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Multicenter Study
. 2019 May;25(5):507-519.
doi: 10.1017/S1355617719000018. Epub 2019 Mar 20.

Neurocognitive SuperAging in Older Adults Living With HIV: Demographic, Neuromedical and Everyday Functioning Correlates

Rowan Saloner  1 , Laura M Campbell  1 , Vanessa Serrano  2 , Jessica L Montoya  2 , Elizabeth Pasipanodya  2 , Emily W Paolillo  1 , Donald Franklin  2 , Ronald J Ellis  2 , Scott L Letendre  3 , Ann C Collier  4 , David B Clifford  5 , Benjamin B Gelman  6 , Christina M Marra  7 , J Allen McCutchan  3 , Susan Morgello  8 , Ned Sacktor  9 , Dilip V Jeste  2 , Igor Grant  2 , Robert K Heaton  2 , David J Moore  2 ; CHARTER and HNRP Groups
Affiliations
Multicenter Study

Neurocognitive SuperAging in Older Adults Living With HIV: Demographic, Neuromedical and Everyday Functioning Correlates

Rowan Saloner et al. J Int Neuropsychol Soc. 2019 May.

Abstract

Objectives: Studies of neurocognitively elite older adults, termed SuperAgers, have identified clinical predictors and neurobiological indicators of resilience against age-related neurocognitive decline. Despite rising rates of older persons living with HIV (PLWH), SuperAging (SA) in PLWH remains undefined. We aimed to establish neuropsychological criteria for SA in PLWH and examined clinically relevant correlates of SA.

Methods: 734 PLWH and 123 HIV-uninfected participants between 50 and 64 years of age underwent neuropsychological and neuromedical evaluations. SA was defined as demographically corrected (i.e., sex, race/ethnicity, education) global neurocognitive performance within normal range for 25-year-olds. Remaining participants were labeled cognitively normal (CN) or impaired (CI) based on actual age. Chi-square and analysis of variance tests examined HIV group differences on neurocognitive status and demographics. Within PLWH, neurocognitive status differences were tested on HIV disease characteristics, medical comorbidities, and everyday functioning. Multinomial logistic regression explored independent predictors of neurocognitive status.

Results: Neurocognitive status rates and demographic characteristics differed between PLWH (SA=17%; CN=38%; CI=45%) and HIV-uninfected participants (SA=35%; CN=55%; CI=11%). In PLWH, neurocognitive groups were comparable on demographic and HIV disease characteristics. Younger age, higher verbal IQ, absence of diabetes, fewer depressive symptoms, and lifetime cannabis use disorder increased likelihood of SA. SA reported increased independence in everyday functioning, employment, and health-related quality of life than non-SA.

Conclusions: Despite combined neurological risk of aging and HIV, youthful neurocognitive performance is possible for older PLWH. SA relates to improved real-world functioning and may be better explained by cognitive reserve and maintenance of cardiometabolic and mental health than HIV disease severity. Future research investigating biomarker and lifestyle (e.g., physical activity) correlates of SA may help identify modifiable neuroprotective factors against HIV-related neurobiological aging. (JINS, 2019, 25, 507-519).

Keywords: Acquired Immunodeficiency Syndrome; Cannabis; Cognitive decline; Cognitive reserve; Diabetes; Neuropsychology.

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Figures

Figure 1.
Figure 1.. Neurocognitive status criteria.
SuperAging was operationalized as a peak-age global deficit score within normal limits (i.e., less than 0.5) and normal performance on all seven actual-age deficit scores (i.e., less or equal than 0.5).
Figure 2.
Figure 2.. SuperAger (SA) versus cognitively normal (CN) differences in neurocognitive performance.
Cohen’s d effect size estimates reflect differences in actual-age T scores.
Figure 3.
Figure 3.. Everyday functioning and health-related quality of life by neurocognitive status.
Risk ratio (RR) estimates represent the reduction in risk of IADL dependence or unemployment for each pair-wise comparison. Cohen’s d effect size estimates reflect differences in health-related quality of life for each pair-wise comparison. All p-values are significant after Bonferroni-adjustment or Tukey’s HSD. ***p<.001 **p<.01 *p<.05
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