| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
From the University of Pittsburgh School of Medicine (J.T.B.), Pittsburgh, PA; University of Pittsburgh Graduate School of Public Health (L.K.); Bloomberg School of Public Health (J.M.), The Johns Hopkins University, Baltimore, MD; Feinberg School of Medicine (B.C., A.R.), Northwestern University, Chicago, IL; University of Illinois at Chicago (E.M.); Semel Institute for Neuroscience (E.N.M.), University of California Los Angeles; The Johns Hopkins University School of Medicine (N.S., O.A.S.), Baltimore; and School of Public Health (B.R.B.), University of California Los Angeles.
Address correspondence and reprint requests to Dr. James T. Becker, Neuropsychology Research Program, Suite 830, 3501 Forbes Ave., Pittsburgh, PA 15213
Background: The purpose of this study was to evaluate the relationship between cognitive performance, risk factors for cardiovascular and cerebrovascular disease (CVD), and HIV infection in the era of highly active antiretroviral therapy.
Methods: We evaluated the cognitive functions of men enrolled in the cardiovascular disease substudy of the Multicenter AIDS Cohort Study who were aged 
40 years, with no self-reported history of heart disease or cerebrovascular disease. Results from comprehensive neuropsychological evaluations were used to construct composite scores of psychomotor speed and memory performance. Subclinical CVD was assessed by measuring coronary artery calcium and carotid artery intima-media thickness (IMT), as well as laboratory measures, including total cholesterol, fasting glucose, glycosylated hemoglobin, glomerular filtration rate (estimated), and standardized blood pressure and heart rate measures.
Results: After accounting for education, depression, and race, carotid IMT and glomerular filtration rate were significantly associated with psychomotor speed, whereas IMT was associated with memory test performance. HIV serostatus was not significantly associated with poorer cognitive test performance. However, among the HIV-infected individuals, the presence of detectable HIV RNA in plasma was linked to lower memory performance.
Conclusions: These findings suggest that HIV infection may not be the most important predictor of cognitive performance among older gay and bisexual men in the post–highly active antiretroviral therapy era, at least among those with access to medical care and to appropriate medications. Medical factors associated with normal aging are significantly associated with performance on neuropsychological tests, and good clinical management of these factors both in HIV-infected individuals and those at risk for infection may have beneficial effects in the short term and could reduce the risk of subsequent cognitive decline.
Abbreviations: BP = blood pressure; CalCAP = California Computerized Assessment Package; CES-D = Center for Epidemiologic Studies–Depression scale; CVD = cardiovascular and cerebrovascular disease; GFR = glomerular filtration rate; HAART = highly active antiretroviral therapy; HDL = high-density lipoprotein; HAND = HIV-associated neurocognitive disorder; Hb = hemoglobin; IMT = intima-media thickness; LDL = low-density lipoprotein; MACS = Multicenter AIDS Cohort Study; OR = odds ratio; RAVLT = Rey Auditory Verbal Learning Test.
Supplemental data at www.neurology.org
*See appendix.
Supported in part by funds from the National Institute for Allergy and Infectious Diseases to the collaborating MACS sites: UO1-AI-35042, 5-MO1-RR-00052 (GCRC), UO1-AI-35043, UO1-AI-37984, UO1-AI-35039, UO1-AI-35040, UO1-AI-37613, and UO1-AI-35041.
Disclosure: Author disclosures are provided at the end of the article.
Received February 19, 2009. Accepted in final form July 16, 2009.
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
