lasting 7 to 14 days, and 3 to 4 weeks after completing withdrawal. At these times, participants received medical exams and were evaluated for symptoms of withdrawal, as well as cognition and mood. Viral load, plasma cortisol, DHEA sulfate ester (DHEA-S), interleukin-6 (IL-6), and soluble CD14 (sCD14) were determined. Multivariable models examined the relationships between markers of HPA activation and the other parameters over time. RESULTS HPA activation as indexed by cortisol/DHEA-S ratio increased during withdrawal, as did markers of immune activation, IL-6 and sCD14. There were no significant associations between viral load and indicators of HPA activation. In longitudinal analyses, higher cortisol/DHEA sulfate was related to worse cognition overall, and more mood disturbance. Increase in IL-6 was associated with worse cognitive performance on a learning task. There were no significant associations with sCD14. CONCLUSIONS Worsening of cognition and measures of mood disturbance during withdrawal were associated with activation of the HPA axis and some measures of inflammation. Whether repeated episodes of opioid withdrawal have a cumulative impact on long-term HIV outcomes and neurocognition is a topic for further investigation.
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Affiliation(s)
- Igor Grant
- HIV Neurobehavioral Research Program, Department of Psychiatry, University of California San Diego, San Diego, CA 92103, USA; (A.U.); (R.K.H.); (R.L.H.); (D.R.F.); (S.L.L.)
| | - Evgeny Krupitsky
- Department of Pharmacology, Pavlov State Medical University, 197022 Saint Petersburg, Russia; (E.K.); (M.V.); (O.T.); (E.B.); (D.L.); (E.Z.)
- Department of Addictions, Bekhterev National Medical Research Center for Psychiatry and Neurology, 192019 Saint Petersburg, Russia
| | - Marina Vetrova
- Department of Pharmacology, Pavlov State Medical University, 197022 Saint Petersburg, Russia; (E.K.); (M.V.); (O.T.); (E.B.); (D.L.); (E.Z.)
| | - Anya Umlauf
- HIV Neurobehavioral Research Program, Department of Psychiatry, University of California San Diego, San Diego, CA 92103, USA; (A.U.); (R.K.H.); (R.L.H.); (D.R.F.); (S.L.L.)
| | - Robert K. Heaton
- HIV Neurobehavioral Research Program, Department of Psychiatry, University of California San Diego, San Diego, CA 92103, USA; (A.U.); (R.K.H.); (R.L.H.); (D.R.F.); (S.L.L.)
| | - Richard L. Hauger
- HIV Neurobehavioral Research Program, Department of Psychiatry, University of California San Diego, San Diego, CA 92103, USA; (A.U.); (R.K.H.); (R.L.H.); (D.R.F.); (S.L.L.)
- Center for Behavior Genetics of Aging, University of California San Diego, La Jolla, CA 92093, USA
- Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego, CA 92093, USA
| | - Olga Toussova
- Department of Pharmacology, Pavlov State Medical University, 197022 Saint Petersburg, Russia; (E.K.); (M.V.); (O.T.); (E.B.); (D.L.); (E.Z.)
| | - Donald R. Franklin
- HIV Neurobehavioral Research Program, Department of Psychiatry, University of California San Diego, San Diego, CA 92103, USA; (A.U.); (R.K.H.); (R.L.H.); (D.R.F.); (S.L.L.)
| | - Scott L. Letendre
- HIV Neurobehavioral Research Program, Department of Psychiatry, University of California San Diego, San Diego, CA 92103, USA; (A.U.); (R.K.H.); (R.L.H.); (D.R.F.); (S.L.L.)
- Department of Medicine, University of California, San Diego, CA 92093, USA
| | - George Woody
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA 19104, USA;
| | - Elena Blokhina
- Department of Pharmacology, Pavlov State Medical University, 197022 Saint Petersburg, Russia; (E.K.); (M.V.); (O.T.); (E.B.); (D.L.); (E.Z.)
| | - Dmitry Lioznov
- Department of Pharmacology, Pavlov State Medical University, 197022 Saint Petersburg, Russia; (E.K.); (M.V.); (O.T.); (E.B.); (D.L.); (E.Z.)
| | - Edwin Zvartau
- Department of Pharmacology, Pavlov State Medical University, 197022 Saint Petersburg, Russia; (E.K.); (M.V.); (O.T.); (E.B.); (D.L.); (E.Z.)
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Umlauf A, Vaida F, Gupta S, Cherner M, Gershon RC, Heaton RK. Automated procedure for demographic adjustments on cognitive test scores. Appl Neuropsychol Adult 2023:1-10. [PMID: 38052056 DOI: 10.1080/23279095.2023.2288231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/07/2023]
Abstract
Performances of normal people on cognitive tests are known to vary by demographic characteristics, such as age, education, and sex. Thus, cognitive test scores should be corrected for demographic influences when they are used to detect below-expected results due to disease or injury involving the central nervous system (CNS). Normative corrections, if estimated from a large, diverse, and well-characterized cohort of controls, help to remove expected differences in cognitive performance associated with normal demographic characteristics and associated socio-economic disadvantages. In this paper, we (1) describe in detail the process of generating regression-based normative standards, and its advantages and limitations, (2) provide recommendations for applying these normative standards to data from individuals and populations at risk for CNS dysfunction, and (3) introduce an R package, test2norm, that contains functions for producing and applying normative formulas to generate demographically corrected scores for measuring deviations from expected, normal cognitive performances.
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Affiliation(s)
- Anya Umlauf
- University of California San Diego, La Jolla, CA, USA
| | - Florin Vaida
- University of California San Diego, La Jolla, CA, USA
| | | | | | - Richard C Gershon
- Department of Medical Social Sciences, Northwestern University, Chicago, IL, USA
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Moore RC, Kuehn KS, Heaton A, Sundermann EE, Campbell LM, Torre P, Umlauf A, Moore DJ, Kosoris N, Wright DW, LaPlaca MC, Waldrop D, Anderson AM. An Automated Virtual Reality Program Accurately Diagnoses HIV-Associated Neurocognitive Disorders in Older People With HIV. Open Forum Infect Dis 2023; 10:ofad592. [PMID: 38149107 PMCID: PMC10750141 DOI: 10.1093/ofid/ofad592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 11/27/2023] [Indexed: 12/28/2023] Open
Abstract
Background HIV-associated neurocognitive disorders (HANDs) remain prevalent despite antiretroviral therapy, particularly among older people with HIV (PWH). However, the diagnosis of HAND is labor intensive and requires expertise to administer neuropsychological tests. Our prior pilot work established the feasibility and accuracy of a computerized self-administered virtual reality program (DETECT; Display Enhanced Testing for Cognitive Impairment and Traumatic Brain Injury) to measure cognition in younger PWH. The present study expands this to a larger sample of older PWH. Methods We enrolled PWH who were ≥60 years old, were undergoing antiretroviral therapy, had undetectable plasma viral loads, and were without significant neuropsychological confounds. HAND status was determined via Frascati criteria. Regression models that controlled for demographic differences (age, sex, education, race/ethnicity) examined the association between DETECT's cognition module and both HAND status and Global Deficit Score (GDS) derived via traditional neuropsychological tests. Results Seventy-nine PWH (mean age, 66 years; 28% women) completed a comprehensive neuropsychological battery and DETECT's cognition module. Twenty-five (32%) had HAND based on the comprehensive battery. A significant correlation was found between the DETECT cognition module and the neuropsychological battery (r = 0.45, P < .001). Furthermore, in two separate regression models, HAND status (b = -0.79, P < .001) and GDS impairment status (b = -0.83, P < .001) significantly predicted DETECT performance. Areas under the curve for DETECT were 0.78 for differentiating participants by HAND status (HAND vs no HAND) and 0.85 for detecting GDS impairment. Conclusions The DETECT cognition module provides a novel means to identify cognitive impairment in older PWH. As DETECT is fully immersive and self-administered, this virtual reality tool holds promise as a scalable cognitive screening battery.
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Affiliation(s)
- Raeanne C Moore
- Department of Psychiatry, School of Medicine, University of California at San Diego, La Jolla, California, USA
| | - Kevin S Kuehn
- Department of Psychiatry, School of Medicine, University of California at San Diego, La Jolla, California, USA
| | - Anne Heaton
- Department of Psychiatry, School of Medicine, University of California at San Diego, La Jolla, California, USA
| | - Erin E Sundermann
- Department of Psychiatry, School of Medicine, University of California at San Diego, La Jolla, California, USA
| | - Laura M Campbell
- Department of Psychiatry, School of Medicine, University of California at San Diego, La Jolla, California, USA
- University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego State University, San Diego, California, USA
| | - Peter Torre
- San Diego State University, San Diego, California, USA
| | - Anya Umlauf
- Department of Psychiatry, School of Medicine, University of California at San Diego, La Jolla, California, USA
| | - David J Moore
- Department of Psychiatry, School of Medicine, University of California at San Diego, La Jolla, California, USA
| | | | - David W Wright
- Department of Emergency Medicine, School of Medicine, Emory University, Atlanta, Georgia, USA
| | - Michelle C LaPlaca
- Department of Biomedical Engineering, Georgia Tech and Emory University, Atlanta, Georgia, USA
| | - Drenna Waldrop
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
| | - Albert M Anderson
- Division of Infectious Diseases, Department of Medicine, School of Medicine, Emory University, Atlanta, Georgia, USA
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Wang CX, Hussain MA, Carvalho de LT, Castellanos-Ponce V, Cherner M, Palmer BW, Umlauf A, Heaton RK, Ellis RJ, Marquine MJ. B - 45 Differences in the Association between Social Activity and Neurocognition between Latino and Non-Hispanic White Older Adults with HIV. Arch Clin Neuropsychol 2023; 38:1409. [PMID: 37807444 DOI: 10.1093/arclin/acad067.251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2023] Open
Abstract
OBJECTIVE Older Hispanics/Latinos/as/x (henceforth Latinos) are disproportionately affected by HIV-associated neurocognitive impairment compared to their non-Hispanic White counterparts. We examined social activity as a possible protective factor against worse neurocognitive outcomes for older people with HIV (PWH). Given cultural values regarding interpersonal relationships, we also examined whether the association between social activity and neurocognition was stronger for Latino than White PWH. METHOD Community-dwelling PWH (N = 114; 50% Latino [53% Spanish-speaking]; Overall group: Age: M = 58.03 SD = 5.75; Education: M = 13.29, SD = 3.39; 82% male; 58% AIDS; 95% on antiretroviral therapy; 4% detectable plasma RNA) completed neuropsychological and neuromedical evaluations. Global neurocognition was derived from demographically adjusted T-scores on a battery of 10 tests with separate norms for English and Spanish-speakers. A questionnaire assessed participants' engagement in 7 social activities over the past year. Covariates included physical activity, depressed mood, and HIV disease characteristics. RESULTS There were no ethnic differences in degree or nature of social activity. A linear regression model revealed a significant interaction between ethnicity and social activity on global neurocognitive T-scores, (β = 0.45, SE = 0.18, p = 0.02), such that increased engagement in social activities was associated with better global neurocognition in White PWH (β = 3.40, SE = 1.13, p < 0.01), but not Latino PWH (β = 0.57, SE = 1.00, p = 0.57). CONCLUSIONS Results indicate a possible protective influence of social activity on neurocognition in older White, but not Latino PWH, highlighting the importance of examining the generalizability of this relationship across ethnic/cultural groups. Future studies might examine the quality of social activities and their link with neurocognition in diverse older PWH.
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Marcotte TD, Umlauf A, Grelotti DJ, Sones EG, Mastropietro KF, Suhandynata RT, Huestis MA, Grant I, Fitzgerald RL. Evaluation of Field Sobriety Tests for Identifying Drivers Under the Influence of Cannabis: A Randomized Clinical Trial. JAMA Psychiatry 2023; 80:914-923. [PMID: 37531115 PMCID: PMC10398547 DOI: 10.1001/jamapsychiatry.2023.2345] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 05/04/2023] [Indexed: 08/03/2023]
Abstract
Importance With increasing medicinal and recreational cannabis legalization, there is a public health need for effective and unbiased evaluations for determining whether a driver is impaired due to Δ9-tetrahydrocannabinol (THC) exposure. Field sobriety tests (FSTs) are a key component of the gold standard law enforcement officer-based evaluations, yet controlled studies are inconclusive regarding their efficacy in detecting whether a person is under the influence of THC. Objective To examine the classification accuracy of FSTs with respect to cannabis exposure and driving impairment (as determined via a driving simulation). Design, Setting, and Participants This double-blind, placebo-controlled parallel randomized clinical trial was conducted from February 2017 to June 2019 at the Center for Medicinal Cannabis Research, University of California, San Diego. Participants were aged 21 to 55 years and had used cannabis in the past month. Data were analyzed from August 2021 to April 2023. Intervention Participants were randomized 1:1:1 to placebo (0.02% THC), 5.9% THC cannabis, or 13.4% THC cannabis smoked ad libitum. Main Outcome and Measures The primary end point was law enforcement officer determination of FST impairment at 4 time points after smoking. Additional measures included officer estimation as to whether participants were in the THC or placebo group as well as driving simulator data. Officers did not observe driving performance. Results The study included 184 participants (117 [63.6%] male; mean [SD] age, 30 [8.3] years) who had used cannabis a mean (SD) of 16.7 (9.8) days in the past 30 days; 121 received THC and 63, placebo. Officers classified 98 participants (81.0%) in the THC group and 31 (49.2%) in the placebo group as FST impaired (difference, 31.8 percentage points; 95% CI, 16.4-47.2 percentage points; P < .001) at 70 minutes after smoking. The THC group performed significantly worse than the placebo group on 8 of 27 individual FST components (29.6%) and all FST summary scores. However, the placebo group did not complete a median of 8 (IQR, 5-11) FST components as instructed. Of 128 participants classified as FST impaired, officers suspected 127 (99.2%) as having received THC. Driving simulator performance was significantly associated with results of select FSTs (eg, ≥2 clues on One Leg Stand was associated with impairment on the simulator: odds ratio, 3.09; 95% CI, 1.63-5.88; P < .001). Conclusions and Relevance This randomized clinical trial found that when administered by highly trained officers, FSTs differentiated between individuals receiving THC vs placebo and driving abilities were associated with results of some FSTs. However, the high rate at which the participants receiving placebo failed to adequately perform FSTs and the high frequency that poor FST performance was suspected to be due to THC-related impairment suggest that FSTs, absent other indicators, may be insufficient to denote THC-specific impairment in drivers. Trial Registration ClinicalTrials.gov Identifier: NCT02849587.
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Affiliation(s)
- Thomas D. Marcotte
- Center for Medicinal Cannabis Research, Department of Psychiatry, University of California, San Diego
| | - Anya Umlauf
- Center for Medicinal Cannabis Research, Department of Psychiatry, University of California, San Diego
| | - David J. Grelotti
- Center for Medicinal Cannabis Research, Department of Psychiatry, University of California, San Diego
| | - Emily G. Sones
- Center for Medicinal Cannabis Research, Department of Psychiatry, University of California, San Diego
| | - Kyle F. Mastropietro
- Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, San Diego
| | - Raymond T. Suhandynata
- Center for Medicinal Cannabis Research, Department of Pathology, University of California, San Diego
- Center for Medicinal Cannabis Research, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, San Diego
| | - Marilyn A. Huestis
- Institute for Emerging Health Professions, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Igor Grant
- Center for Medicinal Cannabis Research, Department of Psychiatry, University of California, San Diego
| | - Robert L. Fitzgerald
- Center for Medicinal Cannabis Research, Department of Pathology, University of California, San Diego
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10
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Miranda A, Perry W, Umlauf A, Young JW, Morgan EE, Minassian A. A Pilot Assessment of the Effects of HIV and Methamphetamine Dependence on Socially Dysregulated Behavior in the Human Behavioral Pattern Monitor. AIDS Behav 2023; 27:2617-2628. [PMID: 36738342 PMCID: PMC9898694 DOI: 10.1007/s10461-023-03987-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/09/2023] [Indexed: 02/05/2023]
Abstract
Deficits in social cognition are seen in both people living with HIV (PWH) and people with a history of methamphetamine (METH) dependence. Dually affected individuals may experience additive negative effects on social cognition due to these conditions. We evaluated social cognition in 4 diagnostic groups (HIV-/METH-, HIV-/METH+, HIV+/METH-, HIV+/METH+). First, we used traditional social-emotional functioning assessments, the Difficulties in Emotion Regulation Scale and the Faux Pas Task, to determine any significant effects of METH dependence and HIV on social cognition. Next, we quantified social cognition using the Human Behavioral Pattern Monitor by evaluating social behavior represented by interaction with novel objects. METH dependence significantly affected social-emotional functions and HIV significantly affected on object interactions, however no significant additive effects were observed using these methods. The nuanced relationship between HIV and METH dependence suggests that other factors (i.e., adaptive life skills) likely mediate social cognition-related behaviors.
