Toggle Main Menu Toggle Search

Open Access padlockePrints

The role of cognitive reserve in mediating HIV-associated neurocognitive disorders in older adults living with-treated HIV in Mbeya, Tanzania: A cross-sectional observational study

Lookup NU author(s): Dr Stella Paddick



This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).


© 2023 The Authors. International Journal of Geriatric Psychiatry published by John Wiley & Sons Ltd.Introduction: HIV-associated neurocognitive disorders (HAND) are a spectrum of cognitive impairments in chronic HIV infection. HAND is common in sub-Saharan Africa (SSA), despite combination antiretroviral therapy (cART). Older people appear to be at increased risk. It is unknown if cognitive reserve (CR), which is protective in neurodegenerative dementias, protects against HAND. Objective: To evaluate the association of CR and risk of HAND in an older cART-treated population in SSA. Methods: Cross-sectional observational study completed in hospital outpatient clinics in Southwest Tanzania. We assessed HIV-positive participants aged ≥50 years established on cART using a neuropsychological test battery, functional assessment, informant history and depression screen. Control participants were HIV-negative individuals attending chronic disease clinics. We used operationalised Frascati criteria for HAND diagnosis. CR was measured using the Cognitive Reserve Index (CRI) and other proxy measures. Results: The prevalence of HAND was 64.4% (n = 219/343). Lower CRI score [odds ratio (OR) = 0.971, p = 0.009] and less formal education (OR = 4.364, p = 0.026) were independent risk factors for HAND but HIV-severity measures were not. Unemployment and low-skilled manual work were associated with increased risk of HAND in bivariate analysis but not in multivariable analysis. Conclusions: Higher total CRI score and more formal education appeared to be protective against HAND, in this cohort. Potentially, cognitively and socially stimulating activities and exercise could increase cognitive reserve in later life. Cognitive reserve could possibly be more important than HIV-disease severity in risk of HAND in older people with treated HIV.

Publication metadata

Author(s): Sadler M, Kuhoga E, Thumma-Reddy N, Chuma E, Said K, Kaminyoge MS, Mussa B, Walker R, Livingston G, Gray WK, Paddick S-M, Mbwele B

Publication type: Article

Publication status: Published

Journal: International Journal of Geriatric Psychiatry

Year: 2023

Volume: 38

Issue: 12

Online publication date: 23/12/2023

Acceptance date: 28/11/2023

Date deposited: 19/02/2024

ISSN (print): 0885-6230

ISSN (electronic): 1099-1166

Publisher: John Wiley and Sons Ltd


DOI: 10.1002/gps.6042


Altmetrics provided by Altmetric


Funder referenceFunder name
The Mbeya College of Health Sciences
The Newcastle University Masters in Research programme