Skip to main content

Advertisement

SpringerLink
Log in

Depression and Apathy Among People Living with HIV: Implications for Treatment of HIV Associated Neurocognitive Disorders

  • Original Paper
  • Published:
AIDS and Behavior Aims and scope Submit manuscript

Abstract

Depression and apathy are common among people living with HIV (PLWH). However, in PLWH, it is unclear whether depression and apathy are distinct conditions, which contribute to different patterns of disruption to cognitive processing and brain systems. Understanding these conditions may enable the development of prognostic indicators for HIV associated neurocognitive disorders (HAND). The present study examined substance use behavior and cognitive deficits, associated with depression and apathy, in 120 PLWH, using hierarchical regression analyses. Higher levels of depression were associated with a history of alcohol dependence and greater deficits in processing speed, motor and global cognitive functioning. Higher levels of apathy were associated with a history of cocaine dependence. It is recommended that PLWH get screened appropriately for apathy and depression, in order to receive the appropriate treatment, considering the comorbidities associated with each condition. Future research should examine the neurological correlates of apathy and depression in PLWH.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Dew MA, Becker JT, Sanchez J, Caldararo R, Lopez OL, Wess J, et al. Prevalence and predictors of depressive, anxiety and substance use disorders in HIV-infected and uninfected men: a longitudinal evaluation. Psychol Med. 1997;27(2):395–409.

    Article  CAS  PubMed  Google Scholar 

  2. Ciesla JA, Roberts JE. Meta-analysis of the relationship between HIV infection and risk for depressive disorders. Am J Psychiatr. 2001;158(5):725–30.

    Article  CAS  PubMed  Google Scholar 

  3. Asch SM, Kilbourne AM, Gifford AL, Burnam MA, Turner B, Shapiro MF, et al. Underdiagnosis of depression in HIV: who are we missing? J Gen Intern Med. 2003;18(6):450–60.

    Article  PubMed Central  PubMed  Google Scholar 

  4. Wolff LC, Alvarado MR, Wolff RM. Prevalencia, factores de riesgo y manejo de la depresión en pacientes con infección por VIH: revisión de la literatura. Revista Chilena de Infectología. 2010;27:65–74.

    Article  Google Scholar 

  5. Judd F, Komiti A, Chua P, Mijch A, Hoy J, Grech P, et al. Nature of depression in patients with HIV/AIDS. Aust N Z J Psychiatr. 2005;39(9):826–32.

    Article  Google Scholar 

  6. Hoare J, Fouche JP, Spottiswoode B, Joska JA, Schoeman R, Stein DJ, et al. White matter correlates of apathy in HIV-positive subjects: a diffusion tensor imaging study. J Neuropsychiatr Clin Neurosci. 2010;22(3):313–20.

    Article  Google Scholar 

  7. Castellon SA, Hinkin CH, Myers HF. Neuropsychiatric disturbance is associated with executive dysfunction in HIV-1 infection. J Int Neuropsychol Soc. 2000;6(3):336–47.

    Article  CAS  PubMed  Google Scholar 

  8. Association AP. Diagnostic and statistical manual of mental disorders. 5th ed. Arlington: American Psychiatric Publishing; 2013.

    Google Scholar 

  9. Marin RS. Apathy: a neuropsychiatric syndrome. J Neuropsychiatr Clin Neurosci. 1991;3(3):243–54.

    Article  CAS  Google Scholar 

  10. Tagariello P, Girardi P, Amore M. Depression and apathy in dementia: same syndrome or different constructs? A critical review. Arch Gerontol Geriatr. 2009;49(2):246–9.

    Article  CAS  PubMed  Google Scholar 

  11. Rabkin JG, Ferrando SJ, van Gorp W, Rieppi R, McElhiney M, Sewell M. Relationships among apathy, depression, and cognitive impairment in HIV/AIDS. J Neuropsychiatr Clin Neurosci. 2000;12(4):451–7.

    Article  CAS  Google Scholar 

  12. Castellon SA, Hinkin CH, Wood S, Yarema KT. Apathy, depression, and cognitive performance in HIV-1 infection. J Neuropsychiatr Clin Neurosci. 1998;10(3):320–9.