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Affiliation(s)
- Alannah Miranda
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA.
| | - William Perry
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Anya Umlauf
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Jared W Young
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Erin E Morgan
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Arpi Minassian
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
- Center of Excellence on Stress and Mental Health, San Diego, CA, USA
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11
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Fitzgerald RL, Umlauf A, Hubbard JA, Hoffman MA, Sobolesky PM, Ellis SE, Grelotti DJ, Suhandynata RT, Huestis MA, Grant I, Marcotte TD. Driving Under the Influence of Cannabis: Impact of Combining Toxicology Testing with Field Sobriety Tests. Clin Chem 2023; 69:724-733. [PMID: 37228223 PMCID: PMC10320013 DOI: 10.1093/clinchem/hvad054] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 04/13/2023] [Indexed: 05/27/2023]
Abstract
BACKGROUND Cannabis is increasingly used both medically and recreationally. With widespread use, there is growing concern about how to identify cannabis-impaired drivers. METHODS A placebo-controlled randomized double-blinded protocol was conducted to study the effects of cannabis on driving performance. One hundred ninety-one participants were randomized to smoke ad libitum a cannabis cigarette containing placebo or delta-9-tetrahydrocannabinol (THC) (5.9% or 13.4%). Blood, oral fluid (OF), and breath samples were collected along with longitudinal driving performance on a simulator (standard deviation of lateral position [SDLP] and car following [coherence]) over a 5-hour period. Law enforcement officers performed field sobriety tests (FSTs) to determine if participants were impaired. RESULTS There was no relationship between THC concentrations measured in blood, OF, or breath and SDLP or coherence at any of the timepoints studied (P > 0.05). FSTs were significant (P < 0.05) for classifying participants into the THC group vs the placebo group up to 188 minutes after smoking. Seventy-one minutes after smoking, FSTs classified 81% of the participants who received active drug as being impaired. However, 49% of participants who smoked placebo (controls) were also deemed impaired at this same timepoint. Combining a 2 ng/mL THC cutoff in OF with positive findings on FSTs reduced the number of controls classified as impaired to zero, 86 minutes after smoking the placebo. CONCLUSIONS Requiring a positive toxicology result in addition to the FST observations substantially improved the classification accuracy regarding possible driving under the influence of THC by decreasing the percentage of controls classified as impaired.
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Affiliation(s)
| | - Anya Umlauf
- Department of Psychiatry, University of California San Diego, Center for Medicinal Cannabis Research, San Diego, CA, United States
| | | | | | | | - Shannon E Ellis
- Department of Cognitive Sciences, University of California San Diego, La Jolla, CA, United States
| | - David J Grelotti
- Department of Psychiatry, University of California San Diego, Center for Medicinal Cannabis Research, San Diego, CA, United States
| | | | - Marilyn A Huestis
- Institute for Emerging Health Professions, Thomas Jefferson University, Philadelphia, PA, United States
| | - Igor Grant
- Department of Psychiatry, University of California San Diego, Center for Medicinal Cannabis Research, San Diego, CA, United States
| | - Thomas D Marcotte
- Department of Psychiatry, University of California San Diego, Center for Medicinal Cannabis Research, San Diego, CA, United States
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12
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Oprea C, Ianache I, Vasile S, Costescu C, Tardei G, Nica M, Umlauf A, Achim C. Brain opportunistic infections and tumors in people living with HIV - still a challenge in efficient antiretroviral therapy era. J Neurovirol 2023; 29:297-307. [PMID: 37219810 PMCID: PMC10204662 DOI: 10.1007/s13365-023-01135-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 03/23/2023] [Accepted: 04/07/2023] [Indexed: 05/24/2023]
Abstract
The aim of the study was to evaluate the incidence of brain opportunistic pathologies and survival in patients living with HIV from a Romanian tertiary center. A 15-year prospective observational study of brain opportunistic infections diagnosed in HIV-infected patients was performed at Victor Babes Hospital, Bucharest, between January 2006 and December 2021. Characteristics and survival were compared related to modes of HIV acquisition and type of opportunistic infection. A total of 320 patients were diagnosed with 342 brain opportunistic infections (incidence 9.79 per 1000 person-years), 60.2% males with median age at diagnosis of 31 years (IQR 25, 40). Median CD4 cell count and VL were 36/μL (IQR 14, 96) and 5.1 log10 copies/mL (IQR 4, 5.7) respectively. The routes of HIV acquisition were heterosexual (52.6%), parenteral route in early childhood (31.6%), injecting drug use (12.9%), men having sex with men (1.8%), and vertical (1.2%). The most common brain infections were progressive multifocal leukoencephalopathy (31.3%), cerebral toxoplasmosis (26.9%), tuberculous meningitis (19.3%), and cryptococcal meningitis (16.7%). Patients infected by parenteral mode in early childhood were younger at diagnosis of both opportunistic infection and HIV (p < 0.001 and p < 0.001, respectively), developed more frequently PML (p < 0.001), and had the lowest early (p = 0.002) and late (p = 0.019) mortality rates. Risk factors for shorter survival were age > 30 years (p = 0.001), injecting drug use (p = 0.003), CD4 + < 100/μL (p = 0.007), and VL > 5 log10 copies/mL at diagnosis (p < 0.001). The incidence and mortality rate of brain opportunistic infections were high and did not decrease significantly during the study period, due to late presentation or non-adherence to ART.
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Affiliation(s)
- Cristiana Oprea
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.
- Victor Babes Clinical Hospital of Infectious and Tropical Diseases, Bucharest, Romania.
| | - Irina Ianache
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
- Victor Babes Clinical Hospital of Infectious and Tropical Diseases, Bucharest, Romania
| | - Sorina Vasile
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | | | - Gratiela Tardei
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Maria Nica
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
- Victor Babes Clinical Hospital of Infectious and Tropical Diseases, Bucharest, Romania
| | - Anya Umlauf
- Department of Psychiatry, University of California San Diego, La Jolla, San Diego, CA, USA
| | - Cristian Achim
- Department of Psychiatry, University of California San Diego, La Jolla, San Diego, CA, USA
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13
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Okwuegbuna OK, Kaur H, Iudicello J, Bush WS, Bharti A, Umlauf A, Ellis RJ, Franklin DR, Heaton RK, McCutchan JA, Kallianpur AR, Letendre SL. Anemia and Erythrocyte Indices Are Associated With Neurocognitive Performance Across Multiple Ability Domains in Adults With HIV. J Acquir Immune Defic Syndr 2023; 92:414-421. [PMID: 36580636 PMCID: PMC10006328 DOI: 10.1097/qai.0000000000003155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 12/19/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND Anemia is linked to neurocognitive impairment (NCI) in people with HIV (PWH), but its impact within specific ability domains, and in diverse populations with HIV, is uncertain. METHODS Participants included 1339 PWH enrolled in observational HIV cohort studies with a mean of 3 comprehensive neurocognitive assessments over 30 months. Global and domain-specific neurocognitive function were assessed by the global deficit score and domain deficit score (GDS and DDS, respectively) or as GDS-defined or DDS-defined NCI (GDS ≥ 0.5, DDS > 0.5). Time-dependent associations of anemia or red-cell indices with neurocognitive function were evaluated by multivariable regression. RESULTS The mean age at entry was 43.6 years (85% male, 23.9% Hispanic, 16.7% African ancestry by self-report, and 69.8% virally suppressed). Anemia occurred at entry in 297 (22.2%) and developed subsequently in another 129 (9.6%). Anemia (present in 26.8% of cognitively impaired PWH at entry) and lower hemoglobin were associated with higher (worse) GDS values; the association for anemia persisted after multivariable adjustment and in virally suppressed persons ( P < 0.0001). Anemia was also associated with reduced processing speed, motor function, learning, delayed recall, working memory (all P < 0.01), executive function ( P = 0.021), and verbal fluency ( P = 0.035), and these findings persisted in longitudinal analyses (adjusted P < 0.01 for all domains, except verbal fluency). Higher mean corpuscular volume and mean corpuscular hemoglobin were associated with less impairment in learning and recall (all P < 0.05). CONCLUSIONS Anemia in diverse and virally suppressed PWH associates with reduced neurocognitive performance in multiple domains, cross-sectionally and over time. The impact of identifying and treating anemia to prevent or slow neurocognitive decline in PWH should be prospectively evaluated.
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Affiliation(s)
| | - Harpreet Kaur
- Department of Genomic Medicine, Lerner Research Institute, Cleveland Clinic
| | | | - William S. Bush
- Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Ajay Bharti
- Department of Medicine, University of California, San Diego, CA
| | - Anya Umlauf
- Department of Psychiatry, University of California, San Diego, CA
| | - Ronald J. Ellis
- Department of Neuroscience, University of California, San Diego, CA
- Department of Psychiatry, University of California, San Diego, CA
| | | | - Robert K. Heaton
- Department of Psychiatry, University of California, San Diego, CA
| | | | - Asha R. Kallianpur
- Department of Genomic Medicine, Lerner Research Institute, Cleveland Clinic
- Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, OH
- Department of Molecular Medicine, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH
| | - Scott L. Letendre
- Department of Medicine, University of California, San Diego, CA
- Department of Psychiatry, University of California, San Diego, CA
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14
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Brody LA, Kamalyan L, Karcher K, Guarena LA, Bender AA, McKenna BS, Umlauf A, Franklin D, Marquine MJ, Heaton RK. NIH Toolbox Emotion Battery Findings Among People with HIV: Normative Comparisons and Clinical Associations. Patient Relat Outcome Meas 2023; 14:15-30. [PMID: 36814680 PMCID: PMC9939807 DOI: 10.2147/prom.s391113] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 01/28/2023] [Indexed: 02/16/2023] Open
Abstract
Purpose Depression and other aspects of emotional health in people with HIV (PWH) can affect functional independence, disease progression, and overall life quality. This study used the NIH Toolbox Emotion Battery (NIHTB-EB), which assesses many features of emotional health, to more comprehensively investigate differences among adults living with and without HIV, and to identify factors associated with emotional health for PWH. Patients and Methods Participants (n=1451; age: M=50.19, SD=16.84; 47.90% women) included 433 PWH living in southern California seen from 2003 to 2021 (64.72% AIDS, 92.25% on antiretroviral therapy) and 1018 healthy participants from NIHTB-EB national normative cohort. Participants completed the NIHTB-EB and PWH underwent comprehensive HIV disease and psychiatric evaluations. We investigated differences in emotional health by HIV status via independent samples t-tests (continuous scores) and Chi2 tests ("problematic" emotional health scores). Multivariable linear regression models examined correlates of emotional health among PWH. Results PWH had significantly worse emotional health than people without HIV across Social Satisfaction (Cohen's d=0.71, p<0.001), Psychological Well-Being (Cohen's d=0.49, p<0.001) and Negative Affect (Cohen's d=0.19, p<0.01) summary T-scores, and most component scales. PWH also had higher rates of "problematic" emotional health, particularly in Social Satisfaction (45% vs 17%, p<0.0001). Poor emotional health among PWH was associated with lifetime Major Depressive and Substance Use Disorders, relationship status (lost relationship versus in relationship), unemployment, and cognitive difficulties and loss of functional independence. Conclusion The NIHTB-EB identified that difficulties with multiple aspects of emotional health are common among PWH, and appear to be relatively independent of cognitive impairment as well as HIV disease and treatment history, but are strongly associated with everyday functioning. Given the cross-sectional nature of this study, longitudinal studies should be employed to evaluate causality pertaining to predictors of emotional health in PWH. These findings may inform interventions to promote emotional wellbeing in PWH.
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Affiliation(s)
- Lilla A Brody
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine, New York, NY, USA
- Department of Psychiatry, HIV Neurobehavioral Research Program, San Diego, CA, USA
| | - Lily Kamalyan
- Department of Psychiatry, HIV Neurobehavioral Research Program, San Diego, CA, USA
- Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, San Diego, CA, USA
| | - Kayle Karcher
- Department of Psychiatry, HIV Neurobehavioral Research Program, San Diego, CA, USA
| | - Lesley A Guarena
- Department of Psychiatry, HIV Neurobehavioral Research Program, San Diego, CA, USA
| | - Alexis A Bender
- Division of Geriatrics & Gerontology, Department of Medicine, Emory University, Atlanta, GA, USA
| | - Benjamin S McKenna
- Department of Psychiatry, HIV Neurobehavioral Research Program, San Diego, CA, USA
| | - Anya Umlauf
- Department of Psychiatry, HIV Neurobehavioral Research Program, San Diego, CA, USA
| | - Donald Franklin
- Department of Psychiatry, HIV Neurobehavioral Research Program, San Diego, CA, USA
| | - Maria J Marquine
- Division of Geriatrics, Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Robert K Heaton
- Department of Psychiatry, HIV Neurobehavioral Research Program, San Diego, CA, USA
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Browne SH, Vaida F, Umlauf A, Tucker AJ, Blaschke TF, Benson CA. Supporting the Art: Medication Adherence Patterns in Persons Prescribed Ingestible Sensor-enabled Oral Pre-Exposure Prophylaxis to Prevent Human Immunodeficiency Virus Infection. Clin Infect Dis 2023; 76:134-143. [PMID: 36484300 PMCID: PMC10202440 DOI: 10.1093/cid/ciac280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Timely, accurate adherence data may support oral pre-exposure prophylaxis (PrEP) success and inform prophylaxis choice. We evaluated a Food and Drug Administration (FDA)-approved digital health feedback system (DHFS) with ingestible-sensor-enabled (IS) tenofovir-disoproxil-fumarate plus emtricitabine (Truvada®) in persons starting oral PrEP. METHODS Human immunodeficiency virus (HIV)-negative adults were prescribed IS-Truvada® with DHFS for 12 weeks to observe medication taking behavior. Baseline demographics, urine toxicology, and self-report questionnaires were obtained. Positive detection accuracy and adverse events were computed as percentages, with Kaplan Meier Estimate for persistence-of-use. In participants persisting ≥28 days, adherence patterns (taking and timing) were analyzed, and mixed-effects logistic regression modeled characteristics associated with treatment adherence. RESULTS Seventy-one participants were enrolled, mean age 37.6 years (range 18-69), 90.1% male, 77.5% White, 33.8% Hispanic, 95.8% housed, and 74.6% employed. Sixty-three participants (88.7%) persisted ≥28 days, generating 4987 observation days, average 79.2 (29-105). Total confirmed doses were 86.2% (95% confidence interval [CI] 82.5, 89.4), decreasing over time, odds ratio (OR) 0.899 (95% CI .876, .923) per week, P < .001; 79.4% (95% CI 66.7%, 87.3%) of participants had ≥80% adherence. Pattern analysis showed days without confirmed doses clustered (P = .003); regular dose timing was higher among participants with ≥80% confirmed doses (0.828, 95% CI .796 to .859) than among those with <80% (0.542, 95% CI95 .405 to .679) P < .001. In multi-predictor models, better adherence was associated with older age, OR 1.060 (95% CI 1.033, 1.091) per year, P < .001; negative vs positive methamphetamine screen, OR 5.051 (95% CI 2.252, 11.494), P < .001. CONCLUSIONS DHFS with IS-Truvada® distinguished adherent persons from those potentially at risk of prophylactic failure. Ongoing methamphetamine substance use may impact oral PrEP success.
