Cognitive reserve protects against apathy in individuals with human immunodeficiency virus

Abstract

Apathy is associated with impaired neuropsychological functioning in individuals with HIV. While cognitive reserve (CR) delays neurocognitive decline, CR's relationship with apathy has never been studied. We examined CR's association with apathy in 116 HIV-positive individuals recruited from an urban AIDS center and assessed whether this relationship is moderated by age and/or disease severity. Participants completed the Wechsler Test of Adult Reading and Apathy Evaluation Scale. A CR-composite, combining years of education and word-reading ability, significantly predicted apathy (t = -2.37, p = .02). CR's relationship with apathy was not moderated by age, but participants with nadir CD4 levels ≤ 200 demonstrated a stronger association (t = -3.25, p = .002) than those with nadir CD4 levels > 200 (t = -0.61, p = .55). These findings suggest a protective effect of CR against apathy in HIV-infected individuals across the age span, particularly after a certain threshold of disease severity.

Keywords: Aging; Apathy; Cognitive reserve; HIV; Neuropsychology.

Fig. 1.

Significant interaction between CR and nadir CD4 count in predicting apathy. High and low values of nadir CD4 count represented as 1 SD above and below the mean of the current sample. CR represents the minimum and maximum values in the current sample. Error bars represent 95% confidence limit. Examination of simple slopes revealed that the relationship between CR and apathy was stronger for those with lower nadir CD4 cell counts (t = −4.56, p < .001) and was not significant for those with higher nadir CD4 cell counts (t = −0.30, p = .76).