Cherner Marianna, Ellis Ronald J, Lazzaretto Deborah, Young Corinna, Mindt Monica Rivera, Atkinson J Hampton, Grant Igor, Heaton Robert K
Department of Psychiatry, University of California San Diego, La Jolla, 92093-0603, USA.
AIDS. 2004 Jan 1;18 Suppl 1:S27-34.
The effects of aging on the presentation of HIV-associated neurocognitive disorders are largely unknown. In a cross-sectional observational study, we compared the neuropsychological profiles of 67 HIV-positive patients aged at least 50 years with those of 52 participants aged 35 years or less.
Participants received neuropsychological, psychiatric and neuromedical evaluations. Raw neuropsychological test scores were converted to demographically corrected T-scores; all were corrected for the effects of normal aging. Clinical ratings of impairment were assigned to the neuropsychological results.
The two groups did not differ statistically with respect to demographic variables, percentage with AIDS, or CD4 cell counts. The 'younger' group had higher viral burdens in plasma and cerebrospinal fluid (CSF), and fewer were receiving antiretroviral treatment. The proportion of neuropsychologically impaired subjects in the 'older' group was slightly greater than in the younger group, and the older group tended to have higher rates of impairment across most ability domains. When group differences in CSF viral load were modeled statistically, both viral burden and age were significant predictors of neuropsychological impairment, together with a significant interaction between viral burden and age. Older individuals with detectable virus in CSF had twice the prevalence of neuropsychological impairment of those with undetectable levels. Among younger individuals, this proportion was not affected by viral load. Lifetime major depression, substance use disorder, and current depression symptoms were not associated with neuropsychological impairment.
Although further studies with larger and older samples are needed, this investigation suggests that older adults may be at greater risk of HIV-related neurocognitive dysfunction.
衰老对人类免疫缺陷病毒（HIV）相关神经认知障碍表现的影响在很大程度上尚不清楚。在一项横断面观察性研究中，我们比较了67名年龄至少50岁的HIV阳性患者与52名年龄35岁及以下参与者的神经心理学概况。
参与者接受了神经心理学、精神病学和神经医学评估。原始神经心理学测试分数被转换为根据人口统计学校正的T分数；所有分数均针对正常衰老的影响进行了校正。对神经心理学结果进行了损伤的临床评级。
两组在人口统计学变量、艾滋病患者百分比或CD4细胞计数方面无统计学差异。“较年轻”组血浆和脑脊液（CSF）中的病毒载量较高，接受抗逆转录病毒治疗的人数较少。“较年长”组中神经心理学受损受试者的比例略高于较年轻组，并且较年长组在大多数能力领域的损伤率往往更高。当对脑脊液病毒载量的组间差异进行统计学建模时，病毒载量和年龄都是神经心理学损伤的重要预测因素，同时病毒载量和年龄之间存在显著交互作用。脑脊液中可检测到病毒的老年个体神经心理学损伤的患病率是病毒水平不可检测个体的两倍。在较年轻个体中，这一比例不受病毒载量影响。终生重度抑郁症、物质使用障碍和当前抑郁症状与神经心理学损伤无关。
尽管需要对更大规模和更年长的样本进行进一步研究，但这项调查表明，老年人可能面临更高的与HIV相关神经认知功能障碍风险。
