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Functional deficits and other psychiatric associations with abnormal scores on the Montreal Cognitive Assessment (MoCA) in older HIV-infected patients

Published online by Cambridge University Press:  24 April 2019

James A. Bourgeois ,
Malcolm John ,
Roland Zepf ,
Meredith Greene ,
Steven Frankel  and
Nancy A. Hessol
James A. Bourgeois*
Affiliation:
Baylor Scott & White Health, Central Texas Division, College of Medicine, Texas A&M University Health Science Center, Temple, TX, USA
Malcolm John
Affiliation:
Department of Medicine, University of California San Francisco, San Francisco, CA, USA
Roland Zepf
Affiliation:
Department of Medicine, University of California San Francisco, San Francisco, CA, USA
Meredith Greene
Affiliation:
Department of Medicine, Division of Geriatrics, University of California San Francisco, San Francisco, CA, USA
Steven Frankel
Affiliation:
Department of Psychiatry, University of California San Francisco, San Francisco, CA, USA
Nancy A. Hessol
Affiliation:
Department of Clinical Pharmacy, University of California San Francisco, San Francisco, CA, USA
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Abstract

Objective:

The authors assessed the association of physical function, social variables, functional status, and psychiatric co-morbidity with cognitive function among older HIV-infected adults.

Design:

From 2012–2014, a cross-sectional study was conducted among HIV-infected patients ages 50 or older who underwent comprehensive clinical geriatric assessment.

Setting:

Two San Francisco HIV clinics.

Participants:

359 HIV-infected patients age 50 years or older

Measurements

Unadjusted and adjusted Poisson regression measured prevalence ratios and 95% confidence intervals for demographic, functional and psychiatric variables and their association with cognitive impairment using a Montreal Cognitive Assessment (MoCA) score < 26 as reflective of cognitive impairment.

Results

Thirty-four percent of participants had a MoCA score of < 26. In unadjusted analyses, the following variables were significantly associated with an abnormal MoCA score: born female, not identifying as homosexual, non-white race, high school or less educational attainment, annual income < $10,000, tobacco use, slower gait speed, reported problems with balance, and poor social support. In subsequent adjusted analysis, the following variables were significantly associated with an abnormal MoCA score: not identifying as homosexual, non-white race, longer 4-meter walk time, and poor social support. Psychiatric symptoms of depressive, anxiety, and post-traumatic stress disorders did not correlate with abnormal MoCA scores.

Conclusions:

Cognitive impairment remains common in older HIV-infected patients. Counter to expectations, co-morbid psychiatric symptoms were not associated with cognitive impairment, suggesting that cognitive impairment in this sample may be due to neurocognitive disorders, not due to other psychiatric illness. The other conditions associated with cognitive impairment in this sample may warrant separate clinical and social interventions to optimize patient outcomes.

Keywords

HIVHIV-associated neurocognitive disorderMontreal Cognitive Assessment (MoCA)psychiatric co-morbidityfunctional assessment
Type
Original Research Article
Information
International Psychogeriatrics , Volume 32 , Issue 1: Issue Theme: Cultural Diversity in Psychogeriatrics , January 2020 , pp. 105 - 118
Copyright
© International Psychogeriatric Association 2019 