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Affiliation(s)
- Sara H Browne
- Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, California, USA
- Specialists in Global Health, Encinitas, California, USA
| | - Florin Vaida
- Department of Family Medicine and Public Health, University of California San Diego, La Jolla, California, USA
| | - Anya Umlauf
- Department of Psychiatry, University of California San Diego, La Jolla, California, USA
| | - Amanda J Tucker
- Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, California, USA
| | | | - Constance A Benson
- Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, California, USA
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Kamalyan L, Guareña LA, Díaz-Santos M, Suarez P, Cherner M, García Alcorn MY, Umlauf A, Franklin DR, Mindt MR, Fortuny LAI, Heaton RK, Marquine MJ. Influence of Educational Background, Childhood Socioeconomic Environment, and Language Use on Cognition among Spanish-Speaking Latinos Living Near the US-Mexico Border. J Int Neuropsychol Soc 2022; 28:876-890. [PMID: 34486514 PMCID: PMC8898321 DOI: 10.1017/s1355617721001028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES We investigated the impact of culturally relevant social, educational, and language factors on cognitive test performance among Spanish speakers living near the US-Mexico border. METHODS Participants included 254 healthy native Spanish speakers from the Neuropsychological Norms for the US-Mexico Border Region in Spanish (NP-NUMBRS) project (Age: M = 37.3, SD = 10.4; Education: M = 10.7, SD = 4.3; 59% Female). A comprehensive neuropsychological battery was administered in Spanish. Individual test scaled scores and T-scores (based on region-specific norms adjusted for age, education, and sex) were averaged to create Global Mean Scaled and T-scores. Measures of culturally relevant factors included a self-reported indicator of educational quality/access (proportion of education in Spanish-speaking country, quality of school/classroom setting, stopped attending school to work), childhood socioeconomic environment (parental education, proportion of time living in Spanish-speaking country, childhood socioeconomic and health status, access to basic resources, work as a child), and Spanish/English language use and fluency. RESULTS Several culturally relevant variables were significantly associated with unadjusted Global Scaled Scores in univariable analyses. When using demographically adjusted T-scores, fewer culturally relevant characteristics were significant. In multivariable analyses, being bilingual (p = .04) and working as a child for one's own benefit compared to not working as a child (p = .006) were significantly associated with higher Global Mean T-score, accounting for 9% of variance. CONCLUSIONS Demographically adjusted normative data provide a useful tool for the identification of brain dysfunction, as these account for much of the variance of sociocultural factors on cognitive test performance. Yet, certain culturally relevant variables still contributed to cognitive test performance above and beyond basic demographics, warranting further investigation.
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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
| | - Lesley A. Guareña
- Department of Psychiatry, HIV Neurobehavioral Research Program, University of California, San Diego
- Department of Medicine, Division of Geriatrics and Gerontology, University of California, San Diego
| | - Mirella Díaz-Santos
- Department of Psychiatry and Biobehavioral Sciences, Hispanic Neuropsychiatric Center of Excellence, University of California, Los Angeles
| | - Paola Suarez
- Department of Psychiatry and Biobehavioral Sciences, Hispanic Neuropsychiatric Center of Excellence, University of California, Los Angeles
| | - Mariana Cherner
- Department of Psychiatry, HIV Neurobehavioral Research Program, 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
| | - Monica Rivera Mindt
- Department of Psychology & Latino American and Latino Studies Institute, Fordham University
| | | | - 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
- Department of Medicine, Division of Geriatrics and Gerontology, University of California, San Diego
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17
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Delgadillo JD, Campbell LM, Marquine MJ, Heaton A, Rooney AS, Umlauf A, Jeste DV, Moore DJ, Moore RC. Higher religiosity and spirituality are associated with ethnic group membership among middle-aged and older adults living with HIV. HIV Res Clin Pract 2022; 23:91-98. [PMID: 36000621 PMCID: PMC10243211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
Abstract
Background: HIV is a chronic illness that impacts the lives of more than 1 million people in the United States. As persons living with HIV (PWH) are living longer, it is important to understand the influence that religiosity/spirituality has among middle-aged and older PWH. Objective: Compare the degree of religiosity/spirituality among middle-aged and older PWH and HIV-negative individuals, and to identify demographic, clinical, and psychosocial factors associated with religiosity/spirituality among PWH. Method: Baseline data on 122 PWH and 92 HIV-negative individuals (ages 36-65 years; 61.1% Non-Hispanic White) from a longitudinal study were analyzed for the current study. Recruitment occurred through HIV treatment clinics and community organizations in San Diego. Participants completed questionnaires on religiosity, spirituality, and psychosocial functioning. Independent samples t-tests, Pearson correlations, and multiple linear regression analyses were conducted to test the study objective. Results: No significant differences in religiosity/spirituality were found between PWH and HIV-negative individuals. Demographic and psychosocial variables were unrelated to religiously/spirituality among HIV-negative individuals. Among PWH, multiple linear regression models indicated higher daily spirituality was significantly associated with racial/ethnic minority membership (Hispanic/Latino, African American/Black, or Other), fewer years of estimated duration of HIV, greater social support, and higher grit. Greater engagement in private religious practices was significantly associated with racial/ethnic minority membership and higher social support. Conclusions: For PWH, being a racial/ethnic minority and having higher social support was associated with greater engagement in religious/spiritual practices. Future longitudinal studies should examine whether religion/spirituality impacts well-being across the lifespan among racial/ethnic minority groups of PWH.
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Affiliation(s)
- Jeremy D. Delgadillo
- Advancing Diversity in Aging Research (ADAR) Program, San Diego State University, 6505 Alvarado Road, Suite 110, San Diego, CA 92120
| | - Laura M. Campbell
- San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, 6363 Alvarado Court, San Diego, CA 92120
| | - Maria J. Marquine
- University of California, San Diego, Department of Psychiatry, 9500 Gilman Drive, La Jolla, CA 92093
| | - Anne Heaton
- University of California, San Diego, Department of Psychiatry, 9500 Gilman Drive, La Jolla, CA 92093
| | | | - Anya Umlauf
- University of California, San Diego, Department of Psychiatry, 9500 Gilman Drive, La Jolla, CA 92093
| | - Dilip V. Jeste
- University of California, San Diego, Department of Psychiatry, 9500 Gilman Drive, La Jolla, CA 92093
| | - David J. Moore
- University of California, San Diego, Department of Psychiatry, 9500 Gilman Drive, La Jolla, CA 92093
| | - Raeanne C. Moore
- University of California, San Diego, Department of Psychiatry, 9500 Gilman Drive, La Jolla, CA 92093
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18
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De Almeida SM, Rotta I, Tang B, Umlauf A, Vaida F, Cherner M, Franklin D, Letendre S, Ellis RJ. Higher Cerebrospinal Fluid Soluble Urokinase-type Plasminogen Activator Receptor, But Not Interferon γ-inducible Protein 10, Correlate With Higher Working Memory Deficits. J Acquir Immune Defic Syndr 2022; 90:106-114. [PMID: 35090158 PMCID: PMC8986587 DOI: 10.1097/qai.0000000000002924] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 01/18/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND We hypothesized that the induction of monocyte activation biomarkers, especially soluble urokinase-type plasminogen activator receptor (suPAR) and interferon γ-inducible protein 10 (IP-10), is lower in HIV-1C than HIV-1B, owing to a defective Tat cysteine dimotif (C30S). METHODS A total of 68 paired cerebrospinal fluid (CSF) and blood samples from people with HIV (PWH), free of CNS opportunistic infections, from a Southern Brazil outpatient HIV clinic were evaluated such as HIV-1B subtype (n = 27), HIV-1C (n = 26), other (n = 15), and 19 HIV-negative controls. The levels of suPAR, IP-10, neopterin, and β2 microglobulin (β2m) in the CSF and serum were quantified using different immunoassays. RESULTS Overall, in PWH, increases in CSF suPAR, CSF/serum suPAR, and CSF/serum β2m correlated with worse working memory deficits (r = 0.303, 0.353, and 0.289, respectively, all P < 0.05). The medians of IP-10, suPAR, neopterin, and β2m in CSF and serum and the CSF/serum ratio and suPAR index were comparable between the HIV-1B and HIV-1C subtypes. CSF IP-10 and neopterin and serum IP-10 and suPAR levels were higher in PWH than the HIV-negative controls (P = 0.015, P = 0.001, P < 0.0001, and P < 0.001, respectively). The serum β2m level was higher in HIV-associated dementia than neuropsychologically normal or asymptomatic (P = 0.024). DISCUSSION We observed that higher levels of CSF suPAR and the suPAR quotient correlated with worse working memory deficit. Elevated levels of monocyte activation were similar in both HIV-1 B and C subtypes, providing no evidence of reduced neuropathogenicity of HIV-1 subtype C Tat compared with subtype B.
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Affiliation(s)
- Sergio M De Almeida
- Neuroinfection Unity and Virology Laboratory, Universidade Federal Do Paraná, Curitiba, Paraná, Brazil
| | - Indianara Rotta
- Neuroinfection Unity and Virology Laboratory, Universidade Federal Do Paraná, Curitiba, Paraná, Brazil
| | - Bin Tang
- Department of Psychiatry, University of California, San Diego, CA
| | - Anya Umlauf
- Department of Psychiatry, University of California, San Diego, CA
| | - Florin Vaida
- Division of Biostatistics and Bioinformatics, Department of Family Medicine and Public Health, University of California, San Diego, CA
| | - Mariana Cherner
- Department of Psychiatry, University of California, San Diego, CA
- HIV Neurobehavioral Research Center, University of California, San Diego, CA
| | - Donald Franklin
- HIV Neurobehavioral Research Center, University of California, San Diego, CA
| | - Scott Letendre
- HIV Neurobehavioral Research Center, University of California, San Diego, CA
- Division of Infectious Diseases, Department of Medicine, University of California, San Diego, CA; and
| | - Ronald J Ellis
- HIV Neurobehavioral Research Center, University of California, San Diego, CA
- Department of Neurosciences, University of California, San Diego, CA
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19
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Marcotte TD, Umlauf A, Grelotti DJ, Sones EG, Sobolesky PM, Smith BE, Hoffman MA, Hubbard JA, Severson J, Huestis MA, Grant I, Fitzgerald RL. Driving Performance and Cannabis Users' Perception of Safety: A Randomized Clinical Trial. JAMA Psychiatry 2022; 79:201-209. [PMID: 35080588 PMCID: PMC8792796 DOI: 10.1001/jamapsychiatry.2021.4037] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
IMPORTANCE Expanding cannabis medicalization and legalization increases the urgency to understand the factors associated with acute driving impairment. OBJECTIVE To determine, in a large sample of regular cannabis users, the magnitude and time course of driving impairment produced by smoked cannabis of different Δ9-tetrahydrocannabinol (THC) content, the effects of use history, and concordance between perceived impairment and observed performance. DESIGN, SETTING, AND PARTICIPANTS This double-blind, placebo-controlled parallel randomized clinical trial took place from February 2017 to June 2019 at the Center for Medicinal Cannabis Research, University of California San Diego. Cannabis users were recruited for this study, and analysis took place between April 2020 and September 2021. INTERVENTIONS Placebo or 5.9% or 13.4% THC cannabis smoked ad libitum. MAIN OUTCOMES AND MEASURES The primary end point was the Composite Drive Score (CDS), which comprised key driving simulator variables, assessed prior to smoking and at multiple time points postsmoking. Additional measures included self-perceptions of driving impairment and cannabis use history. RESULTS Of 191 cannabis users, 118 (61.8%) were male, the mean (SD) age was 29.9 (8.3) years, and the mean (SD) days of use in the past month was 16.7 (9.8). Participants were randomized to the placebo group (63 [33.0%]), 5.9% THC (66 [34.6%]), and 13.4% THC (62 [32.5%]). Compared with placebo, the THC group significantly declined on the Composite Drive Score at 30 minutes (Cohen d = 0.59 [95% CI, 0.28-0.90]; P < .001) and 1 hour 30 minutes (Cohen d = 0.55 [95% CI, 0.24-0.86]; P < .001), with borderline differences at 3 hours 30 minutes (Cohen d = 0.29 [95% CI, -0.02 to 0.60]; P = .07) and no differences at 4 hours 30 minutes (Cohen d = -0.03 [95% CI, -0.33 to 0.28]; P = .87). The Composite Drive Score did not differ based on THC content (likelihood ratio χ24 = 3.83; P = .43) or use intensity (quantity × frequency) in the past 6 months (likelihood ratio χ24 = 1.41; P = .49), despite postsmoking blood THC concentrations being higher in those with the highest use intensity. Although there was hesitancy to drive immediately postsmoking, increasing numbers (81 [68.6%]) of participants reported readiness to drive at 1 hour 30 minutes despite performance not improving from initial postsmoking levels. CONCLUSIONS AND RELEVANCE Smoking cannabis ad libitum by regular users resulted in simulated driving decrements. However, when experienced users control their own intake, driving impairment cannot be inferred based on THC content of the cigarette, behavioral tolerance, or THC blood concentrations. Participants' increasing willingness to drive at 1 hour 30 minutes may indicate a false sense of driving safety. Worse driving performance is evident for several hours postsmoking in many users but appears to resolve by 4 hours 30 minutes in most individuals. Further research is needed on the impact of individual biologic differences, cannabis use history, and administration methods on driving performance. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02849587.
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Affiliation(s)
| | - Anya Umlauf
- Department of Psychiatry, University of California San Diego, San Diego
| | - David J. Grelotti
- Department of Psychiatry, University of California San Diego, San Diego
| | - Emily G. Sones
- Department of Psychiatry, University of California San Diego, San Diego
| | - Philip M. Sobolesky
- Department of Pathology, University of California San Diego, San Diego,Department of Pathology and Laboratory Medicine, Santa Clara Valley Medical Center, San Jose, California
| | - Breland E. Smith
- Department of Pathology, University of California San Diego, San Diego,LetsGetChecked Labs, Monrovia, California
| | - Melissa A. Hoffman
- Department of Pathology, University of California San Diego, San Diego,Vividion Therapeutics, San Diego, California
| | - Jacqueline A. Hubbard
- Department of Pathology, University of California San Diego, San Diego,Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | | | - Marilyn A. Huestis
- Institute for Emerging Health Professions, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Igor Grant
- Department of Psychiatry, University of California San Diego, San Diego
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20
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Marquine M, Kamalyan L, Yassai-Gonzalez D, Cherner M, Ellis R, Umlauf A, Jeste D, Heaton R. Metabolic Syndrome and Neurocognitive Function among older Hispanics/Latinos with HIV. Innov Aging 2021. [PMCID: PMC8681302 DOI: 10.1093/geroni/igab046.2514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Neurocognitive impairment is prevalent among persons with HIV (PWH), particularly among Hispanics/Latinos/as/x (henceforth Hispanics). We examined disparities in HIV-associated neurocognitive function between older Hispanic and non-Hispanic White PWH, and the potential role of metabolic syndrome (MetS) in explaining these disparities. Participants included 116 community-dwelling PWH ages 50-75, who were 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, SD=5.7; Education: M=13, SD=3.4; 83% male, 58% AIDS, 94% on antiretroviral therapy [ART], 4% detectable plasma RNA). A global neurocognition score was derived from T-Scores on a comprehensive neurocognitive battery, with separate demographic adjustments for English and Spanish-speakers. MetS was ascertained via standard criteria that considered central obesity, elevated triglycerides, low high-density lipoprotein cholesterol, and elevated fasting glucose, as well as current medical treatment for these conditions. Covariates examined included sociodemographic, psychiatric, substance use and HIV-disease characteristics. Hispanics had higher rates of MetS (56%) than non-Hispanic Whites (37%; p<.05). A stepwise regression model on global neurocognition including ethnicity and covariates that differed between ethnic groups, selected only Hispanic ethnicity as a significant predictor (B=-3.82, SE=1.27, p<.01). A comparable model also including MetS showed that both Hispanic ethnicity (B=-3.39, SE=1.31, p=.01) and MetS (B=-2.73, SE=1.31, p=.04), were significantly associated with worse global neurocognition. Findings indicate that MetS does not fully explain disparities in neurocognitive function between Hispanic and non-Hispanic White older PWH, but rather is an independent predictor of neurocognitive function along with Hispanic ethnicity.
