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Cognitive reserve and neuropsychological functioning in older HIV-infected people

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Abstract

Progress in treatments has led to HIV+ patients getting older. Age and HIV are risk factors for neurocognitive impairment (NCI). We explored the role of cognitive reserve (CR) on cognition in a group of virologically suppressed older HIV+ people. We performed a multicenter study, consecutively enrolling asymptomatic HIV+ subjects ≥60 years old during routine outpatient visits. A comprehensive neuropsychological battery was administered. Raw test scores were adjusted based on Italian normative data and transformed into z-scores; NCI was defined according to Frascati criteria. All participants underwent the Brief Intelligence Test (TIB) and the Cognitive Reserve Index (CRI) questionnaire as proxies for CR. Relationships between TIB, CRI, and NCI were investigated by logistic or linear regression analyses. Sixty patients (85 % males, median age 66, median education 12, 10 % HCV co-infected, 25 % with past acquired immunodeficiency syndrome (AIDS)-defining events, median CD4 cells count 581 cells/μL, median nadir CD4 cells count 109 cells/μL) were enrolled. Twenty-four patients (40 %) showed Asymptomatic Neurocognitive Impairment. At logistic regression analysis, only CRI (OR 0.94; 95 % CI 0.91–0.97; P = 0.001) and TIB (OR 0.80; 95 % CI 0.71–0.90; P < 0.001) were associated with a lower risk of NCI. Higher CRI and TIB were significantly correlated with a better performance (composite z-score) both globally and at individual cognitive domains. Our findings highlight the role of CR over clinical variables in maintaining cognitive integrity in a virologically suppressed older HIV-infected population. A lifestyle characterized by experiences of mental stimulation may help to cope aging and HIV-related neurodegeneration.

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Acknowledgments

The authors want to thank all the study’s participants.

Preliminary results of this work were previously presented as poster at the Conference on Retroviruses and Opportunistic Infections (CROI), Seattle, Washington, USA, February 23–26, 2015.

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Authors and Affiliations

  1. Institute of Infectious Diseases, Catholic University of Sacred Heart, Rome, Italy

    Benedetta Milanini, Nicoletta Ciccarelli, Massimiliano Fabbiani, Silio Limiti, Elena Visconti, Enrica Tamburrini, Roberto Cauda & Simona Di Giambenedetto

  2. Division of Infectious Diseases, Santa Caterina Novella Hospital, Galatina, Italy

    Pierfrancesco Grima

  3. Division of Infectious Diseases, University of Siena, Siena, Italy

    Barbara Rossetti

Authors
  1. Benedetta Milanini
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  2. Nicoletta Ciccarelli
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  3. Massimiliano Fabbiani
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  4. Silio Limiti
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  5. Pierfrancesco Grima
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  6. Barbara Rossetti
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  7. Elena Visconti
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  8. Enrica Tamburrini
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  9. Roberto Cauda
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  10. Simona Di Giambenedetto
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Correspondence to Benedetta Milanini.

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Conflict of interest

No specific funding was received for this study. MF received speakers’ honoraria from Abbott Virology, Merck Sharp & Dohme, and Janssen-Cilag. RC has been advisor for Gilead, Janssen-Cilag, and Basel Pharmaceutical, received speakers’ honoraria from ViiV, Bristol-Myers Squibb, Merck Sharp and Dohme, Abbott, Gilead, and Janssen-Cilag, and research support from “Fondazione Roma.” SDG received speakers’ honoraria and support for travel meetings from Gilead, Bristol-Myers Squibb, Abbott, Boehringer Ingelheim, Janssen-Cilag, and GlaxoSmithKline. All the other authors declare that they have not conflict of interest.

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Milanini, B., Ciccarelli, N., Fabbiani, M. et al. Cognitive reserve and neuropsychological functioning in older HIV-infected people. J. Neurovirol. 22, 575–583 (2016). https://doi.org/10.1007/s13365-016-0426-7

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