Skip to main content

Positive Psychological Factors are Linked to Successful Cognitive Aging Among Older Persons Living with HIV/AIDS


We aimed to characterize successful cognitive aging (SCA) among older HIV-infected (HIV+) and HIV-uninfected (HIV−) adults, and to determine associations with positive psychological factors and health-related quality of life (HRQoL). Ninety-nine HIV+ and 46 HIV− older adults (≥ 50 years) completed measures of neurocognition, positive psychological factors, and HRQoL. Using study-defined SCA criteria (i.e., no cognitive or everyday impairment or major depressive disorder), we compared positive psychological factors and HRQoL across four groups: HIV+/SCA+, HIV+/SCA−, HIV−/SCA+, HIV−/SCA−. SCA was identified in 29% of the HIV+ sample compared to 61% of the HIV− sample (p < 0.01). HIV+/SCA+ participants had higher scores on 8 of 10 measures of positive psychological factors as well as better HRQoL (ps < 0.05) as compared to the HIV+/SCA− group. Furthermore, the HIV+/SCA+ participants had comparable scores on these factors as HIV− adults. Fewer HIV+ than HIV− participants met SCA criteria; however, the level of positive psychological factors among the HIV+/SCA+ group was comparable to the HIV− sample. Our findings present opportunities for interventions to optimize positive psychological factors and potentially improve SCA among older HIV+ adults.


Nuestro objetivo fue caracterizar el envejecimiento cognitivo exitoso (ECE) entre personas mayores VIH+ y VIH−, y determinar asociaciones con factores psicológicos positivos y con la calidad de vida relacionada a la salud (CVrS). Noventa y nueve personas mayores (de 50 años o más) VIH+ y 46 VIH− completaron indicadores de neurocognición, de factores psicológicos positivos y de CVrS. Mediante la utilización de criterios de ECE definidos por el presente estudio (p. ej. la ausencia de deterioro cognitivo, impedimentos en el funcionamiento cotidiano, o trastorno depresivo mayor) comparamos los factores psicológicos positivos y la CVrS entre cuatro grupos: VIH+/ECE+, VIH+/ECE−, VIH−/ECE+, VIH−/ECE−. El ECE fue identificado en 29% de la muestra de VIH+ comparado con 61% de la muestra de VIH− (p < 0,01). Los participantes VIH+/ECE+ obtuvieron puntuaciones más altas en 8 de los 10 indicadores de factores psicológicos positivos, así como mejor CVrS (ps < 0,05), comparado con el grupo VIH+/ECE−. Además, los participantes VIH+/ECE+ obtuvieron valores comparables a los de los adultos VIH− en estos factores. Una proporción menor de participantes VIH+ que VIH− cumplieron criterios de ECE; sin embargo, el nivel de los factores psicológicos positivos en el grupo VIH+/ECE+ fue comparable a la muestra de la población VIH−. Nuestros resultados presentan oportunidades de intervención para optimizar los factores psicológicos positivos y potencialmente mejorar el ECE entre los adultos mayores con VIH.

This is a preview of subscription content, access via your institution.

Fig. 1


  1. 1.

    United States Senate Special Committee on Aging. Hearing: older Americans: the changing face of HIV/AIDS in America. Washington, DC: United States Senate Special Committee on Aging; 2013.

    Google Scholar 

  2. 2.

    Smit M, Brinkman K, Geerlings S, et al. Future challenges for clinical care of an ageing population infected with HIV: a modelling study. Lancet Infect Dis. 2015;15(7):810–8.

    Article  PubMed  PubMed Central  Google Scholar 

  3. 3.

    High KP, Brennan-Ing M, Clifford DB, et al. HIV and aging: state of knowledge and areas of critical need for research. A report to the NIH office of AIDS research by the HIV and aging working group. J Acquir Immune Defic Syndr. 2012;60:S1–18.

    CAS  Article  PubMed  Google Scholar 

  4. 4.

    Heaton RK, Clifford DB, Franklin DR Jr, et al. HIV-associated neurocognitive disorders persist in the era of potent antiretroviral therapy: CHARTER Study. Neurology. 2010;75:2087–96.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  5. 5.

    Valcour V, Shikuma C, Shiramizu B, et al. Higher frequency of dementia in older HIV-1 individuals: the Hawaii aging with HIV-1 cohort. Neurology. 2004;63:822–7.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  6. 6.

