Intraindividual variability in neuropsychological performance predicts cognitive decline and death in HIV.
Year: 2018
Type: article
Study design: Observational Study
Abstract: OBJECTIVE: HIV-associated neurocognitive disorder (HAND) occurs in a significant percentage of HIV-infected (HIV+) adults. Increased intraindividual variability (IIV) in cognitive function may be an early marker of emerging neurocognitive disorder, which suggests that IIV may be a sensitive measure of neurologic compromise in HIV. In the current study, we hypothesize that increased IIV may predict impending morbidity, including future cognitive decline and death. METHOD: In 708 HIV+ participants followed longitudinally for up to 14 years, we assessed the role of dispersion in forecasting death and cognitive decline. Incident neurocognitive impairment was predicted in a mixed-effects ordinal logistic regression model using age, gender, baseline mean cognitive functioning, CD4+, time followed, years of education, and dispersion at the previous visit. Death before the next visit was predicted in a binomial mixed-effects regression model using age, gender, baseline mean cognitive functioning, CD4+, time followed, years of education, and dispersion. RESULTS: Point-in-time dispersion and change in dispersion between visits predict future cognitive decline and death in HIV+ individuals. Individuals with greater dispersion at a visit or who had larger changes in dispersion between visits were more likely to demonstrate greater neurocognitive impairment at the subsequent visit. Greater IIV was also associated with an increased risk of death prior to the subsequent visit, even after controlling for HAND severity and global cognitive functioning. CONCLUSIONS: We conclude that the IIV in cognitive functioning may be more predictive of future disease consequence than mean level of cognitive functioning. (PsycINFO Database Record (c) 2018 APA, all rights reserved).
Source: Neuropsychology
DOI: 10.1037/neu0000482
Institution: University of California, Los Angeles
Language: English
Topic: HIV Research and Treatment
Subfield: Virology
Field: Immunology and Microbiology
Domain: Life Sciences
Open Access status: hybrid
Awards: California NeuroAIDS Tissue Network, Modeling RDoc Dimensions Across Levels of Analysis, Neuropsychology AIDS Fellowship, NNTC Data Coordinating Center, The Manhattan HIV Brain Bank, Texas NeuroAIDS Research Center, NATIONAL NEUROLOGICAL AIDS BANK, Hemodynamic Biomarkers of Healthy and Diseased Aging
OpenAlex ID: W2891257602