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References

Ammassari, A. et al. (2004). Depressive symptoms, neurocognitive impairment, and adherence to highly active antiretroviral therapy among HIV-infected persons. Psychosomatics, 45, 394–402. doi: 10.1176/appi.psy.45.5.394.CrossRefGoogle Scholar
Ances, B. M. and Ellis, R. J. (2007). Dementia and neurocognitive disorders due to HIV-1 infection. Seminars in Neurology, 27, 86–92.CrossRefGoogle Scholar
Anderson, A. M. et al. (2017). Prevalence and correlates of persistent HIV-1 RNA in cerebrospinal fluid during antiretroviral therapy. The Journal of Infectious Diseases, 215, 105–113.CrossRefGoogle ScholarPubMed
Applebaum, A. and Brennan, M. (2009). Mental health and depression. In Brennan, M., Karpiak, S. E., Cantor, M. H. and Shippy, R. A. (eds.) Research on Older Adults with HIV: An in-depth Examination of an Emerging Population (pp. 27–34). New York, NY: Nova Science Publishers.Google Scholar
Atkinson, J. H. et al. (2009). Psychiatric context of acute/early HIV infection. The NIMH Multisite Acute HIV Infection Study: IV. AIDS and Behavior, 13, 1061–1067.CrossRefGoogle Scholar
Becker, J. T. et al. (2011). Subcortical brain atrophy persists even in HAART-regulated HIV disease. Brain Imaging and Behavior; 5, 77–85.CrossRefGoogle ScholarPubMed
Bohnert, K. M. and Breslau, N. (2011). Assessing the performance of the short screening scale for post-traumatic stress disorder in a large nationally-representative survey. International Journal of Methods in Psychiatric Research, 20, e1–e5.CrossRefGoogle Scholar
Brito e Silva, E. T., Caixeta, L. F., Soares, V. L. and Sagawa, G. R. (2011). HIV-associated dementia in older adults: clinical and tomographic aspects. International Psychogeriatrics, 23, 1061–1069. doi: 10.1017/S1041610210002474.CrossRefGoogle Scholar
Brown, R. L. and Rounds, L. A. (1995). Conjoint screening questionnaires for alcohol and other drug abuse: criterion validity in a primary care practice. Wisconsin Medical Journal, 94, 135–140.Google Scholar
Centers for Disease Control and Prevention (2014). Diagnoses of HIV Infection in the United States and Dependent Areas, 2014. Retrieved from https://www.cdc.gov/hiv/pdf/library/reports/surveillance/cdc-hiv-surveillance-report-us.pdf1.Google Scholar
Crane, H. M., Van Rompaey, S. E., Dillingham, P. W., Herman, E., Diehr, P. and Kitahata, M. M. (2006). A single-item measure of health-related quality-of-life for HIV-infected patients in routine clinical care. AIDS Patient Care and STDs, 20, 161–174.CrossRefGoogle ScholarPubMed
Cross, S., Onen, N., Gase, A., Overton, T. E. and Ances, B. M. (2013). Identifying risk factors for HIV-associated neurocognitive disorders using the International HIV Dementia Scale. Journal of Neuroimmune Pharmacology, 8, 1114–1122. doi: 10.1007/s11481-01309505-1.CrossRefGoogle Scholar
Cutrona, C., Russell, D. and Rose, J. (1986). Social support and adaptation to stress by the elderly. Psychology and Aging, 1, 47–54.CrossRefGoogle ScholarPubMed
De Ronchi, D. et al. (2002). Risk factors for cognitive impairment in HIV-1-infected persons with different risk behaviors. Archives of Neurology, 59, 812–818.CrossRefGoogle ScholarPubMed
Dhalla, S. and Kopec, J. A. (2007). The CAGE questionnaire for alcohol misuse: a review of reliability and validity studies. Clinical and Investigative Medicine, 30, 33–41.CrossRefGoogle ScholarPubMed
Eggers, C. et al. (2017). HIV-1-associated neurocognitive disorder: epidemiology, pathogenesis, diagnosis, and treatment. Journal of Neurology, 264, 1715–1727. doi: 10.1007/s00415-017-8503-2.CrossRefGoogle Scholar