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Affiliation(s)
- Maria Marquine
- University of California San Diego, La Jolla, California, United States
| | - Lily Kamalyan
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California, United States
| | | | - Mariana Cherner
- University of California San Diego, SAN DIEGO, California, United States
| | - Ronald Ellis
- University of California San Diego, San Diego, California, United States
| | - Anya Umlauf
- University of California San Diego, San Diego, California, United States
| | - Dilip Jeste
- University of California San Diego, La Jolla, California, United States
| | - Robert Heaton
- University of California San Diego, San Diego, California, United States
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21
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Hubbard JA, Hoffman MA, Ellis SE, Sobolesky PM, Smith BE, Suhandynata RT, Sones EG, Sanford SK, Umlauf A, Huestis MA, Grelotti DJ, Grant I, Marcotte TD, Fitzgerald RL. Biomarkers of Recent Cannabis Use in Blood, Oral Fluid and Breath. J Anal Toxicol 2021; 45:820-828. [PMID: 34185831 DOI: 10.1093/jat/bkab080] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 06/15/2021] [Accepted: 07/07/2021] [Indexed: 12/25/2022] Open
Abstract
Proving driving under the influence of cannabis (DUIC) is difficult. Establishing a biomarker of recent use to supplement behavioral observations may be a useful alternative strategy. We determined whether cannabinoid concentrations in blood, oral fluid (OF), or breath could identify use within 3h, likely the period of greatest impairment. In a randomized trial, 191 frequent (≥4/week) and occasional (<4/week) cannabis users smoked one cannabis (placebo [0.02%], 5.9% or 13.4% THC) cigarette ad libitum. Blood, OF and breath samples were collected prior to and up to 6h after smoking. Samples were analyzed for 10 cannabinoids in OF, 8 in blood, and THC in breath. Frequent users had more residual THC in blood and were categorized as "recently used" prior to smoking; this did not occur in OF. Per se limits ranging from undetectable to 5 ng/mL THC in blood offered limited usefulness as biomarkers of recent use. Cannabinol (CBN, cutoff=1 ng/mL) in blood offered 100% specificity but only 31.4% sensitivity, resulting in 100% PPV and 94.0% NPV at 4.3% prevalence; but CBN may vary by cannabis chemovar. A 10 ng/mL THC cutoff in OF exhibited the overall highest performance to detect use within 3h (99.7% specificity, 82.4% sensitivity, 92.5% PPV, 99.2% NPV) but was still detectable in 23.2% of participants ~4.4h post smoking limiting specificity at later time points. OF THC may be a helpful indicator of recent cannabis intake, but this does not equate to impairment. Behavioral assessment of impairment is still required to determine DUIC. This study only involved cannabis inhalation and additional research evaluating alternative routes of ingestion (i.e., oral) is needed.
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Affiliation(s)
- J A Hubbard
- Department of Pathology, University of California, San Diego, 10300 Campus Point Drive, Suite 150, San Diego, CA 92121 USA
| | - M A Hoffman
- Department of Pathology, University of California, San Diego, 10300 Campus Point Drive, Suite 150, San Diego, CA 92121 USA
| | - S E Ellis
- Department of Cognitive Science, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA 92092 USA.,Halıcıoğlu Data Science Institute, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA 92092 USA
| | - P M Sobolesky
- Department of Pathology, University of California, San Diego, 10300 Campus Point Drive, Suite 150, San Diego, CA 92121 USA
| | - B E Smith
- Department of Pathology, University of California, San Diego, 10300 Campus Point Drive, Suite 150, San Diego, CA 92121 USA
| | - R T Suhandynata
- Department of Pathology, University of California, San Diego, 10300 Campus Point Drive, Suite 150, San Diego, CA 92121 USA
| | - E G Sones
- Department of Psychiatry, University of California, San Diego, 220 Dickinson, MC #8231, San Diego, CA 92103 USA
| | - S K Sanford
- Department of Psychiatry, University of California, San Diego, 220 Dickinson, MC #8231, San Diego, CA 92103 USA
| | - A Umlauf
- Department of Psychiatry, University of California, San Diego, 220 Dickinson, MC #8231, San Diego, CA 92103 USA
| | - M A Huestis
- Institute for Emerging Health Professions, Thomas Jefferson University, Philadelphia, PA 19107 USA
| | - D J Grelotti
- Department of Psychiatry, University of California, San Diego, 220 Dickinson, MC #8231, San Diego, CA 92103 USA
| | - I Grant
- Department of Psychiatry, University of California, San Diego, 220 Dickinson, MC #8231, San Diego, CA 92103 USA
| | - T D Marcotte
- Department of Psychiatry, University of California, San Diego, 220 Dickinson, MC #8231, San Diego, CA 92103 USA
| | - R L Fitzgerald
- Department of Pathology, University of California, San Diego, 10300 Campus Point Drive, Suite 150, San Diego, CA 92121 USA
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22
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Hoffman MA, Hubbard JA, Sobolesky PM, Smith BE, Suhandynata RT, Sanford S, Sones E, Ellis S, Umlauf A, Huestis MA, Grelotti DJ, Grant I, Marcotte TD, Fitzgerald RL. Blood and Oral Fluid Cannabinoid Profiles of Frequent and Occasional Cannabis Smokers. J Anal Toxicol 2021; 45:851-862. [PMID: 34173005 DOI: 10.1093/jat/bkab078] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 06/14/2021] [Accepted: 06/25/2021] [Indexed: 01/14/2023] Open
Abstract
Increased prevalence of cannabis consumption and impaired driving are a growing public safety concern. Some states adopted per se driving laws, making it illegal to drive with more than a specified ∆9-tetrahydrocannabinol (THC) blood concentration of THC in a biological fluid (typically blood). Blood THC concentrations decrease significantly (~90%) with delays in specimen collection, suggesting use of alternative matrices, such as oral fluid (OF). We characterized 10 cannabinoids' concentrations, including THC metabolites, in blood and OF from 191 frequent and occasional users by LC-MS-MS for up to 6 h after ad libitum smoking. Subjects self-titrated when smoking placebo, 5.9 or 13.4% THC cannabis. Higher maximum blood THC concentrations (Cmax) were observed in individuals who received the 5.9% THC versus the 13.4% THC plant material. In blood, the Cmax of multiple analytes, including THC and its metabolites, were increased in frequent compared to occasional users, whereas there were no significant differences in OF Cmax. Blood THC remained detectable (≥5 ng/mL) at the final sample collection for 14% of individuals who smoked either the 5.9% or 13.4% THC cigarette, whereas 54% had detectable THC in OF when applying the same cutoff. Occasional and frequent cannabis users' profiles were compared, THC was detectable for significantly longer in blood and OF from frequent users. Detection rates between frequent and occasional users at multiple per se cutoffs showed larger differences in blood versus OF. Understanding cannabinoid profiles of frequent and occasional users and the subsequent impact on detectability with current drug per se driving limits is important to support forensic interpretations and the development of scientifically supported driving under the influence of cannabis laws.
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Affiliation(s)
- Melissa A Hoffman
- Department of Pathology, University of California, 10300 Campus Point Drive, Suite 150, San Diego, CA 92121 USA
| | - Jacqueline A Hubbard
- Department of Pathology, University of California, 10300 Campus Point Drive, Suite 150, San Diego, CA 92121 USA
| | - Philip M Sobolesky
- Department of Pathology, University of California, 10300 Campus Point Drive, Suite 150, San Diego, CA 92121 USA
| | - Breland E Smith
- Department of Pathology, University of California, 10300 Campus Point Drive, Suite 150, San Diego, CA 92121 USA
| | - Raymond T Suhandynata
- Department of Pathology, University of California, 10300 Campus Point Drive, Suite 150, San Diego, CA 92121 USA
| | - Sandra Sanford
- Department of Psychiatry Science, University of California, 9500 Gilman Drive, San Diego, La Jolla, CA 92092 USA
| | - Emily Sones
- Department of Psychiatry Science, University of California, 9500 Gilman Drive, San Diego, La Jolla, CA 92092 USA
| | - Shannon Ellis
- Department of Cognitive Science, University of California, 9500 Gilman Drive, San Diego, La Jolla, CA 92092 USA.,Halıcıoğlu Data Science Institute, University of California, 9500 Gilman Drive, San Diego, La Jolla, CA 92092 USA
| | - Anya Umlauf
- Department of Psychiatry Science, University of California, 9500 Gilman Drive, San Diego, La Jolla, CA 92092 USA
| | - Marilyn A Huestis
- Institute for Emerging Health Professions, Thomas Jefferson University, Philadelphia, PA 19107 USA
| | - David J Grelotti
- Department of Psychiatry Science, University of California, 9500 Gilman Drive, San Diego, La Jolla, CA 92092 USA
| | - Igor Grant
- Department of Psychiatry Science, University of California, 9500 Gilman Drive, San Diego, La Jolla, CA 92092 USA
| | - Thomas D Marcotte
- Department of Psychiatry Science, University of California, 9500 Gilman Drive, San Diego, La Jolla, CA 92092 USA
| | - Robert L Fitzgerald
- Department of Pathology, University of California, 10300 Campus Point Drive, Suite 150, San Diego, CA 92121 USA
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23
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Chang RC, Soontornniyomkij B, Umlauf A, Soontornniyomkij V. Antiretroviral Tenofovir Induces Senescence-Associated β-Galactosidase Activity in Primary Human Brain Vascular Cells in Multi-Layer Three-Dimensional Co-Culture. Cureus 2021; 13:e15327. [PMID: 34235009 PMCID: PMC8240677 DOI: 10.7759/cureus.15327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 01/12/2021] [Indexed: 11/05/2022] Open
Abstract
Introduction In the current context of early diagnosis of HIV infection, immediate initiation of antiretroviral (ARV) therapy, and lifelong chronic treatment, the potential ARV toxicity is of particular concern. Emtricitabine (FTC) and tenofovir (TFV) are commonly used as backbone drugs in ARV regimens recommended for initial therapy of HIV infection. Here we assessed the effects of FTC and TFV exposure on senescence-associated β-galactosidase (SA-β-Gal) activity, a marker of cellular senescence, in human brain vascular cells. Design Multi-layer three-dimensional cell co-cultures and in vitro assays. Methods To mimic the small vessel wall structure in vivo, three types of primary human brain vascular cells (endothelial cells, smooth muscle cells, and pericytes) were co-cultured on three Alvetex Scaffold disks placed on top of each other in order (three-layer three-dimensional cell co-cultures) and exposed to clinically relevant concentrations of ARV drugs (FTC, TFV, or FTC+TFV combination) or vehicle for eight days (four or five biological replicates per condition, 18 replicates totally). The SA-β-Gal activity was quantitatively assayed in vitro by using the chemiluminescent Galacto-Star System (T1012; Applied Biosystems, Thermo Fisher Scientific, Waltham, MA) in 54 protein lysates extracted from individual cell-culture disks. Three-factor analysis of variance (cell type, FTC, TFV) was used to assess differences in the SA-β-Gal activity levels normalized by the corresponding total protein concentrations. Results There was a trend for the FTC by TFV interaction effect on SA-β-Gal activity (P = 0.058). The effects of FTC and TFV were not significantly different among the three cell types. The overall effect of FTC was not significant when controlling for TFV and cell type. The overall effect of TFV was significant when controlling for FTC and cell type (F(1,48) = 30.61, P < 0.001, partial η2 = 0.389). In the absence of FTC, TFV raised SA-β-Gal activity by 0.631 units on average, regardless of cell type (P < 0.001, partial η2 = 0.368). In the presence of FTC, TFV raised SA-β-Gal activity by 0.303 units on average, regardless of cell type (P = 0.015, partial η2 = 0.118). Conclusion Our preliminary findings suggest that primary human brain vascular cells exposed to TFV at clinically relevant concentrations undergo cellular senescence. This potential adverse effect of TFV should be further studied in animal models of HIV infection.
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Affiliation(s)
- Rachel C Chang
- Psychiatry, University of California San Diego, La Jolla, USA
| | | | - Anya Umlauf
- Psychiatry, University of California San Diego, La Jolla, USA
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Marquine MJ, Yassai-Gonzalez D, Perez-Tejada A, Umlauf A, Kamalyan L, Morlett Paredes A, Suarez P, Rivera Mindt M, Franklin D, Artiola I Fortuny L, Cherner M, Heaton RK. Demographically adjusted normative data for the Wisconsin Card Sorting Test-64 item: Results from the Neuropsychological Norms for the U.S.-Mexico Border Region in Spanish (NP-NUMBRS) project. Clin Neuropsychol 2021; 35:339-355. [PMID: 31900055 PMCID: PMC7523029 DOI: 10.1080/13854046.2019.1703042] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Revised: 11/30/2019] [Accepted: 12/04/2019] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The Wisconsin Card Sorting Test (WCST) is among the most commonly used tests of executive functioning. We aimed to generate normative data on the 64-item version of this test (WCST-64) for Spanish-speakers living in the U.S.-Mexico Border region. METHODS Participants included 189 native Spanish-speakers (Age: 19-60; Education: 0-20; 59.3% female) from the Neuropsychological Norms for the U.S.-Mexico Border Region in Spanish (NP-NUMBRS) project who completed the WCST-64. Univariable and interactive associations between demographic variables and raw scores were examined via Spearman correlations, Wilcoxon Rank-sum tests and linear regressions. T-scores for various WCST-64 measures (Total Errors, Perseverative Responses, Perseverative Errors, Conceptual Level Responses and Number of Categories) were obtained using fractional polynomial equations with weights for age, education, and gender. Percentile scores were reported for Failures to Maintain Set. Rates of impairment (T-score < 40) were calculated by applying the newly developed norms and published norms for non-Hispanic English-speaking Whites and Blacks. RESULTS Older age was associated with worse performance and education was linked to better performance on most WCST-64 raw scores, with stronger education effects among females than males. The norms developed here resulted in expected rates of impairment (14-16% across measures). Applying published norms for non-Hispanic Blacks resulted in generally comparable impairment rates. In contrast, applying previously published norms for non-Hispanic Whites overestimated impairment (38-52% across measures). CONCLUSIONS These data will enhance interpretation performance on the WCST-64 for Spanish-speakers living in the U.S.-Mexico Border region. Future work will need to examine the generalizability of these norms to other Hispanic/Latino groups.
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Affiliation(s)
- María J Marquine
- Department of Psychiatry, University of California, San Diego, La Jolla, California, USA
| | - David Yassai-Gonzalez
- Department of Psychiatry, University of California, San Diego, La Jolla, California, USA
| | - Alan Perez-Tejada
- Department of Psychiatry, University of California, San Diego, La Jolla, California, USA
| | - Anya Umlauf
- Department of Psychiatry, University of California, San Diego, La Jolla, California, USA
| | - Lily Kamalyan
- Department of Psychiatry, University of California, San Diego, La Jolla, California, USA
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, La Jolla, California, USA
| | | | - Paola Suarez
- Department of Psychiatry and Behavioral Sciences, University of California Los Angeles, Los Angeles, California, USA
| | - Monica Rivera Mindt
- Department of Psychology and Latin American and Latina/o Studies Institute, Fordham University, The Bronx, New York, USA
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Donald Franklin
- Department of Psychiatry, University of California, San Diego, La Jolla, California, USA
| | | | - Mariana Cherner
- Department of Psychiatry, University of California, San Diego, La Jolla, California, USA
| | - Robert K Heaton
- Department of Psychiatry, University of California, San Diego, La Jolla, California, USA
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Mindt MR, Marquine MJ, Aghvinian M, Scott TM, Cherner M, Paredes AM, Taylor MJ, Umlauf A, Suarez P, Diaz-Santos M, Kamalyan L, Heaton A, Fortuny LAI, Heaton RK. Demographically-adjusted norms for the processing speed subtests of the WAIS-III in a Spanish-speaking adult population: Results from the Neuropsychological Norms for the U.S.-Mexico Border Region in Spanish (NP-NUMBRS) project. Clin Neuropsychol 2021; 35:293-307. [PMID: 32233833 PMCID: PMC8186464 DOI: 10.1080/13854046.2020.1723707] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Revised: 01/14/2020] [Accepted: 01/23/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE The Wechsler Adult Intelligence Scale (WAIS) processing speed subtests are among the most ubiquitous indices of processing speed in the field. The aim of this study was to develop and examine demographically-adjusted normative data for Spanish language versions of the WAIS-III Digit Symbol Coding (DSC) and Symbol Search (SS) subtests for US-dwelling Spanish-speakers living in the US/Mexico border region. METHODS The sample included 203 healthy participants who were part of the larger Neuropsychological Norms for the US-Mexico Border Region in Spanish (NP-NUMBRS) project (DSC: n = 201; SS: n = 200). RESULTS Older age and higher education were both related to lower scores on the DSC and SS subtests (all ps < .0001). There were no significant effects for gender (all ps > .05). Raw-to-scaled score conversions were calculated for both subtests, and fractional polynomial equations were derived to compute demographically-adjusted T-scores accounting for age, education, and gender for each subtest and the Processing Speed Index. Published norms for English-speaking non-Hispanic white adults slightly overestimated impairment rates (T-scores <40) on both the DSC and SS subtests, while the norms for English-speaking non-Hispanic Black/African Americans and the new NP-NUMBRS norms Spanish-speakers both yielded impairment rates that fell within expected limits for healthy controls (i.e. 13%-14%). CONCLUSIONS This study suggests that population-specific normative data can improve the diagnostic validity of these measures for U.S.-dwelling Spanish-speakers living in the US/Mexico border region. Future research is needed to investigate the utility of these norms for other U.S.-dwelling Spanish-speaking subpopulations (e.g. Caribbean, Central American, South American).
