Neurocognitive functioning predicts frailty index in HIV.

TitleNeurocognitive functioning predicts frailty index in HIV.
Publication TypeJournal Article
Year of Publication2018
AuthorsOppenheim, H, Paolillo, EW, Moore, RC, Ellis, RJ, Letendre, SL, Jeste, DV, Grant, I, Moore, DJ
Corporate AuthorsHIV Neurobehavioral Research Program (HNRP)
Date Published2018 07 10
KeywordsAdolescent, Adult, Age Factors, Aged, Cognition Disorders, Cross-Sectional Studies, Female, Frailty, HIV Infections, Humans, Male, Middle Aged, Neuropsychological Tests, Predictive Value of Tests, Severity of Illness Index, Young Adult

OBJECTIVE: To evaluate the association between a frailty index (i.e., scale of accumulated deficits) and neurocognitive functioning among persons living with HIV/AIDS (PLWHA).METHODS: Observational, cross-sectional data were gathered from the University of California, San Diego, HIV Neurobehavioral Research Program from 2002 to 2016. Eight hundred eleven PLWHA aged 18 to 79 years completed comprehensive physical, neuropsychological, and neuromedical evaluations. The frailty index was composed of 26 general and HIV-specific health maintenance measures, and reflects the proportion of accumulated deficits from 0 (no deficits) to 1 (all 26 deficits). Multiple linear regression was used to examine the association between continuous frailty index scores and neurocognitive functioning.RESULTS: Participants had a mean age of 44.6 years (11.2), and were mostly male (86.9%) and white (60.2%) with a mean frailty index of 0.26 (0.11). Over the study period, prevalence of HIV-related components (e.g., low CD4) decreased, while non-HIV comorbidities (e.g., diabetes) increased. There were no changes in the frailty index by study year. Higher frailty index was associated with worse global neurocognitive functioning, even after adjusting for covariates (age, employment, and premorbid intellectual functioning; b = -0.007; 95% confidence interval [CI] = -0.0112 to -0.003; < 0.001). The cognitive domains of verbal fluency (b = -0.004; 95% CI = -0.006 to -0.002), executive functioning (b = -0.004; 95% CI = -0.006 to -0.002), processing speed (b = -0.005; 95% CI = -0.007 to -0.003), and motor skills (b = -0.006; 95% CI = -0.007 to -0.005) also significantly predicted worse frailty index score ( values <0.001).CONCLUSION: A frailty index can standardize how clinicians identify PLWHA who may be at higher risk of neurocognitive impairment.

Alternate JournalNeurology
PubMed ID29875216
PubMed Central IDPMC6053109
Grant ListP50 DA026306 / DA / NIDA NIH HHS / United States
U24 MH100928 / MH / NIMH NIH HHS / United States
R24 MH059745 / MH / NIMH NIH HHS / United States
T32 DA031098 / DA / NIDA NIH HHS / United States
K23 MH107260 / MH / NIMH NIH HHS / United States
L30 MH104725 / MH / NIMH NIH HHS / United States
P30 MH062512 / MH / NIMH NIH HHS / United States
P01 DA012065 / DA / NIDA NIH HHS / United States
U01 MH083506 / MH / NIMH NIH HHS / United States
R01 MH099987 / MH / NIMH NIH HHS / United States