    Greysen SR, Horwitz LI, Covinsky KE, Gordon K, Ohl ME, Justice AC. Does social isolation predict hospitalization and mortality among HIV+ and uninfected older veterans? J Am Geriatr Soc. 2013;61(9):1456–63.

    Article  PubMed  PubMed Central  Google Scholar 

  7. 7.

    Foley JM, Gooding AL, Thames AD, et al. Visuospatial and Attentional abilities predict driving simulator performance among older HIV-infected adults. Am J Alzheimer’s Dis Other Demen. 2013;28(2):185–94.

    CAS  Article  Google Scholar 

  8. 8.

    Morgan EE, Iudicello JE, Weber E, et al. Synergistic effects of HIV infection and older age on daily functioning. J Acquir Immune Defic Syndr. 2012;61(3):341–8.

    Article  PubMed  PubMed Central  Google Scholar 

  9. 9.

    Thames AD, Kim MS, Becker BW, et al. Medication and finance management among HIV-infected adults: the impact of age and cognition. J Clin Exp Neuropsychol. 2011;33(2):200–9.

    Article  PubMed  Google Scholar 

  10. 10.

    Vance DE, Fazeli PL, Gakumo CA. The impact of neuropsychological performance on everyday functioning between older and younger adults with and without HIV. J Assoc Nurses AIDS Care. 2013;24(2):112–25.

    Article  PubMed  Google Scholar 

  11. 11.

    Vance DE, Wadley VG, Crowe MG, Raper JL, Ball KK. Cognitive and Everyday Functioning in Older and Younger Adults with and without HIV. Clin Gerontol. 2011;34(5):413–26.

    Article  PubMed  PubMed Central  Google Scholar 

  12. 12.

    Doyle K, Weber E, Atkinson JH, Grant I, Woods SP, the HIV Neurobehavioral Research Program (HNRP) Group. Aging, prospective memory, and health-related quality of life in HIV infection. AIDS Behav. 2012;16(8):2309–18.

    Article  PubMed  PubMed Central  Google Scholar 

  13. 13.

    Tozzi V, Balestra P, Galgani S, et al. Neurocognitive performance and quality of life in patients with HIV infection. AIDS Res Hum Retroviruses. 2003;19(8):643–52.

    Article  PubMed  Google Scholar 

  14. 14.

    Castellon SA, Hardy DJ, Hinkin CH, et al. Components of depression in HIV-1 infection: their differential relaitonship to neurocognitive performance. J Clin Exp Neuropsychol. 2006;28(3):420–37.

    Article  PubMed  PubMed Central  Google Scholar 

  15. 15.

    Shimizu SM, Chow DC, Valcour V, et al. The impact of depressive symptoms on neuropsychological performance tests in HIV-infected adults: a study of the Hawaii Aging with HIV cohort. World J AIDS. 2011;1(4):139–45.

    Article  PubMed  PubMed Central  Google Scholar 

  16. 16.

    Jeste DV, Savla GN, Thompson WK, et al. Association between older age and more successful aging: critical role of resilience and depression. Am J Psychiatry. 2013;170:188–96.

    Article  PubMed  PubMed Central  Google Scholar 

  17. 17.

    Moore RC, Fazeli PL, Jeste DV, Moore DJ, Grant I, Woods SP, the HNRP Group. Successful cognitive aging and health-related quality of life in younger and older adults infected with HIV. AIDS Behav. 2014;18(6):1186–97.

    Article  PubMed  PubMed Central  Google Scholar 

  18. 18.

    Moore RC, Eyler LT, Mausbach BT, et al. Complex interplay between health and successful aging: role of perceived stress, resilience, and social support. Am J Geriatr Psychiatry. 2014;23(6):622–32.

    Article  PubMed  PubMed Central  Google Scholar 

  19. 19.

    Vahia I, Thompson WK, Depp CA, Allison MA, Jeste DV. Developing a dimensional model for successful cognitive and emotional aging. Int Psychogeriatr. 2012;24(4):515–23.

    Article  PubMed  Google Scholar 

  20. 20.

    Moore RC, Moore DJ, Thompson WK, Vahia IV, Grant I, Jeste DV. A case-controlled study of successful aging in older adults with HIV. J Clin Psychiatry. 2013;14(5):e417–23.

    Article  Google Scholar 

  21. 21.

