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Multicenter Study
. 2020 Jan;21(1):30-42.
doi: 10.1111/hiv.12795. Epub 2019 Oct 7.

The Neurocognitive Assessment in the Metabolic and Aging Cohort (NAMACO) study: baseline participant profile

M Métral  1 , Kea Darling  2 , I Locatelli  3 , I Nadin  1   4 , G Santos  2 , P Brugger  5 , H Kovari  6 , A Cusini  7 , K Gutbrod  8 , P E Tarr  9 , A Calmy  10 , T D Lecompte  10 , F Assal  4 , A Monsch  11 , U Kunze  11 , M Stoeckle  12 , M Schwind  13 , P Schmid  14 , R Pignatti  15 , C Di Benedetto  16 , R Du Pasquier  1 , M Cavassini  2 ; NAMACO study group; Swiss HIV Cohort Study
Collaborators, Affiliations
Multicenter Study

The Neurocognitive Assessment in the Metabolic and Aging Cohort (NAMACO) study: baseline participant profile

M Métral et al. HIV Med. 2020 Jan.

Abstract

Objectives: The aim of the study was to examine baseline neurocognitive impairment (NCI) prevalence and factors associated with NCI among patients enrolled in the Neurocognitive Assessment in the Metabolic and Aging Cohort (NAMACO) study.

Methods: The NAMACO study is an ongoing, prospective, longitudinal, multicentre and multilingual (German, French and Italian) study within the Swiss HIV Cohort Study. Between 1 May 2013 and 30 November 2016, 981 patients ≥ 45 years old were enrolled in the study. All underwent standardized neuropsychological (NP) assessment by neuropsychologists. NCI was diagnosed using Frascati criteria and classified as HIV-associated or as related to other factors. Dichotomized analysis (NCI versus no NCI) and continuous analyses (based on NP test z-score means) were performed.

Results: Most patients (942; 96.2%) had viral loads < 50 HIV-1 RNA copies/mL. NCI was identified in 390 patients (39.8%): 263 patients (26.8%) had HIV-associated NCI [249 patients (25.4%) had asymptomatic neurocognitive impairment (ANI)] and 127 patients (13%) had NCI attributable to other factors, mainly psychiatric disorders. There was good correlation between dichotomized and continuous analyses, with NCI associated with older age, non-Caucasian ethnicity, shorter duration of education, unemployment and longer antiretroviral therapy duration.

Conclusions: In this large sample of aging people living with HIV with well-controlled infection in Switzerland, baseline HIV-associated NCI prevalence, as diagnosed after formal NP assessment, was 26.8%, with most cases being ANI. The NAMACO study data will enable longitudinal analyses within this population to examine factors affecting NCI development and course.

Keywords: HIV-associated neurocognitive disorder; aging; neurocognitive impairment; neuropsychological testing.

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Figures

Figure 1
Figure 1
Neurocognitive Assessment in the Metabolic and Aging Cohort (NAMACO) study design. SHCS, Swiss HIV Cohort Study; EACS, European AIDS Clinical Society; IADL, Instrumental Activities of Daily Living; PAOFI, Patients’ Assessment of Own Functioning Inventory; CES‐D, Center for Epidemiologic Studies Depression scale; MRI, magnetic resonance imaging.
Figure 2
Figure 2
Neurocognitive assessment algorithm of the Neurocognitive Assessment in the Metabolic and Aging Cohort (NAMACO) study. Neurocognitive impairment was classified according to the Frascati criteria 7 as shown in the boxes with dashed outlines. CNS, central nervous system; CES‐D, Center for Epidemiologic Studies Depression scale; NCI, neurocognitive impairment; NCI, HIV‐associated neurocognitive disorder; ANI, asymptomatic neurocognitive impairment; MND, mild neurocognitive disorder; HAD, HIV‐associated dementia; IADL, Instrumental Activities of Daily Living; SD, standard deviation; NP, neuropsychological.
Figure 3
Figure 3
Percentage of patients with deficits in each of the seven cognitive domains examined by neuropsychological testing. The category ‘All’ refers to all 981 patient participants; the category ‘HIV‐associated NCI’ comprised 263 patients diagnosed with an HIV‐associated neurocognitive impairment (NCI); the category ‘CES‐D > 27’ comprised 90 patients with a Center for Epidemiologic Studies Depression (CES‐D) score > 27 and the category ‘CES‐D > 16’ comprised 262 patients with a CES‐D score > 16.
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