Frequency and Correlates of Subjective Cognitive Impairment in HIV Disease
The increasing prevalence of older adults living with HIV has raised growing concerns about a possible rise in the incidence of neurocognitive disorders due to HIV and other age-related factors. In typical aging, subjective cognitive impairment (SCI) among individuals with normal neurocognitive functioning may be an early manifestation of an incipient neurocognitive disorder. The current study examined the frequency and correlates of SCI in 188 HIV-infected adults without performance-based neurocognitive deficits or a current psychiatric disorder and 133 HIV seronegative comparison participants. All participants completed the Prospective and Retrospective Memory Questionnaire and Profile of Mood States Confusion/Bewilderment scale. Consistent with the diagnostic criteria proposed by Jessen et al. (Alzheimers Dement 10(6):844–852, 2014), participants were classified with SCI if their scores on either of the self-reported measures was greater than 1.5 SD above the normative mean. A logistic regression controlling for current mood complaints and lifetime history of substance use disorders revealed that HIV infection increased the odds of SCI (odds ratio= 4.5 [1.6, 15.4], p = 0.004). Among HIV+ individuals, SCI was associated with lower performance-based learning and delayed memory scores (Cohen’s d range 0.41–0.42.) and poorer global everyday functioning (odds ratio= 8.5 [2.6, 15.9]), but not HIV disease severity (ps > 0.10). In a sample of individuals without neurocognitive impairment or elevated mood symptoms, HIV disease was associated with a nearly fivefold increased odds of SCI compared to seronegative individuals, which may indicate an increased risk for developing major neurocognitive disorders as these HIV+ individuals age.
KeywordsSubjective cognitive impairment HIV Everyday functioning Neurocognitive disorders
The authors have no financial conflicts of interest related to this work. This study was supported by NIH Grants R01-MH073419 and P30-MH62512. The authors are grateful to the UC San Diego HIV Neurobehavioral Research Program (HNRP) Group (I. Grant, PI) for their infrastructure support of the parent R01. In particular, we thank Donald Franklin, Dr. Erin Morgan, Clint Cushman, and Stephanie Corkran for their assistance with data processing, Marizela Verduzco for her assistance with study management, Drs. Scott Letendre and Ronald J. Ellis for their assistance with the neuromedical aspects of the parent project, and Dr. J. Hampton Atkinson and Jennifer Marquie Beck and their assistance with participant recruitment and retention. The views expressed in this article are those of the authors and do not reflect the official policy or position of the Department of the Navy, Department of Defense, nor the United States Government. The authors thank the study volunteers for their participation.
This study was funded by NIH Grants R01-MH073419 and P30-MH62512.
Compliance with Ethical Standards
Conflict of interest
David P. Sheppard declares that he has no conflict of interest. Steven Paul Woods declares that he has no conflict of interest. Paul J. Massman declares that he has no conflict of interest. Paul E. Gilbert declares that he has no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
- 13.Hessen E, Nordlund A, Stålhammar J, Eckerström M, Bjerke M, Eckerström C, et al. T-Tau is associated with objective memory decline over two years in persons seeking help for subjective cognitive decline: a report from the Gothenburg-Oslo MCI study. J Alzheimers Dis. 2015;47(3):619–28.CrossRefGoogle Scholar
- 14.Hessen E, Eckerström M, Nordlund A, Selseth Almdahl I, Stålhammar J, Bjerke M, et al. Subjective cognitive impairment is a predominantly benign condition in memory clinic patients followed for 6 years: the Gothenburg-Oslo MCI study. Dement Geriatr Cogn Dis Extra. 2017;7(1):1–14.CrossRefGoogle Scholar
- 30.Avci G, Loft S, Sheppard DP, Woods SP, HIV Neurobehavioral Research Program (HNRP) Group. The effects of HIV disease and older age on laboratory-based, naturalistic, and self-perceived symptoms of prospective memory: does retrieval cue type and delay interval matter? Neuropsychol Dev Cogn B Aging Neuropsychol Cogn. 2016;23(6):716–43.CrossRefGoogle Scholar
- 37.American Psychiatric Association. Diagnostic and statistical manual of mental disorders: DSM-IV. Washington, DC: American Psychiatric Association; 1994.Google Scholar
- 41.McNair DM, Lorr M, Droppleman LF. Profile of mood states. San Diego: Educational and Industrial Testing Service; 1981.Google Scholar
- 44.Moore RC, Paolillo EW, Heaton A, Fazeli PL, Jeste DV, Moore DJ. Clinical utility of the UCSD Performance-Based Skills Assessment-Brief (UPSA-B) in adults living with HIV: associations with neuropsychological impairment and patient-reported everyday functioning difficulties. PLoS ONE. 2017;12(8):e0183614.CrossRefGoogle Scholar
- 48.Karnofsky DA, Burchenal JH. The clinical evaluation of chemo-therapeutic agents in cancer. In: Maclead CM, editor. Evaluation of chemotherapeutic agents. New York: Columbia University Press; 1949. p. 191–205.Google Scholar
- 49.Corporation Psychological. WAIS-III and WMS-III technical manual. San Antonio: Author; 1997.Google Scholar
- 50.Delis DC, Kramer JH, Kaplan E, Ober BA. The California verbal learning test. 2nd ed. San Antonio: The Psychological Corporation; 2000.Google Scholar
- 51.Battery Army Individual Test. Manual of directions and scoring. Washington, DC: War Department, Adjutant General’s Office; 1944.Google Scholar
- 52.Culbertson WC, Zillmer EA. The tower of London, Drexel University, research version: examiner’s manual. North Tonawanda: Multi-Health Systems; 1999.Google Scholar
- 53.Kløve H. Grooved pegboard. Lafayette: Lafayette Instruments; 1963.Google Scholar