    Article  CAS  Google Scholar 

  13. Kamat R, Morgan E, Marcotte TD, Badiee J, Maich I, Cherner M, et al. Implications of apathy and depression for everyday functioning in HIV/AIDS in Brazil. J Affect Disord. 2013;150(3):1069–75.

    Article  PubMed  Google Scholar 

  14. Wagner GJ, Goggin K, Remien RH, Rosen MI, Simoni J, Bangsberg DR, et al. A closer look at depression and its relationship to HIV antiretroviral adherence. Ann Behav Med. 2011;42(3):352–60.

    Article  PubMed Central  PubMed  Google Scholar 

  15. Barclay TR, Hinkin CH, Castellon SA, Mason KI, Reinhard MJ, Marion SD, et al. Age-associated predictors of medication adherence in HIV-positive adults: health beliefs, self-efficacy, and neurocognitive status. Health Psychol. 2007;26(1):40–9.

    Article  PubMed Central  PubMed  Google Scholar 

  16. Tate D, Paul RH, Flanigan TP, Tashima K, Nash J, Adair C, et al. The impact of apathy and depression on quality of life in patients infected with HIV. AIDS Patient Care STDs. 2003;17(3):115–20.

    Article  PubMed  Google Scholar 

  17. Cole MA, Castellon SA, Perkins AC, Ureno OS, Robinet MB, Reinhard MJ, et al. Relationship between psychiatric status and frontal-subcortical systems in HIV-infected individuals. J Int Neuropsychol Soc. 2007;13(3):549–54.

    PubMed Central  PubMed  Google Scholar 

  18. Fellows RP, Byrd DA, Morgello S, Manhattan HIVBB. Major depressive disorder, cognitive symptoms, and neuropsychological performance among ethnically diverse HIV+ men and women. J Int Neuropsychol Soc. 2013;19(2):216–25.

    Article  PubMed Central  PubMed  Google Scholar 

  19. Bayon C, Ribera E, Cabrero E, Griffa L, Burgos A. Prevalence of depressive and other central nervous system symptoms in HIV-infected patients treated with HAART in Spain. J Int Assoc Phys AIDS Care. 2012;11(5):321–8.

    Article  Google Scholar 

  20. L’Akoa RM, Noubiap JJ, Fang Y, Ntone FE, Kuaban C. Prevalence and correlates of depressive symptoms in HIV-positive patients: a cross-sectional study among newly diagnosed patients in Yaounde, Cameroon. BMC Psychiatr. 2013;13:228.

    Article  Google Scholar 

  21. Malow R, Devieux JG, Stein JA, Rosenberg R, Jean-Gilles M, Attonito J, et al. Depression, substance abuse and other contextual predictors of adherence to antiretroviral therapy (ART) among Haitians. AIDS Behav. 2013;17(4):1221–30.

    Article  PubMed  Google Scholar 

  22. Posada C, Moore DJ, Woods SP, Vigil O, Ake C, Perry W, et al. Implications of hepatitis C virus infection for behavioral symptoms and activities of daily living. J Clin Exp Neuropsychol. 2010;32(6):637–44.

    Article  PubMed Central  PubMed  Google Scholar 

  23. Shapiro ME, Mahoney JR, Peyser D, Zingman BS, Verghese J. Cognitive Reserve Protects Against Apathy in Individuals with Human Immunodeficiency Virus. Arch Clin Neuropsychol. 2013;29(1):110–20.

  24. Shapiro ME, Mahoney JR, Zingman BS, Pogge DL, Verghese J. Apathy correlates with cognitive performance, functional disability, and HIV RNA plasma levels in HIV-positive individuals. J Clin Exp Neuropsychol. 2013;35(9):934–45.

    Article  PubMed Central  PubMed  Google Scholar 

  25. Kalechstein AD, Newton TF, Leavengood AH. Apathy syndrome in cocaine dependence. Psychiatry Res. 2002;109(1):97–100.

    Article  PubMed  Google Scholar 

  26. Winhusen TM, Somoza EC, Lewis DF, Kropp FB, Horigian VE, Adinoff B. Frontal systems deficits in stimulant-dependent patients: evidence of pre-illness dysfunction and relationship to treatment response. Drug Alcohol Depend. 2013;127(1–3):94–100.

