Abstract
There is a paucity of research on the prevalence of subjective cognitive complaints in people living with human immunodeficiency virus, along with the predictors and outcomes related to these complaints. We assessed demographics, substance use and psychiatric predictors, and HIV-related outcomes associated with subjective cognitive complaint items from the Cognitive Difficulties Scale. The sample consisted of 889 people living with HIV in the survey-based Florida Cohort. Results of multivariable regression models indicated that age (45–54), hazardous alcohol consumption, more frequent marijuana use and psychiatric symptoms (depression, anxiety, PTSD) were significant predictors of subjective cognitive complaints. Subjective cognitive complaints were associated with lower adherence to antiretroviral therapy in bivariate analyses, but this relationship was no longer significant after controlling for depression, race, alcohol and drug use. Further research into the relationship between depressive and subjective cognitive complaints may provide additional avenues for intervention.
Resumen
Existe una escasez de investigación sobre la prevalencia de quejas cognitivas subjetivas en personas que viven con el virus de la inmunodeficiencia humana (VIH), junto con los predictores y los resultados relacionados con estas quejas. Evaluamos la demografía, el uso de sustancias y los predictores psiquiátricos, y los resultados relacionados con el VIH asociados con los ítems de quejas cognitivas subjetivas de la Escala de Dificultades Cognitivas. La muestra consistió en 889 personas que viven con el VIH en la cohorte de Florida basada en la encuesta. Los resultados de los modelos de regresión multivariable indicaron que la edad (45-54), el consumo peligroso de alcohol, el uso más frecuente de marihuana y los síntomas psiquiátricos (depresión, ansiedad, trastorno de estrés postraumático) fueron predictores significativos de quejas cognitivas subjetivas. Las quejas cognitivas subjetivas se asociaron con una menor adherencia a la terapia antirretroviral en los análisis bivariados, pero esta relación dejó de ser significativa después de controlar la depresión, la raza, el alcohol y el consumo de drogas. La investigación adicional sobre la relación entre las quejas cognitivas depresivas y subjetivas puede proporcionar vías adicionales de intervención.
This is a preview of subscription content, access via your institution.
Data Availability
The authors confirm that the data supporting the findings of this study are available within the article.
Code Availability
Not applicable.
References
Mitchell AJ, Beaumont H, Ferguson D, Yadegarfar M, Stubbs B. Risk of dementia and mild cognitive impairment in older people with subjective memory complaints: meta-analysis. Acta Psychiatr Scand. 2014;130(6):439–51.
Edmonds EC, Weigand AJ, Thomas KR, Eppig J, Delano-Wood L, Galasko DR, et al. Increasing inaccuracy of self-reported subjective cognitive complaints over 24 months in empirically derived subtypes of mild cognitive impairment. J Int Neuropsychol Soc JINS. 2018;24(8):842–53.
Garzón-Maldonado FJ, Gutiérrez-Bedmar M, Serrano-Castro V, Requena-Toro MV, Padilla-Romero L, García-Casares N. An assessment of telephone assistance systems for caregivers of patients with Alzheimer disease. Neurol Engl Ed. 2017;32(9):595–601.
Jessen F, Amariglio RE, van Boxtel M, Breteler M, Ceccaldi M, Chételat G, et al. A conceptual framework for research on subjective cognitive decline in preclinical Alzheimer’s disease. Alzheimers Dement J Alzheimers Assoc. 2014;10(6):844–52.
Reisberg B, Shulman MB, Torossian C, Leng L, Zhu W. Outcome over seven years of healthy adults with and without subjective cognitive impairment. Alzheimers Dement J Alzheimers Assoc. 2010;6(1):11–24.
Perrotin A, Mormino EC, Madison CM, Hayenga AO, Jagust WJ. Subjective cognition and amyloid deposition imaging: a Pittsburgh compound B positron emission tomography study in normal elderly individuals. Arch Neurol. 2012;69(2):223–9.
Vogel JW, Varga Doležalová M, La Joie R, Marks SM, Schwimmer HD, Landau SM, et al. Subjective cognitive decline and β-amyloid burden predict cognitive change in healthy elderly. Neurology. 2017;89(19):2002–9.
Snitz BE, Small BJ, Wang T, Chang C-CH, Hughes TF, Ganguli M. Do subjective memory complaints lead or follow objective cognitive change? A five-year population study of temporal influence. J Int Neuropsychol Soc JINS. 2015;21(9):732–42.
Gurland BJ, Wilder DE, Lantigua R, Stern Y, Chen J, Killeffer EH, et al. Rates of dementia in three ethnoracial groups. Int J Geriatr Psychiatry. 1999;14(6):481–93.
Heaton RK, Clifford DB, Franklin DR, Woods SP, Ake C, Vaida F, et al. HIV-associated neurocognitive disorders persist in the era of potent antiretroviral therapy: CHARTER study. Neurology. 2010;75(23):2087–96.
