Successful cognitive aging and health-related quality of life in younger and older adults infected with HIV

Abstract

Neurocognitive impairments commonly occur and adversely impact everyday functioning in older adults infected with HIV, but little is known about successful cognitive aging (SCA) and its health-related quality of life (HRQoL) correlates. Seventy younger (≤40 years) and 107 older (≥50 years) HIV+ adults, as well as age-matched seronegative comparison groups of younger (N = 48) and older (N = 77) subjects completed a comprehensive battery of neuropsychological, psychiatric, medical, and HRQoL assessments. SCA was operationalized as the absence of both performance-based neurocognitive deficits and self-reported symptoms (SCA-ANDS) as determined by published normative standards. A stair-step decline in SCA-ANDS was observed in accordance with increasing age and HIV serostatus, with the lowest rates of SCA-ANDS found in the older HIV+ group (19 %). In both younger and older HIV+ adults, SCA-ANDS was strongly related to better mental HRQoL. HIV infection has additive adverse effects on SCA, which may play a unique role in mental well-being among HIV-infected persons across the lifespan.

Figure I

SCA-ANDS by Age and HIV Status Note. NP = Neuropsychological; NP symptoms = T < 60 on POMS confusion/bewilderment scale; NP deficits = global clinical neurocognitive rating < 4, meaning no individual cognitive domains fall in impaired range; NP symptoms and deficits = SCA-ANDS. Y− = Younger HIV−; Y+ = Younger HIV+; O− = Older HIV−; O+ = Older HIV+. Significant differences pairwise: Y−/O−: NP Symptoms (young less symptoms) Y−/O+: all 3 comparisons Y−/Y+: NP Symptoms Y+/O−: no differences Y+/O+: NP Symptoms; NP Symptoms and Deficits O−/O+: all 3 comparisons