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Affiliation(s)
- Monica Rivera Mindt
- Department of Psychology, Fordham University
- Department of Neurology, Icahn School of Medicine at Mount Sinai
| | | | | | | | - Mariana Cherner
- Department of Psychiatry, University of California, San Diego
| | | | | | - Anya Umlauf
- Department of Psychiatry, University of California, San Diego
| | - Paola Suarez
- Department of Psychiatry, University of California, San Diego
| | | | - Lily Kamalyan
- Department of Psychiatry, University of California, San Diego
| | - Anne Heaton
- Department of Psychiatry, University of California, San Diego
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Suarez PA, Díaz-Santos M, Marquine MJ, Kamalyan L, Mindt MR, Umlauf A, Heaton RK, Grant I, Cherner M. Demographically adjusted norms for the Trail Making Test in native Spanish speakers: Results from the neuropsychological norms for the US-Mexico border region in Spanish (NP-NUMBRS) project. Clin Neuropsychol 2021; 35:308-323. [PMID: 32985352 PMCID: PMC8240160 DOI: 10.1080/13854046.2020.1800099] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Revised: 07/14/2020] [Accepted: 07/18/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Despite the wide use of the Trail Making Test (TMT), there is a lack of normative data for Spanish speakers living in the USA. Here we describe the development of regional norms for the TMT for native Spanish speakers residing in the Southwest Mexico-Border Region of the USA. METHOD Participants were 252 healthy native Spanish speakers, 58% women, from ages 19 to 60, and ranging in education from 0 to 20 years, recruited in San Diego, CA and Tucson, AZ. All completed the TMT in Spanish along with a comprehensive neuropsychological test battery as part of their participation in the Neuropsychological Norms for the US-Mexico Border Region in Spanish (NP-NUMBRS) project. Univariable and interactive effects of demographics on test performance were examined. T-scores were calculated using fractional polynomial equations to account for linear and any non-linear effects of age, education, and sex. RESULTS Older age and lower education were associated with worse scores on both TMT A and B. No sex differences were found. The newly derived T-scores showed no association with demographic variables and displayed the expected 16% rates of impairment using a -1 SD cut point based on a normal distribution. By comparison, published norms for English-speaking non-Hispanic Whites applied to the current data yielded significantly higher impairment for both TMT A and B with more comparable rates using non-Hispanic African Americans norms. CONCLUSIONS Population-specific, demographically adjusted regional norms improve the utility and diagnostic accuracy of the TMT for use with native Spanish speakers in the US-Mexico Border region.
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Affiliation(s)
- Paola A Suarez
- Hispanic Neuropsychiatric Center of Excellence-Cultural Neuropsychology Program, University of California, Los Angeles , Los Angeles, CA, USA
| | - Mirella Díaz-Santos
- Hispanic Neuropsychiatric Center of Excellence-Cultural Neuropsychology Program, University of California, Los Angeles , Los Angeles, CA, USA
| | - Maria J Marquine
- Department of Psychiatry, HIV Neurobehavioral Research Program, University of California, San Diego, San Diego, CA, USA
| | - Lily Kamalyan
- Department of Psychiatry, HIV Neurobehavioral Research Program, University of California, San Diego, San Diego, CA, USA
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
| | - Monica Rivera Mindt
- Department of Psychology and Latin American Latino Studies Institute, Fordham University, The Bronx, NY, USA
- Department of Neurology, The Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Anya Umlauf
- Department of Psychiatry, HIV Neurobehavioral Research Program, University of California, San Diego, San Diego, CA, USA
| | - Robert K Heaton
- Department of Psychiatry, HIV Neurobehavioral Research Program, University of California, San Diego, San Diego, CA, USA
| | - Igor Grant
- Department of Psychiatry, HIV Neurobehavioral Research Program, University of California, San Diego, San Diego, CA, USA
| | - Mariana Cherner
- Department of Psychiatry, HIV Neurobehavioral Research Program, University of California, San Diego, San Diego, CA, USA
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Gooding A, Seider T, Marquine M, Suárez P, Umlauf A, Mindt MR, Heaton RK, Fortuni LAI, Cherner M. Demographically-adjusted norms for the paced auditory serial addition test and letter number sequencing test in Spanish-speaking adults: Results from the neuropsychological norms for the U.S.-Mexico border region in Spanish (NP-NUMBRS) Project. Clin Neuropsychol 2021; 35:324-338. [PMID: 32043418 PMCID: PMC8211411 DOI: 10.1080/13854046.2019.1711199] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Revised: 12/23/2019] [Accepted: 12/27/2019] [Indexed: 01/01/2023]
Abstract
OBJECTIVE The Paced Auditory Serial Addition Test (PASAT) and Wechsler Adult Intelligence Scale Letter Number Sequencing subtest (LNS) are two commonly used measures of working memory. Demographic variables (age, education, ethnicity, etc.) can impact performance on these measures, underscoring the need for demographically adjusted norms. We aimed to develop normative data for the PASAT and LNS for Spanish-speaking adults living in the U.S.-Mexico border region as part of a larger normative effort. METHOD Participants were native Spanish-speakers from the Neuropsychological Norms for the U.S. Mexico Border Region in Spanish (NP-NUMBRS) project. Two hundred and forty-nine participants completed the PASAT and 202 participants completed LNS. Ages ranged from 19 to 60 and education from 0 to 20 years. RESULTS Older age was associated with lower scores on LNS (p < .01) but not PASAT. Lower education was associated with lower scores on both tests (ps < .001). Women obtained lower raw scores than men on PASAT (ps < .003), and there were no significant main effects of gender on LNS raw scores. Raw-to-scaled score conversions were calculated, and fractional polynomial equations were developed to calculate demographically-adjusted T-scores accounting for age, education, and gender. Published norms for English-speaking non-Hispanic Whites substantially overestimated rates of impairment (defined as T-score < 40) on both the PASAT and LNS. CONCLUSIONS The use of the population-specific normative data may improve detection of working memory dysfunction in U.S. Spanish-speaking adults and contribute to improved diagnostic accuracy and treatment planning in this population. Whether the norms generalize to U.S. Spanish-speakers from other countries remains to be determined.
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Affiliation(s)
- Amanda Gooding
- Department of Psychiatry, University of California, San Diego, CA
| | - Talia Seider
- Department of Psychiatry & Biobehavioral Sciences, University of California, Los Angeles, CA
| | - Maria Marquine
- Department of Psychiatry, University of California, San Diego, CA
| | - Paola Suárez
- Department of Psychiatry & Biobehavioral Sciences, University of California, Los Angeles, CA
| | - Anya Umlauf
- Department of Psychiatry, University of California, San Diego, CA
| | - Monica Rivera Mindt
- Department of Psychology and Latin American Latino Studies Institute, Fordham University, New York, NY
- Department of Neurology, The Icahn School of Medicine at Mount Sinai, New York, NY
| | - Robert K. Heaton
- Department of Psychiatry, University of California, San Diego, CA
| | | | - Mariana Cherner
- Department of Psychiatry, University of California, San Diego, CA
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Díaz-Santos M, Suárez PA, Marquine MJ, Umlauf A, Rivera Mindt M, Artiola i Fortuny L, Heaton RK, Cherner M. Updated demographically adjusted norms for the Brief Visuospatial Memory Test-revised and Hopkins Verbal Learning Test-revised in Spanish-speakers from the U.S.-Mexico border region: The NP-NUMBRS project. Clin Neuropsychol 2021; 35:374-395. [PMID: 33380275 PMCID: PMC8218787 DOI: 10.1080/13854046.2020.1861329] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 12/01/2020] [Accepted: 12/02/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE We generated demographically adjusted norms for the Brief Visuospatial Memory Test-revised (BVMT-R) and the Hopkins Verbal Learning Test-revised (HVLT-R) for Spanish-speakers from the U.S.-Mexico border region as part of a larger normative project. Methods: Healthy native Spanish-speakers (n = 203; Age: 19-60 years; Education: 0-20 years, 59% women) living in Arizona (n = 63) and California (n = 140) completed the BVMT-R and the HVLT-R as part of the larger Neuropsychological Norms for the U.S.-Mexico Border Region in Spanish (NP-NUMBRS) project. Raw scores were converted to T-scores utilizing fractional polynomial equations, which considered linear and non-linear effects of demographic variables (age, education, sex). To demonstrate the benefit of employing our population-specific norms, we computed the proportion of our participants whose test performance fell below one standard deviation (T-score < 40) when applying published norms from non-Hispanic English-speakers, compared to the base rate derived from the new normative sample. Results: The resulting demographically adjusted T-scores showed the expected psychometric properties and corrected the misclassification in rates of impairment that were obtained when applying norms based on the English-speaking sample. Unexpectedly, participants in Arizona obtained slightly lower HVLT-R T-scores than those in California. This site effect was not explained by available sociodemographic or language factors. Supplementary formulas were computed adjusting for site in addition to demographics. Conclusions: These updated norms improve accuracy in identification of learning and memory impairment among Spanish-speaking adults living in the U.S.-Mexico border region. It will be important to generate additional data for elders, as the present norms are only applicable to adults age 60 and younger.
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Affiliation(s)
- Mirella Díaz-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, Los Angeles, CA, USA
| | - Paola A. 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, Los Angeles, CA, USA
| | - María J. Marquine
- Department of Psychiatry, University of California San Diego, La Jolla, CA USA
| | - Anya Umlauf
- Department of Psychiatry, University of California San Diego, La Jolla, CA USA
| | - 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
| | | | - Robert K. Heaton
- Department of Psychiatry, University of California San Diego, La Jolla, CA USA
| | - Mariana Cherner
- Department of Psychiatry, University of California San Diego, La Jolla, CA USA
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Heaton A, Gooding A, Cherner M, Umlauf A, Franklin DR, Rivera Mindt M, Suárez P, Artiola I Fortuni L, Heaton RK, Marquine MJ. Demographically-adjusted norms for the Grooved Pegboard and Finger Tapping tests in Spanish-speaking adults: Results from the Neuropsychological Norms for the U.S.-Mexico Border Region in Spanish (NP-NUMBRS) Project. Clin Neuropsychol 2021; 35:396-418. [PMID: 32077791 PMCID: PMC7438231 DOI: 10.1080/13854046.2020.1713400] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Revised: 12/31/2019] [Accepted: 01/03/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVE We developed demographically-corrected norms for Spanish-speakers from the U.S.-Mexico border regions of California and Arizona on two tests of motor skills - the Grooved Pegboard Test (Pegboard) and Finger Tapping Test (Tapping) - as part of a larger normative effort. METHOD Participants were native Spanish-speakers from the Neuropsychological Norms for the U.S.-Mexico Border Region in Spanish (NP-NUMBRS) Project (Pegboard: N = 254; Tapping: N = 183; age: 19-60 years; education: 0-20 years; 59% women). We examined the association of demographics (age, education and gender) with raw scores. Raw test scores were then converted to demographically-corrected T-scores via fractional polynomial equations. We also examined rates of impairment (T-score < 40) based on the current norms and on previously published norms for English-speaking non-Hispanic Whites and Blacks. RESULTS Having more years of education was associated with better raw test score performance on both tests (p < .001), and increased age was associated with worse performance on Pegboard (p < .001). Men outperformed women on Tapping, and older age was associated with lower raw scores in men only on the Tapping non-dominant hand trial (p = .02). The normed T-scores were confirmed to be normally distributed and free from demographic influences, and resulted in expected rates of impairment. Applying existing norms for English-speaking non-Hispanic Whites and Blacks to the raw scores of Spanish-speakers generally yielded lower than expected impairment rates (2-13%), with one exception: non-dominant Pegboard, for which non-Hispanic White norms overestimated impairment (23%). CONCLUSIONS Present findings underscore the importance of appropriate, population-specific normative data, even for tests of motor ability.
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Affiliation(s)
- Anne Heaton
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Amanda Gooding
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Mariana Cherner
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Anya Umlauf
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Donald R Franklin
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Monica Rivera Mindt
- Department of Psychology and Latin American Latino Studies Institute, Fordham University, Bronx, NY, USA
- Department of Neurology, The Icahn School of Medicine at Mount Sinai, New York, NY, 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
| | | | - Robert K Heaton
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - María J Marquine
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
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Cherner M, Marquine MJ, Umlauf A, Paredes AM, Mindt MR, Suárez P, Yassai-Gonzalez D, Kamalyan L, Scott T, Heaton A, Diaz-Santos M, Gooding A, Fortuny LAI, Heaton RK. Neuropsychological Norms for the U.S.-Mexico Border Region in Spanish (NP-NUMBRS) Project: Methodology and sample characteristics. Clin Neuropsychol 2021; 35:253-268. [PMID: 32319851 PMCID: PMC7894577 DOI: 10.1080/13854046.2019.1709661] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 12/18/2019] [Accepted: 12/22/2019] [Indexed: 10/24/2022]
Abstract
OBJECTIVE The present paper describes the methodology and sample characteristics of the Neuropsychological Norms for the U.S.-Mexico Border Region in Spanish (NP-NUMBRS) Project, which aimed to generate demographically-adjusted norms for a battery of neuropsychological tests in this population. METHODS The sample consisted of 254 healthy Spanish-speakers, ages 19-60 years, recruited from the U.S.-Mexico border regions of Arizona (n = 102) and California (n = 152). Participants completed a comprehensive neuropsychological test battery assessing multiple domains (verbal fluency, speed of information processing, attention/working memory, executive function, learning and memory, visual-spatial skills and fine motor skills). Fluency in both Spanish and English was assessed with performance-based measures. Other culturally-relevant data on educational, social, and language background were obtained via self-report. Demographic influences on test performances were modeled using fractional polynomial equations that allow consideration of linear and non-linear effects. RESULTS There were no significant demographic differences between participants tested in Arizona and California. Age and gender were similar across education ranges. Two thirds of the sample were Spanish dominant and the remainder were considered bilingual. Individual articles in this Special Issue detail the generation of demographically adjusted T-scores for the various tests in the battery as well as an exploration of bilingualism effects. DISCUSSION Norms developed through the NP-NUMBRS project stand to improve the diagnostic accuracy of neuropsychological assessment in Spanish-speaking young-to-middle-aged adults living in the U.S.-Mexico border region. Application of the present norms to other groups should be done with caution.