    Article  PubMed Central  PubMed  Google Scholar 

  27. Paul R, Flanigan TP, Tashima K, Cohen R, Lawrence J, Alt E, et al. Apathy correlates with cognitive function but not CD4 status in patients with human immunodeficiency virus. J Neuropsychiatr Clin Neurosci. 2005;17(1):114–8.

    Article  Google Scholar 

  28. Devlin KN, Gongvatana A, Clark US, Chasman JD, Westbrook ML, Tashima KT, et al. Neurocognitive effects of HIV, hepatitis C, and substance use history. J Int Neuropsychol Soc. 2012;18(1):68–78.

    Article  PubMed Central  PubMed  Google Scholar 

  29. Bryant VE, Kahler CW, Devlin KN, Monti PM, Cohen RA. The effects of cigarette smoking on learning and memory performance among people living with HIV/AIDS. AIDS Care. 2013;25(10):1308–16.

    Article  PubMed Central  PubMed  Google Scholar 

  30. Robins LN, Wing J, Wittchen H, et al. The composite international diagnostic interview: an epidemiologic instrument suitable for use in conjunction with different diagnostic systems and in different cultures. Arch Gen Psychiatr. 1988;45(12):1069–77.

    Article  CAS  PubMed  Google Scholar 

  31. Kellogg SH, McHugh PF, Bell K, Schluger JH, Schluger RP, LaForge KS, et al. The Kreek-McHugh-Schluger-Kellogg scale: a new, rapid method for quantifying substance abuse and its possible applications. Drug Alcohol Depend. 2003;69(2):137–50.

    Article  PubMed  Google Scholar 

  32. Radloff LS. The CES-D scale: a self-report depression scale for research in the general population. Appl Psychol Meas. 1977;1(3):385–401.

    Article  Google Scholar 

  33. Grace J, Malloy P, Psychological Assessment Resources I. FrSBe, Frontal Systems Behavior Scale: Professional Manual: Psychological Assessment Resources; 2001.

  34. Lane-Brown AT, Tate RL. Measuring apathy after traumatic brain injury: psychometric properties of the apathy evaluation scale and the frontal systems behavior scale. Brain Injury. 2009;23(13–14):999–1007.

    Article  CAS  PubMed  Google Scholar 

  35. Benedict RHB, Schretlen D, Groninger L, Brandt J. Hopkins verbal learning test—revised: normative data and analysis of inter-form and test-retest reliability. Clin Neuropsychol. 1998;12(1):43–55.

    Article  Google Scholar 

  36. Brandt J, Benedict RHB. Hopkins verbal learning test-revised (HVLT-R). Lutz: Psychological Assessment Resources, Inc.; 1991.

    Google Scholar 

  37. Benedict RHB. Brief Visuospatial Memory Test-Revised. Odessa: Psychological Assessment Resources; 1997.

    Google Scholar 

  38. Benton AL, Hamsher K, Sivan AB. Multilingual aphasia examination. Iowa City: AJA Associates; 1994.

    Google Scholar 

  39. Golden CJ. Stroop color and word test. Chicago: Stoelting; 1978.

    Google Scholar 

  40. Reitan RM. Trail Making Test. Tucson: Reitan Neuropsychology Laboratory; 1992.

    Google Scholar 

  41. Kløve H. Grooved Pegboard. Lafeyette: Lafeyette Instruments; 1963.

    Google Scholar 

  42. Wechsler D. Wechsler Adult Intelligence Scale-III (WAIS-III). San Antonio: The Psychological Corporation; 1997.

    Google Scholar 

  43. Carey CL, Woods SP, Gonzalez R, Conover E, Marcotte TD, Grant I, et al. Predictive validity of global deficit scores in detecting neuropsychological impairment in HIV infection. J Clin Exp Neuropsychol. 2004;26(3):307–19.

    Article  PubMed  Google Scholar 

  44. Heaton RK, Franklin DR, Ellis RJ, McCutchan JA, Letendre SL, Leblanc S, et al. HIV-associated neurocognitive disorders before and during the era of combination antiretroviral therapy: differences in rates, nature, and predictors. J Neurovirol. 2011;17(1):3–16.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  45. Benedict RHB, Schretlen D, Groninger L, Dobraski M, Shpritz B. Revision of the brief visuospatial memory test: studies of normal performance, reliability, and validity. Psychol Assess. 1996;8(2):145–53.