McArthur JC, Steiner J, Sacktor N, Nath A. Human immunodeficiency virus-associated neurocognitive disorders: mind the gap. Ann Neurol. 2010;67(6):699–714.
Kamkwalala A, Hulgan T, Newhouse P. Subjective memory complaints are associated with poorer cognitive performance in adults with HIV. AIDS Care. 2017;29(5):654–9.
Bassel C, Rourke SB, Halman MH, Smith ML. Working memory performance predicts subjective cognitive complaints in HIV infection. Neuropsychology. 2002;16(3):400–10.
Hinkin CH, van Gorp WG, Satz P, Marcotte T, Durvasula RS, Wood S, et al. Actual versus self-reported cognitive dysfunction in HIV-1 infection: memory-metamemory dissociations. J Clin Exp Neuropsychol. 1996;18(3):431–43.
Moore LH, van Gorp WG, Hinkin CH, Stern MJ, Swales T, Satz P. Subjective complaints versus actual cognitive deficits in predominantly symptomatic HIV-1 seropositive individuals. J Neuropsychiatry Clin Neurosci. 1997;9(1):37–44.
van Gorp WG, Satz P, Hinkin C, Selnes O, Miller EN, McArthur J, et al. Metacognition in HIV-1 seropositive asymptomatic individuals: self-ratings versus objective neuropsychological performance Multicenter AIDS Cohort Study (MACS). J Clin Exp Neuropsychol. 1991;13(5):812–9.
Wilkins JW, Robertson KR, Snyder CR, Robertson WK, van der Horst C, Hall CD. Implications of self-reported cognitive and motor dysfunction in HIV-positive patients. Am J Psychiatry. 1991;148(5):641–3.
Bryant VE, Whitehead NE, Burrell LE, Dotson VM, Cook RL, Malloy P, et al. Depression and apathy among people living with HIV: implications for treatment of HIV associated neurocognitive disorders. AIDS Behav. 2015;19(8):1430–7.
Rubin LH, Langenecker SA, Phan KL, Keating SM, Neigh GN, Weber KM, et al. Remitted depression and cognition in HIV: The role of cortisol and inflammation. Psychoneuroendocrinology. 2020;114:104609.
Cohen RA, Gullett JM, Porges EC, Woods AJ, Lamb DG, Bryant VE, et al. Heavy Alcohol Use and Age Effects on HIV-Associated Neurocognitive Function. Alcohol Clin Exp Res. 2019;43(1):147–57.
Bryant V, Gullett J, Porges E, Cook RL, Bryant K, Woods AJ, et al. History of alcohol consumption and HIV status relate to functional connectivity differences in the brain during working memory performance. Curr HIV Res. 2020;18:181–93.
Bryant VE, Britton MK, Gullett JM, Porges EC, Woods AJ, Cook RL, et al. Reduced working memory is associated with heavier alcohol consumption history, role impairment and executive function difficulties. AIDS Behav. 2021;25:2720–7.
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.
Fazeli PL, Marceaux JC, Vance DE, Slater L, Long CA. Predictors of cognition in adults with HIV: implications for nursing practice and research. J Neurosci Nurs J Am Assoc Neurosci Nurses. 2011;43(1):36–50.
Royal W, Cherner M, Burdo TH, Umlauf A, Letendre SL, Jumare J, et al. Associations between cognition, gender and monocyte activation among hiv infected individuals in Nigeria. PLoS ONE. 2016;11(2):e0147182.
Ibañez GE, Zhou Z, Cook CL, Slade TA, Somboonwit C, Morano J, et al. The Florida Cohort study: methodology, initial findings and lessons learned from a multisite cohort of people living with HIV in Florida. AIDS Care. 2021;33(4):516–24.
McNair D, Khan R. Self-assessment of cognitive deficits. In: Crook T, Ferris S, Bartus R, editors. Assessment in geriatric psychopharmacology. New Canaan, CT: Mark Powley; 1983. p. 137–43.
Kroenke K, Spitzer RL, Williams JBW, Löwe B. An ultra-brief screening scale for anxiety and depression: the PHQ-4. Psychosomatics. 2009;50(6):613–21.
Spitzer RL, Kroenke K, Williams JBW, Löwe B. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med. 2006;166(10):1092–7.
Prins A, Bovin MJ, Smolenski DJ, Marx BP, Kimerling R, Jenkins-Guarnieri MA, et al. The primary care PTSD screen for DSM-5 (PC-PTSD-5): development and evaluation within a veteran primary care sample. J Gen Intern Med. 2016;31(10):1206–11.
