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Pre-frailty predicts cognitive decline at 2-year follow-up in persons living with HIV

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Abstract

Both HIV disease and frailty syndrome are risk factors for neurocognitive impairment. Longitudinal research among individuals of the general population suggests that frailty predicts future cognitive decline; however, there is limited evidence for these longitudinal relationships among people living with HIV (PLWH). The current study evaluated and compared rates of cognitive decline over 2 years among HIV serostatus and frailty status groups. Participants included 50 PLWH and 60 HIV-uninfected (HIV−) participants who were evaluated at baseline and 2-year follow-up visits. Baseline frailty status (non-frail, pre-frail, and frail) was determined using fried frailty phenotype criteria. Neurocognitive functioning was measured using practice-effect corrected scaled scores derived from a comprehensive neuropsychological battery covering seven cognitive domains. Repeated measures analysis was used to estimate rates of global and domain-specific cognitive change from baseline to 2-year follow-up among each of six HIV/frailty status groups. Among PLWH, the pre-frail group demonstrated consistent declines in global cognitive functioning (B = − 0.029, p = 0.034), processing speed (B = − 0.047, p = 0.031), and motor functioning (B = − 0.048, p = 0.038). Among HIV− participants, pre-frail individuals also declined in global cognitive functioning and processing speed (ps ≤ 0.05). HIV− non-frail participants also declined in the cognitive domains of learning, delayed recall, and motor functioning; however, these declines appeared to be driven by relatively higher baseline scores among this group. Notably, 38% of PLWH changed in frailty status from baseline to follow-up, and those with stable pre-frailty demonstrated higher likelihood for cognitive decline; change in depressive symptoms did not relate to change in frailty status. Current findings highlight pre-frailty as an important clinical syndrome that may be predictive of cognitive decline among PLWH. Interventions to prevent or reduce frailty among vulnerable PLWH are needed to maintain optimal cognitive health.

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Acknowledgments

The San Diego HIV Neurobehavioral Research Center [HNRC] group is affiliated with the University of California, San Diego, the Naval Hospital, San Diego, and the Veterans Affairs San Diego Healthcare System, and includes: Director: Robert K. Heaton, Ph.D., Co-Director: Igor Grant, M.D.; Associate Directors: J. Hampton Atkinson, M.D., Ronald J. Ellis, M.D., Ph.D., and Scott Letendre, M.D.; Center Manager: Thomas D. Marcotte, Ph.D.; Jennifer Marquie-Beck, M.P.H.; Melanie Sherman; Neuromedical Component: Ronald J. Ellis, M.D., Ph.D. (P.I.), Scott Letendre, M.D., J. Allen McCutchan, M.D., Brookie Best, Pharm.D., Rachel Schrier, Ph.D., Debra Rosario, M.P.H.; Neurobehavioral Component: Robert K. Heaton, Ph.D. (P.I.), J. Hampton Atkinson, M.D., Steven Paul Woods, Psy.D., Thomas D. Marcotte, Ph.D., Mariana Cherner, Ph.D., David J. Moore, Ph.D., Matthew Dawson; Neuroimaging Component: Christine Fennema-Notestine, Ph.D. (P.I.), Monte S. Buchsbaum, M.D., John Hesselink, M.D., Sarah L. Archibald, M.A., Gregory Brown, Ph.D., Richard Buxton, Ph.D., Anders Dale, Ph.D., Thomas Liu, Ph.D.; Neurobiology Component: Eliezer Masliah, M.D. (P.I.), Cristian Achim, M.D., Ph.D.; Neurovirology Component: David M. Smith, M.D. (P.I.), Douglas Richman, M.D.; International Component: J. Allen McCutchan, M.D., (P.I.), Mariana Cherner, Ph.D.; Developmental Component: Cristian Achim, M.D., Ph.D.; (P.I.), Stuart Lipton, M.D., Ph.D.; Participant Accrual and Retention Unit: J. Hampton Atkinson, M.D. (P.I.), Jennifer Marquie-Beck, M.P.H.; Data Management and Information Systems Unit: Anthony C. Gamst, Ph.D. (P.I.), Clint Cushman; Statistics Unit: Ian Abramson, Ph.D. (P.I.), Florin Vaida, Ph.D. (Co-PI), Anya Umlauf, M.S., Bin Tang, Ph.D.

Funding

This research was supported by the National Institute of Mental Health (grant numbers R01MH099987, P30MH062512, R25MH081482 (stipend support to ECP)), the National Institute on Alcohol Abuse and Alcoholism (grant number F31 AA027198 (stipend support to EWP)), and the National Institute on Drug Abuse (grant number T32 DA031098 (stipend support to NSS)).

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Authors and Affiliations

  1. San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA

    Emily W. Paolillo

  2. Department of Psychiatry, University of California San Diego, San Diego, CA, 92103-8231, USA

    Emily W. Paolillo, Ni Sun-Suslow, Erin E. Morgan, Dilip V. Jeste & David J. Moore

  3. Rehabiliation Research Center, Santa Clara Valley Medical Center, San Jose, CA, USA

    Elizabeth C. Pasipanodya

  4. Department of Neurosciences, University of California, San Diego, CA, USA

    Ronald J. Ellis

  5. Sam and Rose Stein Institute for Research on Aging, University of California San Diego, San Diego, CA, USA

    Dilip V. Jeste

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  1. Emily W. Paolillo
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Paolillo, E.W., Sun-Suslow, N., Pasipanodya, E.C. et al. Pre-frailty predicts cognitive decline at 2-year follow-up in persons living with HIV. J. Neurovirol. 26, 168–180 (2020). https://doi.org/10.1007/s13365-019-00814-2

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