Milanini Benedetta, Ciccarelli Nicoletta, Fabbiani Massimiliano, Limiti Silio, Grima Pierfrancesco, Rossetti Barbara, Visconti Elena, Tamburrini Enrica, Cauda Roberto, Di Giambenedetto Simona
Institute of Infectious Diseases, Catholic University of Sacred Heart, Rome, Italy.
Division of Infectious Diseases, Santa Caterina Novella Hospital, Galatina, Italy.
J Neurovirol. 2016 Oct;22(5):575-583. doi: 10.1007/s13365-016-0426-7. Epub 2016 Mar 10.
Progress in treatments has led to HIV+ patients getting older. Age and HIV are risk factors for neurocognitive impairment (NCI). We explored the role of cognitive reserve (CR) on cognition in a group of virologically suppressed older HIV+ people. We performed a multicenter study, consecutively enrolling asymptomatic HIV+ subjects ≥60 years old during routine outpatient visits. A comprehensive neuropsychological battery was administered. Raw test scores were adjusted based on Italian normative data and transformed into z-scores; NCI was defined according to Frascati criteria. All participants underwent the Brief Intelligence Test (TIB) and the Cognitive Reserve Index (CRI) questionnaire as proxies for CR. Relationships between TIB, CRI, and NCI were investigated by logistic or linear regression analyses. Sixty patients (85 % males, median age 66, median education 12, 10 % HCV co-infected, 25 % with past acquired immunodeficiency syndrome (AIDS)-defining events, median CD4 cells count 581 cells/μL, median nadir CD4 cells count 109 cells/μL) were enrolled. Twenty-four patients (40 %) showed Asymptomatic Neurocognitive Impairment. At logistic regression analysis, only CRI (OR 0.94; 95 % CI 0.91-0.97; P = 0.001) and TIB (OR 0.80; 95 % CI 0.71-0.90; P < 0.001) were associated with a lower risk of NCI. Higher CRI and TIB were significantly correlated with a better performance (composite z-score) both globally and at individual cognitive domains. Our findings highlight the role of CR over clinical variables in maintaining cognitive integrity in a virologically suppressed older HIV-infected population. A lifestyle characterized by experiences of mental stimulation may help to cope aging and HIV-related neurodegeneration.
治疗方面的进展使得感染HIV的患者年龄增大。年龄和HIV都是神经认知障碍（NCI）的风险因素。我们在一组病毒学抑制的老年HIV感染者中探讨了认知储备（CR）对认知的作用。我们进行了一项多中心研究，在常规门诊就诊期间连续纳入年龄≥60岁的无症状HIV感染者。进行了全面的神经心理学测试。原始测试分数根据意大利常模数据进行调整并转换为z分数；根据弗拉斯卡蒂标准定义NCI。所有参与者都接受了简易智力测试（TIB）和认知储备指数（CRI）问卷作为CR的替代指标。通过逻辑回归或线性回归分析研究TIB、CRI和NCI之间的关系。共纳入60例患者（85%为男性，中位年龄66岁，中位受教育年限12年，10%合并丙型肝炎病毒感染，25%有既往获得性免疫缺陷综合征（AIDS）界定事件，中位CD4细胞计数581个/μL，中位最低CD4细胞计数109个/μL）。24例患者（40%）表现为无症状神经认知障碍。在逻辑回归分析中，只有CRI（比值比0.94；95%置信区间0.91 - 0.97；P = 0.001）和TIB（比值比0.80；95%置信区间0.71 - 0.90；P < 0.001）与较低的NCI风险相关。较高的CRI和TIB在整体和各个认知领域均与较好的表现（综合z分数）显著相关。我们的研究结果突出了CR在维持病毒学抑制的老年HIV感染人群认知完整性方面相对于临床变量的作用。以精神刺激经历为特征的生活方式可能有助于应对衰老和与HIV相关的神经退行性变。