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Affiliation(s)
- Mariana Cherner
- Department of Psychiatry, University of California San Diego
| | | | - Anya Umlauf
- Department of Psychiatry, University of California San Diego
| | | | - Monica Rivera Mindt
- Department of Psychology, Fordham University
- Department of Latin American and Latina/o Studies Institute, Fordham University
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, USA
| | | | | | - Lily Kamalyan
- Department of Psychiatry, University of California San Diego
| | | | - Anne Heaton
- Department of Psychiatry, University of California San Diego
| | | | - Amanda Gooding
- Department of Psychiatry, University of California San Diego
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Bharti AR, McCutchan JA, Umlauf A, Okwuegbuna OK, Letendre S, Cherner M, Burdo T, Jumare J, Williams K, Blattner W, Royal W. Asymptomatic Malaria Co-infection of HIV-Infected Adults in Nigeria: Prevalence of and Impact on Cognition, Mood, and Biomarkers of Systemic Inflammation. J Acquir Immune Defic Syndr 2021; 86:91-97. [PMID: 33021552 PMCID: PMC10742372 DOI: 10.1097/qai.0000000000002516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND HIV and malaria are associated with immunological perturbations and neurocognitive disorders even when asymptomatic. However, the effect of asymptomatic malaria (AM) in HIV-infected adults on neurocognitive impairment (NCI) is not well understood. This study investigated the biomarkers of systemic inflammation and neurocognition in dually infected Nigerian adults. METHODS We assessed the HIV and AM status of 269 adults and measured their global and domain-specific neurocognition and depression using standardized measures. Blood levels of sCD14 and sCD163 were also measured. RESULTS The mean age of the participants (n = 269) was 33 years, 62% were women, and AM among HIV+ and HIV- was similar (36% versus 37%). NCI was found in 23% (62/269) of participants. HIV+/AM+ had a higher prevalence of impaired learning and executive functions and were more depressed than HIV-/AM- or HIV+/AM-. HIV+ with CD4 T-cell counts ≤200/µL were more impaired in the learning domain than those with >200/µL. HIV+/AM+ group had higher levels of sCD14 compared to the other 3 groups and higher levels of sCD163 than the HIV-/AM- group. Higher levels of sCD14 and sCD163 were each associated with NCI. The sCD163 (log10) levels were higher for those with 1+ versus 2+ parasitemia level. CONCLUSIONS HIV and AM coinfection was associated with an increased risk of reduced learning and executive functions, and elevated systemic inflammation. Mood was more depressed in HIV patients with than those without AM. The mechanisms and long-term effects on neurocognition and depression among HIV+/AM+ individuals should be studied because this coinfection is common globally.
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Affiliation(s)
- Ajay R. Bharti
- University of California San Diego, School of Medicine, San Diego, CA
| | | | - Anya Umlauf
- University of California San Diego, School of Medicine, San Diego, CA
| | | | - Scott Letendre
- University of California San Diego, School of Medicine, San Diego, CA
| | - Mariana Cherner
- University of California San Diego, School of Medicine, San Diego, CA
| | - Tricia Burdo
- Temple University, Lewis Katz School of Medicine, Philadelphia, PA
| | - Jibreel Jumare
- University of Maryland, School of Medicine, Baltimore, MD
| | | | | | - Walter Royal
- University of Maryland, School of Medicine, Baltimore, MD
- Neuroscience Institute, Morehouse School of Medicine, Atlanta, GA
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Kanmogne GD, Fonsah JY, Umlauf A, Moul J, Doh RF, Kengne AM, Tang B, Tagny CT, Nchindap E, Kenmogne L, Franklin D, Njamnshi DM, Kuate CT, Mbanya D, Njamnshi AK, Heaton RK. Effects of HIV infection, antiretroviral therapy, and immune status on the speed of information processing and complex motor functions in adult Cameroonians. Sci Rep 2020; 10:14016. [PMID: 32820234 PMCID: PMC7441321 DOI: 10.1038/s41598-020-70981-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 07/28/2020] [Indexed: 12/12/2022] Open
Abstract
HIV-associated neurocognitive deficits include impaired speed-of-information processing (SIP) and motor functions. There is lack of Cameroonian adult norms for assessing SIP or motor functions. This study of 683 Cameroonians (320 HIV+, 363 HIV-) establishes demographically-adjusted norms for six SIP [Wechsler-Adult-Intelligence-Scale (WAIS)-III Digit Symbol (WAIS-IIIDS) and Symbol Search (WAIS-IIISS), Stroop Color-Naming, Stroop Word-Reading, Trail-Making Test-A (TMT-A), Color Trails-1 (CTT1)], and two motor function [Grooved Pegboard-dominant (GP-DH) and non-dominant (GP-NDH) hands] tests. We assessed viral effects on SIP and motor functions. HIV-infected persons had significantly lower (worse) T scores on GP-DH, WAIS-IIIDS, Stroop Word-Reading, TMT-A; lower motor and SIP summary T scores. Significantly higher proportion of cases (20.7%) than controls (10.3%) had impaired SIP. Male cases had better T scores than female cases on GP-NDH, WAIS-IIIDS, WAIS-IIISS, TMT-A, CTT1; better SIP summary T scores. Antiretroviral therapy (ART) was associated with significantly better T scores on GP-NDH, WAIS-IIIDS, Stroop Color-Naming; better motor and SIP summary T scores. Cases with higher CD4 had better T scores on WAIS-IIIDS, TMT-A, CTT1; better SIP summary T scores. Overall, we demonstrate that HIV infection in Cameroon is associated with deficits in SIP and motor functions; ART and higher CD4 are associated with better cognitive performance. We provide SIP and psychomotor functions normative standards, which will be useful for neurobehavioral studies in Cameroon of diseases affecting the brain.
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Affiliation(s)
- Georgette D Kanmogne
- Vice-Chair for Resource Allocation and Faculty Development, Department of Pharmacology and Experimental Neuroscience, College of Medicine, University of Nebraska Medical Center, Omaha, NE, 68198-5800, USA.
| | - Julius Y Fonsah
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
- Department of Neurology, Yaoundé Central Hospital/Brain Research Africa Initiative (BRAIN), Yaoundé, Cameroon
| | - Anya Umlauf
- Department of Psychiatry, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA
| | - Jacob Moul
- Department of Psychiatry, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA
| | - Roland F Doh
- Department of Neurology, Yaoundé Central Hospital/Brain Research Africa Initiative (BRAIN), Yaoundé, Cameroon
| | - Anne M Kengne
- Department of Neurology, Yaoundé Central Hospital/Brain Research Africa Initiative (BRAIN), Yaoundé, Cameroon
| | - Bin Tang
- Department of Psychiatry, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA
| | - Claude T Tagny
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
- Yaoundé University Teaching Hospital, Yaoundé, Cameroon
| | | | | | - Donald Franklin
- Department of Psychiatry, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA
| | - Dora M Njamnshi
- HIV-Day Care Service, Yaoundé Central Hospital, Yaoundé, Cameroon
| | - Callixte T Kuate
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
- Department of Neurology, Laquintinie Hospital, Douala, Cameroon
| | - Dora Mbanya
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
- Yaoundé University Teaching Hospital, Yaoundé, Cameroon
| | - Alfred K Njamnshi
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
- Department of Neurology, Yaoundé Central Hospital/Brain Research Africa Initiative (BRAIN), Yaoundé, Cameroon
| | - Robert K Heaton
- Department of Psychiatry, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA
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LaVergne S, Umlauf A, McCutchan A, Heaton R, Benson C, Kumarasamy N, Bharti AR. Impact of Latent Tuberculosis Infection on Neurocognitive Functioning and Inflammation in HIV-Infected and Uninfected South Indians. J Acquir Immune Defic Syndr 2020; 84:430-436. [PMID: 32282443 PMCID: PMC7321856 DOI: 10.1097/qai.0000000000002368] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND HIV-associated neurocognitive disorder persists in some people living with HIV despite optimal antiretroviral therapy. Latent tuberculosis infection (LTBI) may cause systemic inflammation and immune activation that may impair brain function. We assessed cognition and biomarkers of inflammation in both HIV+ and HIV- South Indians with and without LTBI. METHODS Adults (≥18 years old) with and without HIV infection were screened for LTBI by interferon-gamma release assays, completed comprehensive neurocognitive assessments, and underwent measurement of serum inflammatory biomarker levels. RESULTS The participants (n = 119) were HIV+/LTBI+ (n = 15), HIV+/LTBI- (n = 50), HIV-/LTBI+ (n = 26), and HIV-/LTBI- (n = 28). HIV+ participants, regardless of LTBI status, had more impaired global deficit scores than HIV- participants (odds ratio = 3.42, P = 0.028, adjusted for sex and education differences). Neither global deficit scores nor impairment rates differed in the LTBI+ group compared with the LTBI- group (P = 0.79 and P = 0.41, respectively). The mean log10 interleukin (IL)-6 and monocyte chemoattractant protein-1 values were significantly higher and high sensitivity C-reactive protein lower in the LTBI+ group than the LTBI- group (P = 0.044, 0.023, and 0.03, respectively, adjusting for HIV status and sex). CONCLUSIONS In this cross-sectional study of South Indians, HIV infection, but not LTBI, was associated with increased neurocognitive impairment. Proinflammatory biomarkers (IL-6 and monocyte chemoattractant protein-1, but not tumor necrosis factor-α) were elevated in the LTBI+ groups compared with the LTBI- groups. Biomarkers of immune activation (interferon-γ, macrophage inflammatory protein-1β, IL-2, interferon gamma inducible protein-10, RANTES, and IL-22) did not differ between these groups. Larger longitudinal studies should be conducted to confirm our findings that the effect of LTBI on systemic inflammation or neurocognitive impairment is likely small.
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Affiliation(s)
- Stephanie LaVergne
- Department of Medicine and Psychiatry, University of California, San Diego, CA, USA, Infectious Diseases Medical Centre, Voluntary Health Services (VHS), Chennai, India
| | - Anya Umlauf
- Department of Medicine and Psychiatry, University of California, San Diego, CA, USA, Infectious Diseases Medical Centre, Voluntary Health Services (VHS), Chennai, India
| | - Allen McCutchan
- Department of Medicine and Psychiatry, University of California, San Diego, CA, USA, Infectious Diseases Medical Centre, Voluntary Health Services (VHS), Chennai, India
| | - Robert Heaton
- Department of Medicine and Psychiatry, University of California, San Diego, CA, USA, Infectious Diseases Medical Centre, Voluntary Health Services (VHS), Chennai, India
| | - Constance Benson
- Department of Medicine and Psychiatry, University of California, San Diego, CA, USA, Infectious Diseases Medical Centre, Voluntary Health Services (VHS), Chennai, India
| | - Nagalingeswaran Kumarasamy
- CART Clinical Research Site, Infectious Diseases Medical Centre, Voluntary Health Services (VHS), Chennai, India
| | - Ajay R. Bharti
- Department of Medicine and Psychiatry, University of California, San Diego, CA, USA, Infectious Diseases Medical Centre, Voluntary Health Services (VHS), Chennai, India
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Nguyen AL, Sundermann E, Rubtsova AA, Sabbag S, Umlauf A, Heaton R, Letendre S, Jeste DV, Marquine MJ. Emotional health outcomes are influenced by sexual minority identity and HIV serostatus. AIDS Care 2020; 33:1127-1132. [PMID: 32590909 DOI: 10.1080/09540121.2020.1785998] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
For people living with HIV (PLWH) and sexual minorities (SM), the intersection of identities can compound experiences like stigma and discrimination resulting in poor emotional health. We investigated the separate and interactive associations of HIV serostatus and sexual identity with emotional health. Our dataset included 371 participants. Emotional health was assessed by the NIH Toolbox emotion battery which yields negative affect, social satisfaction, and psychological well-being. Regressions were conducted for each composite, with HIV serostatus, sexual identity, and their interaction as independent variables along with covariates. The HIV serostatus x SM identity interaction was statistically significant in the regression of Negative Affect (p = .01): heterosexuals living with HIV had worse Negative Affect compared to heterosexual HIV-persons (p = .01). The interaction terms were for social satisfaction and psychological well-being were not significant. However, among PLWH, sexual minorities reported better Social Satisfaction (p = .03) and marginally better psychological well-being (p = .07) compared to heterosexuals.
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Affiliation(s)
- Annie L Nguyen
- Department of Family Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Erin Sundermann
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Anna A Rubtsova
- Department of Behavioral, Social, and Health Education Sciences, Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - Samir Sabbag
- Department of Psychiatry, University of Miami, Miami, FL, USA
| | - Anya Umlauf
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Robert Heaton
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Scott Letendre
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA.,Department of Medicine, University of California San Diego, San Diego, CA, USA
| | - Dilip V Jeste
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA.,Department of Neuroscience, University of California San Diego, San Diego, CA, USA.,Sam and Rose Stein Institute for Research on Aging, University of California San Diego, San Diego, CA, USA
| | - María J Marquine
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
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Kohli M, Paolillo EW, Saloner R, Umlauf A, Ellis R, Moore DJ. The Effects of Low-Risk Drinking on Neurocognition Among Older Persons Living With HIV as Compared to Those Without HIV. Alcohol Clin Exp Res 2020; 44:1389-1399. [PMID: 32449941 DOI: 10.1111/acer.14379] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 05/14/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Heavy alcohol use negatively impacts neurocognition, but some studies report neurocognitive benefits associated with light drinking among HIV-seronegative (HIV-) older persons, suggesting a nonlinear or an inverted "J-shaped" association of alcohol consumption on neurocognition. Alcohol use is common among people with HIV (PWH); however, the association between recent "low-risk" alcohol consumption and neurocognition among PWH is poorly understood. METHODS Participants included 310 PWH and 89 HIV- older (≥50 years) adults who reported alcohol abstinence or "low-risk" drinking, defined per the National Institute on Alcohol Abuse and Alcoholism criteria (i.e., ≥15 drinks/wk or ≥5 drinks/d for men; ≥8 drinks/wk or ≥4 drinks/d for women). Neurocognition was measured using global and domain-specific demographically corrected T-scores. Multiple linear regressions examined the interaction between total drinks in the last 30 days (linear and quadratic terms) and HIV serostatus on neurocognition, covarying for age, sex, lifetime major depressive disorder, lifetime nonalcohol substance use disorders, and lifetime alcohol use disorder. RESULTS Total drinks consumed in the last 30 days did not differ by HIV serostatus (p = 0.202). Among HIV- older adults, quadratic effects of total drinks on neurocognition occurred such that optimal neurocognition (i.e., global function, executive function, learning, delayed recall, and motor skills) was detected at intermediate levels of "low-risk" drinking (~20 to 40 drinks), with poorer performance at the lower and higher ranges of "low-risk" consumption. In PWH, total drinks did not exhibit linear or quadratic associations with neurocognition. CONCLUSIONS In HIV- "low-risk" drinkers, intermediate levels of recent alcohol use were associated with better neurocognition, consistent with the inverted J-shaped association. The same nonlinear effect of recent alcohol consumption on neurocognition was absent in PWH, indicating there may be no beneficial or deleterious effects of low-risk alcohol consumption on neurocognition among PWH. Future research is warranted to examine associations between alcohol consumption and HIV-related biopsychosocial disadvantages that may supersede the neurocognitive benefits of alcohol.
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Affiliation(s)
- Maulika Kohli
- From the, San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, (MK, EWP, RS), San Diego State University/University of California, San Diego, San Diego, California.,HIV Neurobehavioral Research Program, (MK, EWP, RS, AU, RE, DJM), Department of Psychiatry, University of California, San Diego, San Diego, California
| | - Emily W Paolillo
- From the, San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, (MK, EWP, RS), San Diego State University/University of California, San Diego, San Diego, California.,HIV Neurobehavioral Research Program, (MK, EWP, RS, AU, RE, DJM), Department of Psychiatry, University of California, San Diego, San Diego, California
| | - Rowan Saloner
- From the, San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, (MK, EWP, RS), San Diego State University/University of California, San Diego, San Diego, California.,HIV Neurobehavioral Research Program, (MK, EWP, RS, AU, RE, DJM), Department of Psychiatry, University of California, San Diego, San Diego, California
| | - Anya Umlauf
- HIV Neurobehavioral Research Program, (MK, EWP, RS, AU, RE, DJM), Department of Psychiatry, University of California, San Diego, San Diego, California
| | - Ronald Ellis
- HIV Neurobehavioral Research Program, (MK, EWP, RS, AU, RE, DJM), Department of Psychiatry, University of California, San Diego, San Diego, California.,Department of Neurosciences, (RE), University of California, San Diego, La Jolla, California
| | - David J Moore
- HIV Neurobehavioral Research Program, (MK, EWP, RS, AU, RE, DJM), Department of Psychiatry, University of California, San Diego, San Diego, California
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Marquine MJ, Morlett Paredes A, Madriaga C, Blumstein Y, Umlauf A, Kamalyan L, Rivera Mindt M, Suarez P, Artiola I Fortuni L, Heaton RK, Cherner M. Demographically-adjusted norms for selected tests of verbal fluency: Results from the Neuropsychological Norms for the US-Mexico Border Region in Spanish (NP-NUMBRS) project. Clin Neuropsychol 2020; 35:269-292. [PMID: 32498654 DOI: 10.1080/13854046.2020.1762931] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Verbal fluency tests are sensitive to various disorders affecting the central nervous system and are commonly included in neuropsychological evaluations. We aimed to develop normative data for two verbal fluency tests in a sample of native Spanish-speakers living in the US-Mexico border region. METHOD Participants included 254 adults from the Neuropsychological Norms for the US-Mexico Border Region in Spanish (NP-NUMBRS) Project (Age: range = 19-60; Education: range = 0-20, 59% female). Participants completed two verbal fluency tests (i.e., letter [PMR] and semantic/category fluency [Animal Naming]) as part of a larger neuropsychological test battery. We examined linear and nonlinear effects of demographic factors (age, education, and gender) on verbal fluency raw scores, and developed T-scores using fractional polynomial equations controlling for demographics. We also calculated the rates of "impairment" (T-scores < 40) that would be obtained by applying the newly developed norms and available norms for non-Hispanic English-speakers on comparable tests. RESULTS There were positive small effects of age and medium effects of education on verbal fluency raw scores. The normalized distribution of T-scores with the new norms showed expected psychometric properties. However, rates of impairment for both letter and semantic fluency were significantly higher when applying non-Hispanic White norms, and significantly lower when applying non-Hispanic Black norms. CONCLUSIONS We provide norms for Spanish-speakers living along the US-Mexico border region for two verbal fluency tests that are co-normed with a more extensive neuropsychological battery. These regional norms will improve interpretation of verbal fluency test performance in Spanish-speakers living in the US-Mexico borderland.
