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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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