    Article  Google Scholar 

  46. Heaton RK, Taylor MJ, Grant I. Revised comprehensive norms for an expanded Halstead-Reitan battery: Demographically adjusted neuropsychological norms for African American and Caucasian adults. Lutz: Psychological Assessment Resources; 2004.

    Google Scholar 

  47. Mirowsky J, Ross CE. Age and Depression. J Health Soc Behav. 1992;33(3):187–205.

    Article  CAS  PubMed  Google Scholar 

  48. Starkstein SE, Jorge R, Mizrahi R, Robinson RG. A prospective longitudinal study of apathy in Alzheimer’s disease. J Neurol Neurosurg Psychiatry. 2006;77(1):8–11.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  49. Antinori A, Arendt G, Becker JT, Brew BJ, Byrd DA, Cherner M, et al. Updated research nosology for HIV-associated neurocognitive disorders. Neurology. 2007;69(18):1789–99.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  50. Marin RS, Biedrzycki RC, Firinciogullari S. Reliability and validity of the Apathy Evaluation Scale. Psychiatry Res. 1991;38(2):143–62.

    Article  CAS  PubMed  Google Scholar 

  51. Poudel-Tandukar K, Bertone-Johnson ER, Palmer PH, Poudel KC. C-reactive protein and depression in persons with Human Immunodeficiency Virus infection. Brain Beha Immun. 2014.

  52. Del Guerra FB, Fonseca JL, Figueiredo VM, Ziff EB, Konkiewitz EC. Human immunodeficiency virus-associated depression: contributions of immuno-inflammatory, monoaminergic, neurodegenerative, and neurotrophic pathways. Journal of neurovirology. 2013;19(4):314–27.

    Article  CAS  PubMed  Google Scholar 

  53. Ances BM, Letendre SL, Alexander T, Ellis RJ. Role of psychiatric medications as adjunct therapy in the treatment of HIV associated neurocognitive disorders. Int Rev Psychiatry. 2008;20(1):89–93.

    Article  PubMed  Google Scholar 

  54. Ishizaki J, Mimura M. Dysthymia and apathy: diagnosis and treatment. Depression research and treatment. 2011;2011:893905.

    Article  PubMed Central  PubMed  Google Scholar 

  55. Padala PR, Burke WJ, Bhatia SC, Petty F. Treatment of apathy with methylphenidate. J Neuropsychiatr Clin Neurosci. 2007;19(1):81–3.

    Article  CAS  Google Scholar 

Download references

Acknowledgments

This work was supported by the National Institutes of Health (Grants R01MH074368 and P01AA019072), and the Lifespan/Tufts/Brown Center for AIDS Research (Grant P30AI042853). This research has been facilitated by the infrastructure and resources provided by the Brown University Center for Alcohol and Addiction Studies, the Lifespan/Tufts/Brown Center for AIDS Research and The Miriam Hospital Immunology Center.

Conflict of interest

The authors have declared that no conflicts of interest exist.

Author information

Authors and Affiliations

  1. Department of Clinical and Health Psychology, University of Florida, 1225 Center Drive, Room 3151, Gainesville, FL, 32611, USA

    Vaughn E. Bryant, Nicole E. Whitehead, Larry E. Burrell II, Vonetta M. Dotson & Ronald A. Cohen

  2. Department of Epidemiology, University of Florida, Gainesville, FL, USA

    Robert L. Cook

  3. Department of Psychiatry and Human Behavior, Brown University, Providence, RI, USA

    Paul Malloy

  4. Department of Psychology, Temple University, Philadelphia, PA, USA

    Kathryn Devlin

  5. Department of Aging and Geriatric Research, University of Florida, Gainesville, FL, USA

    Ronald A. Cohen

Authors
  1. Vaughn E. Bryant
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Nicole E. Whitehead
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Larry E. Burrell II
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Vonetta M. Dotson
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Robert L. Cook
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Paul Malloy
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Kathryn Devlin
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Ronald A. Cohen
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Vaughn E. Bryant.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Bryant, V.E., Whitehead, N.E., Burrell, L.E. et al. Depression and Apathy Among People Living with HIV: Implications for Treatment of HIV Associated Neurocognitive Disorders. AIDS Behav 19, 1430–1437 (2015). https://doi.org/10.1007/s10461-014-0970-1

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10461-014-0970-1

Keywords

Search

Navigation