Fazeli, P. L., Casaletto, K. B., Paolillo, E., Moore, R. C., Moore, D. J. and HNRPO Group (2017). Screening for neurocognitive impairment in HIV-poitive adults aged 50 and over: Montreal Cognitive Assessment relates to self-reported and clinician rated everyday functioning. Journal of Clinical and Experimental Neuropsychology, 39, 842–853. doi: 10.1080/13803395.2016.1273319.CrossRefGoogle ScholarPubMed
Fernandes Filho, S. M. and de Melo, H. R. (2012). Frequency and risk factors for HIV-associated neurocognitive disorder and depression in older individuals with HIV in northeastern Brazil. International Psychogeriatrics, 24, 1648–1655. doi: 10.1017/S1041610212000944.CrossRefGoogle Scholar
Flatt, J. D., Johnson, J. K., Karpiak, S. E., Seidel, L., Larson, B. and Brennan-Ing, M. (2018). Correlates of subjective cognitive decline in lesbian, gay, bisexual, and transgender older adults. Journal of Alzheimer’s Disease, 64, 91–102. doi: 10.3233/JAD-171061.CrossRefGoogle Scholar
Foley, J. M. et al. (2011). Operationalization of the updated diagnostic algorithm for classifying HIV-related cognitive impairment and dementia. International Psychogeriatrics, 23, 835–843. doi: 10.1017/S1041610210002085.CrossRefGoogle Scholar
Green, A. F., Rebok, G. and Lyketsos, C. G. (2008). Influence of social network characteristics on cognition and functional status with aging. International Journal of Geriatric Psychiatry, 23, 972–978. doi: 10.1002/gps.2023.CrossRefGoogle Scholar
Greene, M. et al. (2015). Geriatric syndromes in older HIV-infected adults. Journal of Acquired Immune Deficiency Syndromes, 69, 161–167. doi: 10.1097/QAI.0000000000000556.CrossRefGoogle Scholar
Greene, M. et al. (2018). Loneliness in older adults living with HIV. AIDS and Behavior, 22, 1475–1484.CrossRefGoogle Scholar
Guralnik, J. M. et al. (2000). Lower extremity function and subsequent disability: consistency across studies, predictive models, and value of gait speed alone compared with the short physical performance battery. The Journal of Gerontology Series A Biological Sciences and Medical Sciences, 55, M221–M231.CrossRefGoogle ScholarPubMed
Hammond, E. and Treisman, G. J. (2007). HIV and psychiatric illness. http://psychiatrictimes.com/articles/hiv-and-psychiatric-illness#sthash.qLdeoOUk.dpuf; last accessed 12 January 2007.Google Scholar
Han, S. D. et al. (2017). Loneliness in older black adults with HIV is associated with poorer cognition. Gerontology, 63, 253–262: doi: 10.1159/000455253.CrossRefGoogle Scholar
Hays, R. D. and DiMatteo, M. R. (1987). A short-form measure of loneliness. Journal of Personality Assessment, 51, 69–81.CrossRefGoogle ScholarPubMed
Heaton, R. K. et al. (2010). HIV-associated neurocognitive disorders persist in the era of potent antiretroviral therapy: CHARTER study. Neurology, 75, 2087–2096.CrossRefGoogle ScholarPubMed
Heaton, R. K. et al. (2011). HIV-associated neurocognitive disorders before and during the era of combination antiretroviral therapy: differences in rates, nature, and predictors. Journal of Neurovirology, l17, 3–16. doi: 10.1007/s13365-010-0006-1.CrossRefGoogle Scholar
Hessol, N. A. et al. (2017). Food insecurity and aging outcomes in older adults living with HIV. AIDS and Behavior, 21, 3506–3514.CrossRefGoogle Scholar
Hong, S. and Banks, W. A. (2015). Role of the immune system in HIV-associated neuroinflammation and neurocognitive implications. Brain, Behavior, and Immunity, 45, 1–12. doi: 10.1016/j.bbi.2014.10.008.CrossRefGoogle Scholar
Hughes, T. F., Flatt, J. D., Fu, B., Chang, C. C. and Ganguli, M. (2013). Engagement in social activities and progression from mild to severe cognitive impairment: the MYHAT Study. International Psychogeriatrics, 25, 587–595. doi: 10.1017/S1041610212002086.CrossRefGoogle Scholar