    Malaspina L, Woods SP, Moore DJ, et al. Successful cognitive aging in persons living with HIV infection. J Neurovirol. 2011;17(1):110–9.

    Article  PubMed  Google Scholar 

  22. 22.

    Antinori A, Arendt G, Becker JT, et al. Updated research nosology for HIV-associated neurocognitinve disorders. Neurology. 2007;69(18):1789–99.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  23. 23.

    Blackstone K, Moore DJ, Franklin DR, et al. Defining neurocognitive impairment in HIV: deficit scores versus clinical ratings. Clin Neuropsychol. 2012;26(6):894–908.

    CAS  Article  PubMed  Google Scholar 

  24. 24.

    Robins LN, Wing J, Wittchen HU, 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 Psychiatry. 1998;45(12):1069–77.

    Article  Google Scholar 

  25. 25.

    Wittchen HU. Reliability and validity studies of the WHO–Composite International Diagnostic Interview (CIDI): a critical review. J Psychiatr Res. 1994;28(1):57–84.

    CAS  Article  PubMed  Google Scholar 

  26. 26.

    Fazeli PL, Doyle KL, Scott JC, et al. Shallow encoding and forgetting are associated with dependence in instrumental activities of daily living among older adults living with HIV infection. Arch Clin Neuropsychol. 2014;29(3):278–88.

    Article  PubMed  PubMed Central  Google Scholar 

  27. 27.

    Lawton MP, Brody EM. Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist. 1969;9(3):179–86.

    CAS  Article  PubMed  Google Scholar 

  28. 28.

    Obermeit LC, Beltran J, Casaletto KB, Franklin DR, Letendre S, Ellis R, Fennema-Notestine C, Vaida F, Collier AC, Marra CM, Clifford D, Gelman B, Sacktor N, Morgello S, Simpson D, McCutchan JA, Grant I, Heaton RK, CNS HIV Anti-Retroviral Therapy Effects Research (CHARTER) Group. Evaluating the accuracy of self-report for the diagnosis of HIV-associated neurocognitive disorder (HAND): defining “symptomatic” versus “asymptomatic” HAND. J Neurovirol. 2017;23(1):67–78.

    CAS  Article  PubMed  Google Scholar 

  29. 29.

    Montross LP, Depp CA, Daly J, et al. Correlates of self-rated successful aging among community-dwelling older adults. Am J Geriatr Psychiatry. 2006;14:43–51.

    Article  PubMed  Google Scholar 

  30. 30.

    Ware JE Jr, Sherbourne CD. The MOS 26-item short-form health survey (SF-36): conceptual framework and item selection. Med Care. 1992;30:473–83.

    Article  PubMed  Google Scholar 

  31. 31.

    Duckworth AL, Quinn PD. Development and validation of the short grit scale (Grit-S). J Pers Assess. 2009;91(2):166–74.

    Article  PubMed  Google Scholar 

  32. 32.

    Koening HG, Westlund RE, George LK, Hughes DC, Blazer DG, Hybels C. Abbreviating the Duke Socialy Support Index for use in chronically III elderly individuals. Psychosomatics. 1993;34(1):61–9.

    Article  Google Scholar 

  33. 33.

    Cambell-Sills L, Stein MB. Psychometric analysis and refinement of the Connor-davidson Resilience Scale (CD-RISC): validation of a 10-item measure of resilience. J Trauma Stress. 2007;20(6):1019–28.

    Article  Google Scholar 

  34. 34.

    Lawton P. The philadelphia geriatric center morale scale: a revision. J Gerontol. 1975;30(1):85–9.

    CAS  Article  PubMed  Google Scholar 

  35. 35.

    Scheier MF, Carver CS, Bridges MW. Distinguishing optimism from neuroticism (and trait anxiety, self-mastery, and self-esteem): a reevaluation of the Life Orientation Test. J Personal Soc Psychol. 1994;67(6):1063–78.

    CAS  Article  Google Scholar 

  36. 36.

    Diener E, Emmons RA, Larsen RJ, Griffin S. The satisfaction with life scale. J Pers Assess. 1985;49(1):71–5.

    CAS  Article  PubMed  Google Scholar 

  37. 37.

    Pearlin LI, Lieberman MA, Menaghan EG, Mullan JT. The stress process. J Health Soc Behav. 1981;22(4):337–56.

    CAS  Article  PubMed  Google Scholar 

  38. 38.

