Sheppard David P, Woods Steven Paul, Bondi Mark W, Gilbert Paul E, Massman Paul J, Doyle Katie L
a Department of Psychology , The University of Houston , Houston , TX , USA.
b Department of Psychiatry , The HIV Neurobehavioral Research Program, University of California , San Diego , CA , USA.
Clin Neuropsychol. 2015;29(5):656-77. doi: 10.1080/13854046.2015.1077995. Epub 2015 Aug 26.
This study aimed to determine the combined effects of age and HIV infection on the risk of incident neurocognitive disorders.
A total of 146 neurocognitively normal participants were enrolled at baseline into one of four groups based on age (≤ 40 years and ≥ 50 years) and HIV serostatus resulting in 24 younger HIV-, 27 younger HIV+, 39 older HIV-, and 56 older HIV+ individuals. All participants were administered a standardized clinical neuropsychological battery at baseline and 14.3 ± .2 months later.
A logistic regression predicting incident neurocognitive disorders from HIV, age group, and their interaction was significant (χ(2)[4] = 13.56, p = .009), with a significant main effect of HIV serostatus (χ(2)[1] = 5.01, p = .025), but no main effect of age or age by HIV interaction (ps > .10). Specifically, 15.7% of the HIV+ individuals had an incident neurocognitive disorder as compared to 3.2% of the HIV- group (odds ratio = 4.8 [1.2, 32.6]). Among older HIV+ adults, lower baseline cognitive reserve, prospective memory, and verbal fluency each predicted incident neurocognitive disorders at follow-up.
Independent of age, HIV infection confers a nearly fivefold risk for developing a neurocognitive disorder over approximately one year. Individuals with lower cognitive reserve and mild weaknesses in higher-order neurocognitive functions may be targeted for closer clinical monitoring and preventative measures.
本研究旨在确定年龄和HIV感染对新发神经认知障碍风险的综合影响。
共有146名神经认知功能正常的参与者在基线时根据年龄（≤40岁和≥50岁）和HIV血清学状态被纳入四组之一，从而形成24名年轻HIV阴性、27名年轻HIV阳性、39名年长HIV阴性和56名年长HIV阳性个体。所有参与者在基线时以及14.3±0.2个月后接受了标准化的临床神经心理测试。
一项从HIV、年龄组及其相互作用预测新发神经认知障碍的逻辑回归具有显著性（χ(2)[4]=13.56，p=0.009），HIV血清学状态具有显著的主效应（χ(2)[1]=5.01，p=0.025），但年龄或年龄与HIV的相互作用没有主效应（p>0.10）。具体而言，15.7%的HIV阳性个体发生了新发神经认知障碍，而HIV阴性组为3.2%（优势比=4.8[1.2,32.6]）。在年长的HIV阳性成年人中，较低的基线认知储备、前瞻性记忆和语言流畅性各自预测了随访时的新发神经认知障碍。
独立于年龄，HIV感染在大约一年的时间里使发生神经认知障碍的风险增加近五倍。认知储备较低且高阶神经认知功能存在轻度缺陷的个体可能需要进行更密切的临床监测和采取预防措施。
