Longitudinal psychomotor speed performance in human immunodeficiency virus-seropositive individuals: impact of age and serostatus

Abstract

Older human immunodeficiency virus-seropositive (HIV+) individuals (greater than age 50 years) are twice as likely to develop HIV dementia compared to younger HIV+ individuals. The objective of this study was to examine the impact of both age and serostatus on longitudinal changes in psychomotor speed/executive functioning performance among HIV+ and HIV− individuals. Four hundred and seventy-seven HIV+ and 799 HIV− individuals from the Multicenter AIDS Cohort Study (MACS) were subdivided into three age groups: (1) <40 years, (2) 40-50 years, and (3) >50 years. Psychomotor speed/executive functioning test performance was measured by the Symbol Digit Modalities Test (SDMT) and the Trail Making (TM) Test Parts A and B. Changes in performance were compared among the three age groups for both HIV+ and HIV− individuals. Among HIV+ individuals, on the TM Test Part B the younger group demonstrated improvement in performance over time (P = .007). The older and middle age groups demonstrated decline in performance over time (P = .041 and .030). The older group had a significantly different trajectory relative to the younger group (P = .046). Among the HIV− individuals, there was no effect of age on longitudinal performance. In conclusion, older HIV+ individuals show greater decline over time than younger HIV+ individuals on the TM Test Part B. Our results suggest that both HIV serostatus and age together may impact longitudinal performance on this test. Mild neurocognitive changes over time among older HIV+ individuals are likely to reflect age associated pathophysiological mechanisms including cerebrovascular risk factors.

Figure 1

Trail Making Test Part B, performance over time stratified by HIV serostatus and age group. Standard error bar and predicted slope based on mixed model regression. y-axis, lower number over time indicates improvement, higher number over time indicates deterioration.