    Seeman TE, Lusignolo TM, Albert M, Berkman L. Social relationships, social support, and patterns of cognitive aging in healthy, high-functioning older adults: MacArthur studies of successful aging. Health Psychol. 2001;20(4):243–55.

    CAS  Article  PubMed  Google Scholar 

  39. 39.

    Tedeschi RG, Calhoun LG. The Posttraumatic Growth Inventory: measuring the positive legacy of trauma. J Trauma Stress. 1996;9(3):455–71.

    CAS  Article  PubMed  Google Scholar 

  40. 40.

    McNamara P, Durso R, Brown A. Religiosity in patients with Parkinson’s disease. Neuropsychiatr Dis Treat. 2006;2(3):341–8.

    Article  PubMed  PubMed Central  Google Scholar 

  41. 41.

    Heaton RK, Marcotte TD, Mindt MR, et al. The impact of HIV-associated neuropsychological impairment on everyday functioning. J Int Neuropsychol Soc. 2004;10(3):317–31.

    Article  PubMed  Google Scholar 

  42. 42.

    Milanini B, Castella S, Perkovich B, et al. Psychiatric symptom burden in older people living with HIV with and without cognitive impairment: the UCSF HIV over 60 cohort study. AIDS Care. 2017;.

    PubMed  Google Scholar 

  43. 43.

    Jeste DV, Depp CA, Vahia IV. Successful cognitive and emotional aging. World Psychiatry. 2010;9(2):78–84.

    Article  PubMed  PubMed Central  Google Scholar 

  44. 44.

    Pruchno RA, Wilson-Genderson M, Cartwright F. A two-factor model of successful aging. J Gerontol Ser B Psychol Sci Soc Sci. 2010;65(6):671–9.

    Article  Google Scholar 

  45. 45.

    Fang X, Vincent W, Calabrese SK, Heckman TG, Sikkema KJ, Humphries DL, Hansen NB. Resilience, stress, and life quality in older adults living with HIV/AIDS. Aging Ment Health. 2015;19(11):1015–21.

    Article  PubMed  PubMed Central  Google Scholar 

  46. 46.

    Vance DE, Burrage J Jr, Couch A, Raper J. Promoting successful aging with HIV through hardiness: implications for nursing practice and research. J Gerontol Nurs. 2008;34(6):22–9.

    Article  PubMed  Google Scholar 

  47. 47.

    Sergeant S, Mongrain M. An online optimism intervention reduces depression in pessimistic individuals. J Consult Clin Psychol. 2014;82(2):263–74.

    Article  PubMed  Google Scholar 

  48. 48.

    Depp CA, Vahia IV, Jeste DV. Successful aging: focus on cognitive and emotional health. Annu Rev Clin Psychol. 2010;6:527–50.

    Article  PubMed  Google Scholar 

  49. 49.

    Carver LF, Buchanan D. Successful aging: considering non-biomedical constructs. Clin Interv Aging. 2016;11:1623–30.

    Article  PubMed  PubMed Central  Google Scholar 

Download references


The San Diego HIV Neurobehavioral Research Program [HNRP] 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), Reena Deutsch, Ph.D., Anya Umlauf, M.S. 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.


This work was primarily supported by ID10-SD-057 from California HIV/AIDS Research Program (CHRP) (D.J. Moore, PI) and the University of California San Diego (UCSD) Stein Institute for Research on Aging Faculty Pilot Research Grant (D.J. Moore, PI). Additional support was provided by the following National Institutes of Health (NIH) Grants: R01MH099987 (D.J. Moore & D.V. Jeste, MPI), P30MH062512 (R.K. Heaton, PI), R00 AG048762 (P.L. Fazeli, PI), K23 MH107260 (R.C. Moore, PI).

Author information




Corresponding author

Correspondence to David J. Moore.

Ethics declarations

Ethical Approval

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.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Moore, D.J., Fazeli, P.L., Moore, R.C. et al. Positive Psychological Factors are Linked to Successful Cognitive Aging Among Older Persons Living with HIV/AIDS. AIDS Behav 22, 1551–1561 (2018).

Download citation


  • Aging
  • Cognition
  • Positive Psychology
  • Health-related quality of life

Palabras clave

  • Envejecimiento
  • Cognición
  • Psicología Positiva
  • Calidad de vida relacionada a la Salud