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Affiliation(s)
- María J Marquine
- Department of Psychiatry, University of California, San Diego, San Diego, CA, USA
| | | | - Cecilia Madriaga
- Facultad de Psicología, Universidad de la República, Montevideo, Uruguay
| | - Yanina Blumstein
- Facultad de Psicología, Universidad de la República, Montevideo, Uruguay
| | - Anya Umlauf
- Department of Psychiatry, University of California, San Diego, San Diego, CA, USA
| | - Lily Kamalyan
- Department of Psychiatry, University of California, San Diego, San Diego, CA, USA.,Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, San Diego, San Diego, CA, USA
| | - Monica Rivera Mindt
- Department of Psychology and Latin American and Latina/o Studies Institute, Fordham University & Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Paola Suarez
- Department of Psychiatry and Behavioral Sciences, University of California, Los Angeles, Los Angeles, CA, USA
| | | | - Robert K Heaton
- Department of Psychiatry, University of California, San Diego, San Diego, CA, USA
| | - Mariana Cherner
- Department of Psychiatry, University of California, San Diego, San Diego, CA, USA
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Marquine MJ, Rivera Mindt M, Umlauf A, Suárez P, Kamalyan L, Morlett Paredes A, Yassai-Gonzalez D, Scott TM, Heaton A, Diaz-Santos M, Gooding A, Artiola I Fortuny L, Heaton RK, Cherner M. Introduction to the Neuropsychological Norms for the US-Mexico Border Region in Spanish (NP-NUMBRS) Project. Clin Neuropsychol 2020; 35:227-235. [PMID: 32431209 DOI: 10.1080/13854046.2020.1751882] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The present introduction to the Neuropsychological Norms for the U.S.-Mexico Border Region in Spanish (NP-NUMBRS) project aims to provide an overview of the conceptual framework and rationale that guided the development of this project. METHODS We describe important aspects of our conceptual framework, which was guided by some of the main purposes of neuropsychological testing, including the identification of underlying brain dysfunction, and the characterization of cognitive strengths and weakness relevant to everyday functioning. We also provide our rationale for focusing this norm development project on Spanish-speakers in the United States, and provide an outline of the articles included in this Special Issue focused on the NP-NUMBRS project. CONCLUSIONS The data presented in this Special Issue represent an important tool for clinicians and researchers working in the neuropsychological assessment of Spanish-speakers in the United States.
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Affiliation(s)
- María J Marquine
- Department of Psychiatry, University of California San Diego, San Diego, California, USA
| | - Monica Rivera Mindt
- Departments of Psychology, Fordham University, New York, New York, USA.,Latin American and Latina/o Studies Institute, Fordham University, New York, New York, USA.,Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Anya Umlauf
- Department of Psychiatry, University of California San Diego, San Diego, California, USA
| | - Paola Suárez
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, California, USA
| | - Lily Kamalyan
- Department of Psychiatry, University of California San Diego, San Diego, California, USA
| | | | - David Yassai-Gonzalez
- Department of Psychiatry, University of California San Diego, San Diego, California, USA
| | - Travis M Scott
- Departments of Psychology, Fordham University, New York, New York, USA.,VA Palo Alto Health Care System, Sierra Pacific MIRECC, Palo Alto, California, USA
| | - Anne Heaton
- Department of Psychiatry, University of California San Diego, San Diego, California, USA
| | - Mirella Diaz-Santos
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, California, USA
| | - Amanda Gooding
- Department of Psychiatry, University of California San Diego, San Diego, California, USA
| | | | - Robert K Heaton
- Department of Psychiatry, University of California San Diego, San Diego, California, USA
| | - Mariana Cherner
- Department of Psychiatry, University of California San Diego, San Diego, California, USA
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de Almeida SM, Rotta I, de Pereira AP, Tang B, Umlauf A, Ribeiro CEL, Letendre S, Ellis RJ. Cerebrospinal fluid pleocytosis as a predictive factor for CSF and plasma HIV RNA discordance and escape. J Neurovirol 2020; 26:241-251. [PMID: 32002817 PMCID: PMC7261245 DOI: 10.1007/s13365-020-00828-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 01/10/2020] [Accepted: 01/23/2020] [Indexed: 01/14/2023]
Abstract
The aims of this study were to investigate the frequency of HIV-1 RNA level discordance between the cerebrospinal fluid (CSF) and plasma and of CSF viral escape (CVE) in patients with HIV-1 subtype C on antiretroviral therapy, and evaluate the CSF white blood cell (WBC) performance characteristics in predicting CSF discordance in HIV+ group and the frequency of cognitive impairment in individuals with CSF HIV discordance or escape. HIV-1 RNA levels were assessed in plasma and CSF samples from 68 HIV+ participants without opportunistic infection. CSF discordance was found in 7.4% and CVE in 10%, with comparable frequencies between HIV-1B and C. Twenty samples (29%) showed increased CSF WBC counts. This group had higher CSF and plasma HIV-1 RNA levels than the group with normal WBC counts (p < 0.0001 and 0.006, respectively). The odds of CSF discordance were 18 times higher for a person with CSF WBC count of > 5 cells/mm3 than the group with normal CSF WBC count. CSF WBC counts (cut-off of 15 cells/mm3) showed high-performance characteristics as a predictive biomarker of CSF discordance (AUC the ROC curve 0.98). The frequency of cognitive impairment for CSF escape or discordance was 83% and 80%. The odds of cognitive impairment in these groups were 19 and 15 times higher than those for an HIV(-) person. Viral discordance or escape in the CNS occurs at a comparable frequency for HIV-1C and HIV-1B. The CSF WBC count was effective as a predictive biomarker of CSF and plasma discordance.
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Affiliation(s)
| | - Indianara Rotta
- Virology Laboratory, Hospital de Clínicas, Universidade Federal do Paraná, Curitiba, PR, Brazil
| | | | - Bin Tang
- Department of Medicine and Psychiatry, University of California, San Diego, CA, USA
| | - Anya Umlauf
- Department of Medicine and Psychiatry, University of California, San Diego, CA, USA
| | - Cléa Elisa Lopes Ribeiro
- Infectious Diseases Unity, Hospital de Clínicas, Universidade Federal do Paraná, Curitiba, PR, Brazil
| | - Scott Letendre
- Department of Medicine and Psychiatry, University of California, San Diego, CA, USA
| | - Ronald J Ellis
- Department of Neurosciences and Psychiatry, University of California, San Diego, CA, USA
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Scott TM, Morlett Paredes A, Taylor MJ, Umlauf A, Artiola I Fortuny L, Heaton RK, Cherner M, Marquine MJ, Rivera Mindt M. Demographically-adjusted norms for the WAIS-R Block Design and Arithmetic subtests: Results from the Neuropsychological Norms for the US-Mexico Border Region in Spanish (NP-NUMBRS) project. Clin Neuropsychol 2020; 35:419-432. [PMID: 31928314 DOI: 10.1080/13854046.2019.1707285] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE Wechsler Adult Intelligence Scale (WAIS) Block Design and Arithmetic subtests are frequently used as measures of visuospatial construction and verbal working memory, respectively. As part of a larger test adaptation and norming effort for this population, we generated and investigated demographically-adjusted interpretive norms for WAIS-R Block Design and Arithmetic in Spanish-speaking adults living in the US-Mexico border region. METHOD Participants included 183 community-dwelling adults ages 20-55 (education range: 0-20 years; 58% women) from the NeuroPsychological-Norms for the US-Mexico Border Region in Spanish (NP-NUMBRS) Project. They completed the WAIS-R Block Design and Arithmetic subtests in Spanish. Demographically-adjusted T-scores were calculated for these subtests using fractional polynomial equations adjusting for linear and non-linear effects of age, education (continuous), and sex. We compared our rates of impairment (i.e. T < 40) against rates calculated using published English-speaking WAIS-R standardization sample norms adjusted for age, education, and sex. RESULTS Education was positively associated with performance on Block Design and Arithmetic subtests, and men outperformed women on both subtests. The present Spanish-speaker norms for these subtests yielded expected rates of "impairment" (i.e. 15-16% impaired, a 1 SD cutoff), while existing norms for English-speakers underestimated impairment (i.e. 5-6% impaired) when applied to our Spanish-speaking sample. CONCLUSIONS Regional normative data will improve interpretation of test performance on Block Design and Arithmetic subtests for Spanish-speakers living in the US-Mexico border region and may aid in bolstering the overall analysis of neuropsychological profile patterns in this population. Cross-validation with Spanish-speakers in other regions and/or with other national origins is needed.
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Affiliation(s)
- Travis M Scott
- Department of Psychology, Fordham University, New York, NY, USA.,VA Palo Alto Health Care System, Sierra Pacific MIRECC, Palo Alto, CA, USA
| | | | - Michael J Taylor
- Department of Psychiatry, University of California, San Diego, CA, USA
| | - Anya Umlauf
- 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
| | - María J Marquine
- Department of Psychiatry, University of California, San Diego, CA, USA
| | - Monica Rivera Mindt
- Department of Psychology, Fordham University, New York, NY, USA.,Department of Latin American Latino Studies Institute, Fordham University, New York, NY, USA.,Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Morlett Paredes A, Carrasco J, Kamalyan L, Cherner M, Umlauf A, Rivera Mindt M, Suarez P, Artiola I Fortuny L, Franklin D, Heaton RK, Marquine MJ. Demographically adjusted normative data for the Halstead category test in a Spanish-speaking adult population: Results from the Neuropsychological Norms for the U.S.-Mexico Border Region in Spanish (NP-NUMBRS). Clin Neuropsychol 2020; 35:356-373. [PMID: 31913746 DOI: 10.1080/13854046.2019.1709660] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE The present study aimed to develop norms applicable to Spanish-speakers living in the United States (U.S.)- Mexico border region for the Halstead Category Test (HCT), a test of executive function. METHODS Healthy native Spanish-speakers (N = 252; Age: range 19-60 years, M = 37.28, SD = 10.24; Education: range 0-20 years; M = 10.65, SD = 4.33; 58.33% women) living in the U.S.-Mexico border region of California and Arizona completed the HCT as part of a comprehensive neuropsychological test battery. The univariable and interactive effects of demographic variables on HCT raw scores were examined. Total scores were normed using fractional polynomial equations, controlling for age, education, and gender. T-scores were also computed for HCT scores of the current Spanish-speaking normative sample using published, demographically-adjusted norms for English-speaking non-Hispanic Whites and Blacks. Impairment rates (T-Scores < 40) were calculated using published and current norms. RESULTS Age was significantly associated with increased number of errors, and education and male gender were associated with decreased number of HCT errors (total raw scores). Applying norms developed for English-speaking non-Hispanic Whites and Blacks resulted in overestimation of impairment rates in the current sample (impairment: 48% with White norms and 27% with Black norms). This pattern was evident across levels of education except in participants with 13+ years of education, where rates of impairment using non-Hispanic Black norms were comparable to those based on newly developed norms. CONCLUSION The present study presents norms for the HCT in a sample of U.S. Spanish-speakers, providing an important tool for identifying executive dysfunction in this population.
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Affiliation(s)
| | - Jessica Carrasco
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA.,Department of Psychology, San Diego State University, San Diego, CA, USA
| | - Lily Kamalyan
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA.,Department of Psychology, San Diego State University, San Diego, CA, USA
| | - Mariana Cherner
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Anya Umlauf
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Monica Rivera Mindt
- Department of Psychology and Latin American and Latina/o Studies Institute, Fordham University, Bronx, NY, USA.,Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Paola Suarez
- Department of Psychiatry and Behavioral Sciences, University of California Los Angeles, Los Angeles, CA, USA
| | | | - Donald Franklin
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Robert K Heaton
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - María J Marquine
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
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Umlauf A, Soontornniyomkij B, Sundermann EE, Gouaux B, Ellis RJ, Levine AJ, Moore DJ, Soontornniyomkij V. Risk of developing cerebral β-amyloid plaques with posttranslational modification among HIV-infected adults. AIDS 2019; 33:2157-2166. [PMID: 31688040 PMCID: PMC6852888 DOI: 10.1097/qad.0000000000002336] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Evidence of accelerated brain aging among HIV-infected adults argues for the increased risk of developing cerebral β-amyloid (Aβ) plaques. We compared the frequency of Aβ plaque-bearing cases in our HIV cohort with that in a general cohort reported by Braak et al. We explored posttranslationally modified Aβ forms (N3pE, E22P, phospho-Ser8) in plaques and E22P-Aβ in the postmortem cerebrospinal fluid (CSF) in the HIV cohort. DESIGN Clinicopathological study of HIV-infected adults. METHODS To assess frontal Aβ plaque deposition, we conducted immunohistochemistry for generic Aβ (4G8) and three modified Aβ forms. We determined CSF E22P-Aβ levels by ELISA. RESULTS We found 4G8-Aβ plaques in 29% of 279 HIV-infected cases. Within the age range of 31-70 years, the frequency of 4G8-Aβ plaque-bearing cases was higher in our HIV cohort (n = 273) compared with the general cohort (n = 1110) overall (29.3 vs. 25.8%) and across four age groups by decade (odds ratio 2.35, P < 0.0001). In HIV-infected cases with (n = 37) and without (n = 12) 4G8-Aβ plaques, modified Aβ forms occurred in order: N3pE, E22P, and phospho-Ser8. In CSF assays of HIV-infected cases with (n = 27; 17 focal, 10 widespread) and without (n = 11) 4G8-Aβ plaques, the median E22P-Aβ/Aβ40 ratio was higher among cases with widespread plaques than in cases with focal or absent plaques (P = 0.047). CONCLUSION Our findings suggest HIV-infected adults are at increased risk of developing cerebral Aβ plaques. The occurrence of modified Aβ forms in order suggests the progression stages of Aβ plaque deposition. The potential for E22P-Aβ as a CSF biomarker of cerebral Aβ plaques should be investigated.
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Affiliation(s)
- Anya Umlauf
- aDepartment of Psychiatry bDepartment of Neurosciences, School of Medicine, University of California San Diego, La Jolla cDepartment of Neurology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
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Hussain MA, Kamalyan L, Diaz MM, Umlauf A, Franklin DR, Cherner M, Rivera Mindt M, Artiola i Fortuny R, Heaton RK, Marquine MJ. Predictors of Neurocognitive Impairment in Spanish-Speaking Latinos Living with HIV in the United States using Newly Developed Neuropsychological Test Norms. Arch Clin Neuropsychol 2019. [DOI: 10.1093/arclin/acz029.24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Objective
HIV-associated neurocognitive impairment (NCI) is prevalent and impactful. Yet, there is an absence of published studies that investigate its correlates among Spanish-speaking Latinos living in mainland US- a demographic that represents a large and vulnerable segment of the HIV+ population. The goal of the current study was to examine predictors of NCI among Spanish-speaking Latinos with HIV living in the United States.