Jackson, J. D. et al. (2017). Subjective cognitive concerns are associated with objective memory performance in Caucasian but not African-American persons. Age and Ageing, 46, 988–993. doi: 10.101093/ageing/afx077.CrossRefGoogle Scholar
Janssen, M. A. M., Bosch, M., Koopmans, P. P. and Kessels, R. P. C. (2015). Validity of the Montreal Cognitive Assessment and the HIV Dementia Scale in the assessment of cognitive impairment in HIV-1 infected patients. Journal of Neuorvirology, 21, 383–390. doi: 10.1007/s13365-015-0324-4.CrossRefGoogle ScholarPubMed
John, M. et al. (2016). Geriatric assessments and association with VACS index among HIV-infected older adults in San Francisco. Journal of Acquired Immune Deficiency Syndromes, 72, 534–541.CrossRefGoogle ScholarPubMed
Joska, J. A. et al. (2016). A comparison of five brief screening tools for HIV-associated neurocognitive disorders in the USA and South Africa. AIDS Behavior, 20, 1621–1631; doi: 10.1007/s10461-016-1316-y.CrossRefGoogle ScholarPubMed
Justice, A. C. et al. (2010). Towards a combined prognostic index for survival in HIV infection: the role of 'non-HIV’ biomarkers. HIV Medicine, 11, 143–151. doi: 10.1111/j.1468-1293.2009.00757.x.CrossRefGoogle Scholar
Kallianpur, K. J. et al. (2016). Frailty characteristics in chronic HIV patients are markers of white matter atrophy independently of aging and depressive symptoms: a pilot study. Open Medical Journal, 3, 138–152. doi: 10.2174/1874220301603010138.CrossRefGoogle Scholar
Katz, S., Ford, A. B., Moskowitz, R. W., Jackson, B. A. and Jaffe, M. W. (1963). Studies of illness in the aged. The Index of ADL: a standardized measure of biological and psychosocial function. Journal of the American Medical Association, 185, 914–919.CrossRefGoogle ScholarPubMed
Kopinsky, K. L., Bao, J. and Lin, Y. W. (2007). Neurobiology of HIV, psychiatric and substance abuse comorbidity research: workshop report. Brain, Behavior, and Immunity, 21, 428–441.CrossRefGoogle Scholar
Kroenke, K., Spitzer, R. L. and Williams, J. B. (2001). The PHQ-9: validity of a brief depression severity measure. Journal of General Internal Medicine, 16, 606–613.CrossRefGoogle ScholarPubMed
Larner, A. J. (2015). Optimising the cutoffs of cognitive screening instruments in pragmatic diagnostic accuracy studies: maximising accuracy or the Youden index? Dementia and Geriatric Cognitive Disorders, 39, 167–175.CrossRefGoogle ScholarPubMed
Lawton, M. P. and Brody, E. M. (1969). Assessment of older people: self-maintaining and instrumental activities of daily living. The Gerontologist, 9, 179–186.CrossRefGoogle ScholarPubMed
Lee, R. S., Kochman, A. and Sikkema, K. J. (2002). Internalized stigma among people living with HIV-AIDS. AIDS and Behavior, 6, 309–319. doi: 10.1023/A:1021144511957CrossRefGoogle Scholar
Lees, R., Corbet, S., Johnston, C., Moffitt, E., Shaw, G. and Quinn, T. J. (2013). Test accuracy of short screening tests for diagnosis of delirium or cognitive impairment in an acute stroke unit setting. Stroke, 44, 3078–3083.CrossRefGoogle ScholarPubMed
Letendre, S. et al. (2009). Penetration and effectiveness of antiretroviral therapy in the Central Nervous System. Antiinflammatory & Antiallergy Agents in Medicinal Chemistry, 8, 169–183.CrossRefGoogle Scholar
Lubben, J. E. (1988). Assessing social networks among elderly populations. Family and Community Health, 11, 42–52.CrossRefGoogle Scholar
