Successful Cognitive Aging and Health-Related Quality of Life in Younger and Older Adults Infected with HIV

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1 Successful Cognitive Aging and Health-Related Quality of Life in Younger and Older Adults Infected with HIV Raeanne C. Moore, Ph.D. Postdoctoral Fellow University of California, San Diego October 30, th International Workshop on HIV and Aging

2 Older Age Increases Risk of HAND Neurocognitive disorders are among the most common clinical features of HIV in older adults These neurocognitive declines, in addition to subjective cognitive complaints, can adversely impact everyday functioning, health-related quality of life (HRQoL) in the context of aging with HIV % of cohort Possible Cases Probable Cases 0 Younger NL Older NL Younger NP Abnl Older NP Abnl Younger MCMD Older MCMD Younger HAD Older HAD Valcour et al., 2004

3 Successful Cognitive Aging in HIV Some evidence exists for successful cognitive aging (SCA) (Masapina et al., 2011)

4 Purpose 1) To estimate the prevalence of SCA, as defined by an absence of neurocognitive deficits and symptoms (SCA-ANDS), in older and younger HIV+ adults and older and younger HIVcomparison cohorts 2) To determine the clinical correlates of SCA- ANDS among both younger and older cohorts 3) To determine the relationship of SCA-ANDS to mental and physical HRQoL

5 Participants Younger HIV- (n=48) Older HIV- (n=77) Age 31.2 (4.5) 56.2 (4.6) Younger HIV+ (n=70) 32.8 (4.6) Older HIV+ (n=107) p-value 56.2 (5.2) <0.001 % Female Ethnicity (% Caucasian) Cognitive Reserve (z-score) < (0.7) 0.1 (0.9) (0.6) 0.08 (0.8) 0.06 Affective Disorder (%) <0.001 Lifetime Substance Disorder (%)

6 HIV Disease Characteristics Est. duration of HIV (yrs)* Younger HIV+ (n=70) Older HIV+ (n=107) 8.0 (5.6) 17.6 (7.2) AIDS (%)* cart (%) Nadir CD4* (cell/µl) 250 (147.8, 369.5) 125 (50, 245) Current CD4 (cell/µl) 568 (402, 806.5) 507 (381.3, 759.5) Plasma Detectable (%)

7 Methods SCA-ANDS: Absence of both performancebased neurocognitive deficits & self-reported symptoms NP deficits: global clinical neurocognitive rating < 4, no individual domains in impaired range NP symptoms: <1 SD below the mean on POMS confusion/bewilderment scale HAND: 2+ domains impaired (ratings > 5)

8 Age and HIV Have Additive Adverse Effects on SCA-ANDS

9 Clinical Correlates of SCA-ANDS in HIV Younger HIV+ Older HIV+ Cognitive Reserve Ethnicity Duration of HIV Infection Alcohol Dependence Affective Disorders

10 SCA-ANDS & Health-Related Quality of Life in HIV

11 Subcomponents of Mental Health-Related QoL & SCA-ANDS in HIV SF-36 Subcomponents Emotional Role Limitations Energy/Fatigue Younger HIV+ Older HIV+ Emotional Well-Being Social Functioning General Health SCA-ANDS > non SCA-ANDS, p < 0.01

12 Conclusions and Future Directions HIV and age have additive adverse effects on SCA- ANDS Higher levels of cognitive reserve may play a protective role in SCA-ANDS across the lifespan SCA-ANDS plays an independent role in mental health-related quality of life in HIV Interventions are needed - Targeting cognitive reserve to bolster SCA-ANDS across the lifespan

13 Limitations Cross-sectional design SF-36 is a generic physical & mental health assessment of HRQoL No neurobiological assessments

14 Acknowledgements Principal Investigator» Steven Paul Woods, Psy.D. Co-investigators» Pariya Fazeli, Ph.D.» David J. Moore, Ph.D.» Igor Grant, M. D.» Dilip Jeste, M.D. Research Associates» Marizela Cameron» P. Katie Riggs The HNRC Group Study Volunteers NIH Support» R01-MH073419» P30-MH062512» R01-MH099987» R25-MH081482» ID10-SD-057