Participants and Method
153 Spanish-speaking Latinos living with HIV from the US-Mexico border region (Age: M = 38.2, SD = 9.7; Education: M = 10.9, SD = 3.6; 73% female; 56% AIDS) completed comprehensive neuropsychological, neuromedical, and psychiatric evaluations in Spanish. Scores across 7 cognitive domains were converted to a Global Deficit Score (GDS) based on T-scores on individual tests using newly developed, region specific, and demographically-corrected norms for Spanish-speaking Latinos. NCI was determined using cutoff of GDS > 0.5 (39.2% of sample). Examined predictors included HIV disease characteristics (e.g., AIDS status, current CD4 count, duration of antiretroviral therapy (ART) exposure) and psychiatric comorbidities.
Results
A multivariable logistic regression - including predictors that were associated with NCI in univariable analyses - showed a significant interaction between lifetime history of substance use disorder (LT SUD) and duration of ART exposure, after accounting for AIDS status (LR Chi2 = 3.99, p = 0.046). Stratified analyses showed that among participants who did not have LT SUD, longer ART exposure was associated with decreased NCI (p = 0.01), while rates of NCI among those with LT SUD were not influenced by months of ART exposure (p = 0.91).
Conclusions
Present findings showed that HIV disease burden and psychiatric characteristics might interact to impact NCI among Spanish-speaking Latinos. Considering these influences may help in the provision of comprehensive care to Spanish-speaking, Latino minority groups that suffer from NCI and HIV.
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Yassai-Gonzalez D, Marquine MJ, Perez-Tejada A, Umlauf A, Kamalyan L, Morlett Paredes A, Suarez P, Rivera Mindt M, Artiola i Fortuny L, Franklin DR, Cherner M, Heaton RK. Normative Data for Wisconsin Card Sorting Test-64 Item in a Spanish Speaking Adult Population Living in the US/Mexico Border Region. Arch Clin Neuropsychol 2019. [DOI: 10.1093/arclin/acz029.48] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Objective
The Wisconsin Card Sorting Test (WCST) is a commonly used test of executive functioning. We aimed to generate norms on the WCST-64 item version for Spanish-speakers living in the US.
Participants and Method
Healthy Spanish-speakers (N=189) were recruited (Age M = 38.2, SD = 10.3, range 19-60; Education M = 10.9, SD = 4.5, range 0-20; 59.3% female) from the US-Mexico border region. Participants completed the WCST-64 as part of a larger neuropsychological battery. Spearman correlations and Wilcoxon Rank-sum tests were used to assess associations between demographic variables and raw scores. T-scores enabling demographic corrections for various WCST-64 measures (Total Errors, Perseverative Responses, Perseverative Errors, and Number of Categories Completed) were obtained using fractional polynomial equations with corrections for age, education, and gender. Uncorrected percentile scores were reported for Failures to Maintain Set. Rates of neurocognitive impairment (NCI; T < 40) were calculated by applying the newly developed norms along with published norms for non-Hispanic (NH) White and African American English-speakers.
Results
Older age was significantly associated with worse performance, and higher education was linked to better performance on most WCST-64 raw scores. Current norms resulted in expected rates of NCI (14-16% across measures). Applying norms for NH-Whites overestimated NCI (38-52% across measures). Applying norms for African Americans yielded NCI rates closer to what would be expected, with milder misclassifications (NCI: Total Errors = 14%, Perseverative Responses = 19%, Perseverative Errors = 10%).
Conclusions
Regional normative data will improve interpretation of test performance on the WCST-64 for Spanish-speakers of Mexican origin living in the US and will facilitate a more valid analysis of neuropsychological profile patterns in this population. Future research will need to explore the generalizability of these norms to other groups.
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Heaton A, Gooding A, Cherner M, Umlauf A, Franklin D, Rivera Mindt M, Suarez P, Artiola i Fortuny L, Heaton RK, Marquine MJ. Demographically-Corrected Norms for the Grooved Pegboard Test and Finger Tapping Test in monolingual Spanish speakers from the U.S.-Mexico Border Region. Arch Clin Neuropsychol 2019. [DOI: 10.1093/arclin/acz029.23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Objective
We developed demographically-corrected norms for US-dwelling, Spanish-speaking Hispanics on two widely used tests of motor skills - the Grooved Pegboard Test (Pegs) and Finger Tapping Test (Tapping). We then examined the effects of applying established norms for non-Hispanic Caucasians (NH Whites) and non-Hispanic African Americans (NH Blacks) on motor test results from our Hispanic population.
Participants and Method
254 participants living in the US-Mexico border region of San Diego, CA and Tucson, AZ completed Pegs, and a subset (n = 183) completed Tapping. Age ranged from 19-60 and education from 0-20 years, with 59% women. Raw test scores were converted to demographically-corrected T-scores with a fractional polynomial procedure and compared to a fitted curve for the original data.
Results
Findings included significant main effects of education on both tests (p < .001), and of age for Pegs (p < .001). There was a significant interaction of sex and age on Tapping, such that older age was associated with lower scores in men only (p = .02). The resulting normative T-scores were confirmed to be free from demographic influences. Using a T < 40 cut point, rates of impairment in the Spanish speaking normative sample for dominant (D) and nondominant (ND) hands, respectively, were 17% and 14% for Pegs, and 12% and 10% for Tapping. Applying existing norms for NH Whites and NH Blacks to the raw scores of Spanish speakers generally yielded lower impairment rates on all measures, with one exception, Pegs ND, for which NH White norms overestimated impairment (23%).
Conclusions
Normative standards from other groups are not a good fit for interpreting motor test performance in this Hispanic population, which in the current instance would have generally underdiagnosed fine motor impairment. These findings underscore the importance of appropriate, population-specific normative data- even for tests of motor ability.
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Browne SH, Umlauf A, Tucker AJ, Low J, Moser K, Gonzalez Garcia J, Peloquin CA, Blaschke T, Vaida F, Benson CA. Wirelessly observed therapy compared to directly observed therapy to confirm and support tuberculosis treatment adherence: A randomized controlled trial. PLoS Med 2019; 16:e1002891. [PMID: 31584944 PMCID: PMC6777756 DOI: 10.1371/journal.pmed.1002891] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 08/27/2019] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Excellent adherence to tuberculosis (TB) treatment is critical to cure TB and avoid the emergence of resistance. Wirelessly observed therapy (WOT) is a novel patient self-management system consisting of an edible ingestion sensor (IS), external wearable patch, and paired mobile device that can detect and digitally record medication ingestions. Our study determined the accuracy of ingestion detection in clinical and home settings using WOT and subsequently compared, in a randomized control trial (RCT), confirmed daily adherence to medication in persons using WOT or directly observed therapy (DOT) during TB treatment. METHODS AND FINDINGS We evaluated WOT in persons with active Mycobacterium tuberculosis complex disease using IS-enabled combination isoniazid 150 mg/rifampin 300 mg (IS-Rifamate). Seventy-seven participants with drug-susceptible TB in the continuation phase of treatment, prescribed daily isoniazid 300 mg and rifampin 600 mg, used IS-Rifamate. The primary endpoints of the trial were determination of the positive detection accuracy (PDA) of WOT, defined as the percentage of ingestions detected by WOT administered under direct observation, and subsequently the proportion of prescribed doses confirmed by WOT compared to DOT. Initially participants received DOT and WOT simultaneously for 2-3 weeks to allow calculation of WOT PDA, and the 95% confidence interval (CI) was estimated using the bootstrap method with 10,000 samples. Sixty-one participants subsequently participated in an RCT to compare the proportion of prescribed doses confirmed by WOT and DOT. Participants were randomized 2:1 to receive WOT or maximal in-person DOT. In the WOT arm, if ingestions were not remotely confirmed, the participant was contacted within 24 hours by text or cell phone to provide support. The number of doses confirmed was collected, and nonparametric methods were used for group and individual comparisons to estimate the proportions of confirmed doses in each randomized arm with 95% CIs. Sensitivity analyses, not prespecified in the trial registration, were also performed, removing all nonworking (weekend and public holiday) and held-dose days. Participants, recruited from San Diego (SD) and Orange County (OC) Divisions of TB Control and Refugee Health, were 43.1 (range 18-80) years old, 57% male, 42% Asian, and 39% white with 49% Hispanic ethnicity. The PDA of WOT was 99.3% (CI 98.1; 100). Intent-to-treat (ITT) analysis within the RCT showed WOT confirmed 93% versus 63% DOT (p < 0.001) of daily doses prescribed. Secondary analysis removing all nonworking days (weekends and public holidays) and held doses from each arm showed WOT confirmed 95.6% versus 92.7% (p = 0.31); WOT was non-inferior to DOT (difference 2.8% CI [-1.8%, 9.1%]). One hundred percent of participants preferred using WOT. WOT associated adverse events were <10%, consisting of minor skin rash and pruritus associated with the patch. WOT provided longitudinal digital reporting in near real time, supporting patient self-management and allowing rapid remote identification of those who needed more support to maintain adherence. This study was conducted during the continuation phase of TB treatment, limiting its generalizability to the entire TB treatment course. CONCLUSIONS In terms of accuracy, WOT was equivalent to DOT. WOT was superior to DOT in supporting confirmed daily adherence to TB medications during the continuation phase of TB treatment and was overwhelmingly preferred by participants. WOT should be tested in high-burden TB settings, where it may substantially support low- and middle-income country (LMIC) TB programs. TRIAL REGISTRATION ClinicalTrials.gov NCT01960257.
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Affiliation(s)
- Sara H. Browne
- University of California San Diego, La Jolla, California, United States of America
- * E-mail:
| | - Anya Umlauf
- University of California San Diego, La Jolla, California, United States of America
| | - Amanda J. Tucker
- University of California San Diego, La Jolla, California, United States of America
| | - Julie Low
- Orange County Health Care Agency, Santa Ana, California, United States of America
| | - Kathleen Moser
- Health and Human Services Agency, San Diego, California, United States of America
| | | | | | | | - Florin Vaida
- University of California San Diego, La Jolla, California, United States of America
| | - Constance A. Benson
- University of California San Diego, La Jolla, California, United States of America
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Morlett Paredes A, Carrasco J, Cherner M, Umlauf A, Rivera Mindt M, Suarez P, Artiola i Fortuny L, Franklin DR, Heaton RK, Marquine MJ. Normative Data for the Halstead Category Test in a Spanish-Speaking Adult Population Living in the U.S./México Border Region. Arch Clin Neuropsychol 2019. [DOI: 10.1093/arclin/acz029.32] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Objective
To provide norms applicable to Spanish-speakers living in the US- Mexico border region for the Halstead Category Test, a test of executive function.
Participants and Method
Healthy Spanish-speakers (n = 252) were recruited from the US–Mexico border regions (Age: M = 37.3, SD = 10.2, range 19-60; Education: M = 10.7, SD = 4.3, range 0-20; 58% female). Participants completed the Category Test as part of a larger neuropsychological test battery. Relationships between demographic variables and raw error scores were assessed using Spearman and Wilcoxon Rank-sum tests. Demographically corrected T-scores for the Category Test were normed using fractional polynomial equations accounting for age, education, and sex. For comparison, T-scores were also computed for the Spanish-speaking normative sample using published norms for English-speaking non-Hispanic Whites and African Americans, which were also adjusted for age, education and sex. Impairment rates based on -1SD (T < 40) were calculated using both, published and current, norms.
Results
Older age was significantly associated with higher number of errors (Spearman ρ = 0.32, p < .001) and higher education was associated with lower number of errors (Spearman ρ = -0.52, p < .001), with no other significant demographic effects. Applying non-Hispanic norms resulted in overestimation of impairment rates in the Spanish-speaking sample (impairment rate: 48% with White norms and 27% with African American norms). This pattern was evident across levels of education except in participants with 13+ years of education, where rates of impairment using African American norms were comparable to those based on the newly developed norms.
Conclusions
The present study is the first to develop norms for the Category test in a sample of Spanish-speakers in the US-Mexico border region. These norms will provide tools for the assessment of executive function in this population. Research concerning generalizability of norms to other Spanish-speaking populations is needed.
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Kamalyan L, Hussain MA, Diaz MM, Umlauf A, Franklin DR, Cherner M, Rivera Mindt M, Artiola i Fortuny L, Heaton RK, Marquine MJ. Neurocognitive Impairment in Spanish-Speaking Latinos Living with Human Immunodeficiency Virus in the United States: Validation of Neuropsychological Tests Norms. Arch Clin Neuropsychol 2019. [DOI: 10.1093/arclin/acz029.26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Objective
Latinos in the US are at increased risk for HIV-associated neurocognitive impairment (NCI). Yet, most studies in this group have included English-speakers only. We investigated the rate and pattern of HIV-associated NCI in Spanish-speaking Latinos from the US-Mexico border region by utilizing newly developed norms for this group, and compared it to previously published norms for English-speaking non-Latino Whites and Blacks/African Americans.
Participants and Method
Participants included 153 HIV+ Spanish-speaking Latinos (Age: M = 38.2, SD = 9.7; Education: M = 10.9, SD = 3.6; 27% female; 56% AIDS) living in the greater San Diego area. Participants completed comprehensive neuropsychological, neuromedical and psychiatric assessments in Spanish. The neuropsychological test battery employed in this study - and used extensively in prior studies of HIV- assesses seven ability domains. Raw test scores were converted to demographically-adjusted T-scores using regional norms for Spanish-speakers, and for non-Latino Whites and Blacks. NCI was defined per established criteria.
Results
Rate of global NCI was 39% using norms for Spanish-speaking Latinos, compared to 64% with White norms and 18% with Black norms. Using norms for Spanish speakers, domain specific NCI among those impaired was highest in executive function (68%), speed of information processing (65%), learning (51%), and working memory (50%). The pattern of HIV associated NCI varied when norms developed for non-Latino Whites and Blacks were used.
Conclusions
HIV+ Spanish speakers showed similar rates of global NCI to those in other HIV+ populations, when norms developed for this group were used. In contrast, use of non-Latino White and Black norms resulted in misclassification of impairment. The pattern of NCI differed based on the norms used. Present findings highlight the importance of utilizing norms developed for Spanish-speakers in the US in order to obtain more precise and valid depictions of cognition in this population.
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Kamalyan L, Hussain M, Morlett-Paredes A, Umlauf A, Franklin D, Suarez P, Rivera-Mindt M, Artiola i Fortuny L, Cherner M, Heaton RMarquine M. Comparison of Rates of Impairment Between Three Sets of Normative Data for Spanish-speakers of Mexican Origin in a Healthy Cohort. Arch Clin Neuropsychol 2019. [DOI: 10.1093/arclin/acz035.27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Objective
With over 37 million Spanish-speakers, the US is the second country in the world with the largest number of Spanish-speakers. Identification of neurological dysfunction via neuropsychological testing for this language group requires knowledgeable application of available tests and normative data. Accordingly, we investigated whether rates of neurocognitive impairment (NCI) varied based on the Spanish language normative method used.
Method
Participants included 254 healthy native Spanish-speakers (Age: M = 37.3, SD = 10.4; Education: M = 10.7, SD = 4.3; 59% Female; 78.7% of known Mexican origin/descent) living in the US-Mexico border region. Participants completed the Hopkins Verbal Learning Test-Revised (HVLT-R), Trail Making Test (TMT) A&B, and Animal Naming in Spanish. Raw test scores were converted to demographically-adjusted T-scores based on normative adjustments developed for this population (Neuropsychological Norms for the US-Mexico Border Region in Spanish [NP-NUMBRS]) and norms developed based on samples in Mexico (Latin American Norms from Mexico [LAN-M] and NEUROPSI). Rates of NCI (T < 40) based on the different normative methods were compared via McNemar’s tests.
Results
Rates of NCI for NP-NUMBRS and NEUROPSI fell between the expected 15-17%. Compared to NP-NUMBRS, significantly lower rates were found when applying LAN-M for HVLT-R Total (4%) and Delayed Recall (8%), TMT-A (1%), and Animal Naming (10%; all ps < .0002). No significant differences were found for TMT-B (p > .05).
Conclusions
Present findings revealed that while the NP-NUMBRS and NEUROPSI norms yielded similar NCI rates, and LAN-M norms underestimated NCI on three tests. This highlights the importance of carefully considering available normative adjustments for Spanish-speakers when applying them to specific populations.
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