Luis, C. A., Keegan, A. P. and Mullan, M. (2009). Cross validation of the Montreal Cognitive Assessment in community dwelling older adults residing in the Southeastern US. International Journal of Geriatric Psychiatry, 24, 197–201. doi: 10.1002/gps.2101.CrossRefGoogle ScholarPubMed
MacArthur, J. C. (2004). HIV dementia: an evolving disease. Journal of Neuroimmunology, 157, 3–10.CrossRefGoogle Scholar
McCutchan, J. A. et al. (2012). Role of obesity, metabolic variables, and diabetes in HIV-associated neurocognitive disorder. Neurology, 78, 485–492.CrossRefGoogle ScholarPubMed
Milanini, B., Wendelken, L. A., Esmaeili-Firidouni, P., Chartier, M., Crouch, P. C. and Valcour, V. (2014). The Montreal Cognitive Assessment to screen for cognitive impairment in HIV patients older than 60 years. Journal of Acquired Immune Deficiency Syndromes, 67, 67–70.CrossRefGoogle ScholarPubMed
Mukherjee, T. et al. (2018). Utility of using the Montreal Cognitive Assessment (MoCA) as a screening tool for HIV-associated neurocognitive disorders (HAND) in multi-ethnic Malaysia. AIDS Behavior, 22, 3226–3233. doi: 10.1007/s!0461-018-2073-x.CrossRefGoogle Scholar
Nasreddine, Z. (2010). Montreal Cognitive Assessment (MoCA) Administration and Scoring Instructions. Montreal Cognitive Assessment website. http://www.mocatest.org/wp-content/uploads/2015/tests-instructions/MoCA-Instructions-English_2010.pdf. Updated August 18, 2010, last accessed 30 March 2016.Google Scholar
Nath, A., Schiess, N., Venkatesan, A., Rumbaugh, J., Sacktor, N. and MacArthur, J. (2008). Evolution of HIV dementia with HIV infection. International Review of Psychiatry, 20, 25–31.CrossRefGoogle ScholarPubMed
National Comorbidity Survey Replication (NCS-R). (2005). http://www.hcp.med.harvard.edu/ncs/; last accessed 1 May 2018.Google Scholar
Njamnshi, A. K. et al. (2009). Risk factors for HIV-associated neurocognitive disorders (HAND) in sub-Saharan Africa: the case of Yaounde-Cameroon. Journal of Neurological Sciences, 285, 149–153. doi: 10.1016/j.jns.2009.06.043.CrossRefGoogle Scholar
Noble, J. M., Schupf, N., Manly, J. J., Andrews, H., Tang, M. X. and Mayeux, R. (2017). Secular trends in the incidence of dementia in a multi-ethnic community. Journal of Alzheimer’s Disease, 60, 1065–1075. doi:10.3233/JAD-170300.CrossRefGoogle Scholar
Olivier, I. S., Cacabelos, R. and Naidoo, V. (2018). Risk factors and pathogenesis of HIV-associated neurocognitive disorder: the role of host genetics. International Journal of Molecular Sciences, 19, 3594. doi: 10.3390/ijms19113594.CrossRefGoogle Scholar
Owora, A. H. (2018). Major depression disorder trajectories and HIV disease progression: results from a 6-year outpatient clinic cohort. Medicine, 97, e0252. doi: 10.1097/MD.0000000000010252.CrossRefGoogle ScholarPubMed
Paul, R. H., Brickman, A. M. and Navia, B. et al. (2005). Apathy is associated with volume of the nucleus accumbens in patients infected with HIV. Journal of Neuropsychiatry and Clinical Neurosciences, 17, 167–171.CrossRefGoogle Scholar
Rackstraw, S. et al. (2018). Factors associated with HIV associated neurocognitive disorder in an unselected cohort in East and South London – The HAND Study. In Conference Reports for NATAP, Glasgow HIV, 28-31 October 2018, Glasgow, UK.Google Scholar
Rosso, A. L. et al. (2018). Neighborhood socioeconomic status and cognitive function in late life. American Journal of Epidemiology, 183, 1088–1097. doi: 10.1093/aje/kwv337.CrossRefGoogle Scholar
Sacktor, N. et al. (2002). HIV associated cognitive impairment before and after the advent of combination therapy. Journal of Neurovirology, 8, 136–142.CrossRefGoogle ScholarPubMed
