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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.
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
URL: https://doi.org/10.1002/gps.6042
DOI: 10.1002/gps.6042
Data Access Statement: Deidentified data from this study are available on reasonable application to the lead authors subject to Tanzania National Institute for Medical Research (NIMR) approvals as appropriate.
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