The Veterans Aging Cohort Study (VACS) Index and Neurocognitive Change: A Longitudinal Study.
Title | The Veterans Aging Cohort Study (VACS) Index and Neurocognitive Change: A Longitudinal Study. |
Publication Type | Journal Article |
Year of Publication | 2016 |
Authors | Marquine, MJ, Montoya, JL, Umlauf, A, Fazeli, PL, Gouaux, B, Heaton, RK, Ellis, RJ, Letendre, SL, Grant, I, Moore, DJ |
Corporate Authors | HIV Neurobehavioral Research Program Group |
Journal | Clin Infect Dis |
Volume | 63 |
Issue | 5 |
Pagination | 694-702 |
Date Published | 2016 Sep 01 |
ISSN | 1537-6591 |
Keywords | Adult, Aging, AIDS Dementia Complex, Female, Humans, Internal, Longitudinal Studies, Male, Middle Aged, Veterans |
Abstract | BACKGROUND: The Veterans Aging Cohort Study (VACS) Index, a composite marker of disease severity among human immunodeficiency virus (HIV)-infected persons, has been associated with concurrent risk for neurocognitive impairment (NCI). The present study examined whether the VACS Index predicts longitudinal neurocognitive change.METHODS: Participants included 655 HIV-infected persons followed for up to 6 years in cohort studies at the University of California, San Diego, HIV Neurobehavioral Research Program (mean age at baseline, 42.5 years; 83% male; 60% white; AIDS in 67%; median current CD4(+) T-cell count, 346/μL; 61% receiving antiretroviral therapy). The VACS Index was calculated through standard methods. Participants completed a comprehensive neurocognitive battery. Neurocognitive status was plotted over time using demographically and practice-adjusted global and domain T scores. NCI was defined by global deficit scores derived from T scores.RESULTS: Baseline VACS Index scores were not predictive of changes in global T scores during the follow-up period (P = .14). However, in time-dependent analyses adjusting for covariates, higher VACS Index scores were significantly associated with worse global and domain neurocognitive performance (Ps < .01), as well as increased risk for developing NCI in a subgroup of persons who were neurocognitively normal at baseline (hazard ratio [HR], 1.17; P < .001). We categorized VACS Index scores by quartiles and found that the upper-quartile group was significantly more likely to develop NCI than the lower quartile (HR, 2.16; P < .01) and middle groups (HR, 1.76; P < .01).CONCLUSIONS: Changes in VACS Index scores correspond to changes in neurocognitive function. HIV-infected persons with high VACS Index scores are at increased risk for decline and incident NCI. The VACS Index shows promise as a tool for identifying HIV-infected persons at risk for NCI. |
DOI | 10.1093/cid/ciw328 |
Alternate Journal | Clin Infect Dis |
PubMed ID | 27199461 |
PubMed Central ID | PMC4981756 |
Grant List | K99 AG048762 / AG / NIA NIH HHS / United States K23 MH105297 / MH / NIMH NIH HHS / United States P50 DA026306 / DA / NIDA NIH HHS / United States T32 MH019934 / MH / NIMH NIH HHS / United States U24 MH100928 / MH / NIMH NIH HHS / United States R24 MH059745 / 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 |