San Francisco Department of Public Health Population Health Division (2018). HIV epidemiology annual report 2017. https://www.sfdph.org/dph/files/reports/RptsHIVAIDS/AnnualReport2017-Green-20180904-Web.pdf; last accessed 2 March 2019.Google Scholar
SAS Institute Inc., ed. (2014). SAS/STAT user’s guide, version 9.4. Cary, NC: SAS Institute Inc.Google Scholar
Sattler, F. R. et al. (2015). Abdominal obesity contributes to neurocognitive impairment in HIV-infected patients with increased inflammation and immune activation. Journal of Acquired Immune Deficiency Syndromes, 68, 277–284.CrossRefGoogle ScholarPubMed
Sims, R. C., Levy, S. A., Mwendwa, D. T., Callender, C. O. and Campbell, A. L. (2011). The influence of functional social support on executive functioning in middle-aged African Americans. Aging, Neuropsychology, and Cognition, 18, 414–431. doi:10.1080/13825585.2011.567325CrossRefGoogle Scholar
Spiegelman, D. and Hertzmark, E. (2005). Easy SAS calculations for risk or prevalence ratios and differences. American Journal of Epidemiology, 162, 199–200.CrossRefGoogle Scholar
Spitzer, R. L., Kroenke, K., Williams, J. B. and Lowe, B. (2006). A brief measure for assessing generalized anxiety disorder: the GAD-7. Archives of Internal Medicine, 166, 1092–1097.CrossRefGoogle ScholarPubMed
Tedaldi, E. M., Minniti, N. L. and Fischer, T. (2015). HIV-associated neurocognitive disorders: the relationship of HIV infection with physical and social comorbidities. BioMed Research International, 2015, Article ID 641913. doi: 10.1155/2015/641913.CrossRefGoogle ScholarPubMed
Tymchuk, S., Gomez, D., Koenig, N., Gill, M. J., Fujiwara, E. and Power, C. (2018). Associations between depressive symptomatology and neurocognitive impairment in HIV/AIDS. The Canadian Journal of Psychiatry, 63, 329–336. doi: 10.1177/0707743717737029.CrossRefGoogle ScholarPubMed
Valcour, V. G. (2013). HIV, aging, and cognition: emerging issues. Topics in Antiviral Medicine, 21, 119–123.Google ScholarPubMed
Valcour, V. et al. (2004). Higher frequency of dementia in older HIV-1 individuals: the Hawaii Aging with HIV-1 Cohort. Neurology, 63, 822–827.CrossRefGoogle ScholarPubMed
Valcour, V. et al. (2012). Over half of HIV-Infected 60 and older have cognitive deficit in San Francisco Study. In 19th Conference on Retroviruses and Opportunistic Infections, Seattle, WA, March 5-8, 2012. www.natap.org/2012/CROI/croi_78.htm (conference abstract).Google Scholar
Vance, D. E. (2013). The cognitive consequences of stigma, social withdrawal, and depression in adults aging with HIV. Journal of Psychosocial Nursing and Mental Health Services, 51, 18–20. doi: 10.3928/02793695-20130315-01.CrossRefGoogle ScholarPubMed
Wang, Z. et al. (2013). High prevalence of HIV-associated neurocognitive disorder in HIV-infected patients with a baseline CD4 count ≤ 350 cells/μL in Shanghai, China. BioScience Trends, 7, 284–289.Google ScholarPubMed
Watkins, C. C. and Treisman, G. J. (2012). Neuropsychiatric complications of aging with HIV. Journal of Neurovirology, 18, 277–290. doi: 10.1007/s13365-012-0108-z.CrossRefGoogle ScholarPubMed
Watkins, C. C. and Treisman, G. J. (2015). Cognitive impairment in patients with AIDS- prevalence and severity. HIV/AIDS – Research and Palliative Care, 7, 35–47.CrossRefGoogle ScholarPubMed
Weber, E. et al. (2013). Substance use is a risk factor for neurocognitive deficits and neuropsychiatric distress in acute and early HIV infection. Journal of Neurovirology, 19, 65–75. doi: 10.1007/s13365-012-0141-y.CrossRefGoogle ScholarPubMed
Wendelken, L. A. and Valcour, V. (2012). Impact of HIV and aging on neuropsychological function. Journal of Neurovirology, 18, 256–263. doi: 10.1007/s13365-012-0094-1.CrossRefGoogle ScholarPubMed