Bush K, Kivlahan DR, McDonell MB, Fihn SD, Bradley KA. The AUDIT alcohol consumption questions (AUDIT-C): an effective brief screening test for problem drinking ambulatory care quality improvement project (ACQUIP) alcohol use disorders identification test. Arch Intern Med. 1998;158(16):1789–95.
Cook RL, Zhu F, Belnap BH, Weber K, Cook JA, Vlahov D, et al. Longitudinal trends in hazardous alcohol consumption among women with human immunodeficiency virus infection, 1995–2006. Am J Epidemiol. 2009;169(8):1025–32.
Saunders JB, Aasland OG, Babor TF, Fuente JRDL, Grant M. Development of the alcohol use disorders identification test (AUDIT): WHO collaborative project on early detection of persons with harmful alcohol consumption-II. Addiction. 1993;88(6):791–804.
Reid MC, Fiellin DA, O’Connor PG. Hazardous and harmful alcohol consumption in primary care. Arch Intern Med. 1999;159(15):1681–9.
Guttmannova K, Kosterman R, White HR, Bailey JA, Lee JO, Epstein M, et al. The association between regular marijuana use and adult mental health outcomes. Drug Alcohol Depend. 2017;1(179):109–16.
Cerdá M, Moffitt TE, Meier MH, Harrington H, Houts R, Ramrakha S, et al. Persistent cannabis dependence and alcohol dependence represent risks for midlife economic and social problems: a longitudinal cohort study. Clin Psychol Sci J Assoc Psychol Sci. 2016;4(6):1028–46.
Heinz AJ, Fogler KA, Newcomb ME, Trafton JA, Bonn-Miller MO. Problematic alcohol use among individuals with HIV: relations with everyday memory functioning and HIV symptom severity. AIDS Behav. 2014;18(7):1302–14.
Tandetnik C, Hergueta T, Bonnet P, Dubois B, Bungener C. Influence of early maladaptive schemas, depression, and anxiety on the intensity of self-reported cognitive complaint in older adults with subjective cognitive decline. Int Psychogeriatr. 2017;29(10):1657–67.
Saylor D, Dickens AM, Sacktor N, Haughey N, Slusher B, Pletnikov M, et al. HIV-associated neurocognitive disorder–pathogenesis and prospects for treatment. Nat Rev Neurol. 2016;12(4):234–48.
Rubin LH, Maki PM. HIV, depression, and cognitive impairment in the era of effective antiretroviral therapy. Curr HIV/AIDS Rep. 2019;16(1):82–95.
Blair M, Coleman K, Jesso S, Desbeaumes Jodoin V, Smolewska K, Warriner E, et al. Depressive symptoms negatively impact Montreal cognitive assessment performance: a memory clinic experience. Can J Neurol Sci J Can Sci Neurol. 2016;43(4):513–7.
Zlatar ZZ, Muniz M, Galasko D, Salmon DP. Subjective cognitive decline correlates with depression symptoms and not with concurrent objective cognition in a clinic-based sample of older adults. J Gerontol B Psychol Sci Soc Sci. 2018;73(7):1198–202.
Fieo R, Mukherjee S, Dmitrieva NO, Fyffe DC, Gross AL, Sanders ER, et al. Differential item functioning due to cognitive status does not impact depressive symptom measures in four heterogeneous samples of older adults. Int J Geriatr Psychiatry. 2015;30(9):911–8.
Durvasula R, Miller TR. Substance abuse treatment in persons with HIV/AIDS: challenges in managing triple diagnosis. Behav Med Wash DC. 2014;40(2):43–52.
Funding
National Institute on Alcohol Abuse and Alcoholism (NIAAA; U24AA022002; Recipient-Cook), National Institute on Alcohol Abuse and Alcoholism (NIAAA; T32AA025877; Recipient – Cook), National Institute on Alcohol Abuse and Alcoholism (NIAAA; F31AA024060; Recipient – Bryant), National Institute on Alcohol Abuse and Alcoholism (NIAAA; K01AA025306; Recipient – Porges).
Author information
Authors and Affiliations
Contributions
All authors contributed to the study conception and design. Data analysis was conducted by RF, HL, VB and ZZ. The first draft of the manuscript was written by VB and RF. Review and editing was conducted by all other authors. Additionally, all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflicts of interest.
Ethics Approval
All procedures performed in studies 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
Informed consent was obtained from all individual participants in the study.
Consent for Publication
The authors affirm that human research participants provided informed consent for publication of their deidentified data.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Bryant, V.E., Fieo, R.A., Fiore, A.J. et al. Subjective Cognitive Complaints: Predictors and Health Outcomes in People Living with HIV. AIDS Behav 26, 1163–1172 (2022). https://doi.org/10.1007/s10461-021-03469-5
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10461-021-03469-5
Keywords
- HIV
- Subjective cognitive complaints
- Depression
- ART
- Adherence