创伤、经济困难和压力对 HIV 患者的神经认知和日常功能的影响。
Effects of trauma, economic hardship, and stress on neurocognition and everyday function in HIV.
机构信息
San Diego State University.
Department of Psychiatry, University of California.
出版信息
Health Psychol. 2019 Jan;38(1):33-42. doi: 10.1037/hea0000688. Epub 2018 Oct 29.
OBJECTIVE
The causes of neurocognitive and everyday functioning impairment among aging people living with HIV (PLWH) are multifactorial. Exposure to stress and trauma can result in neurocognitive deficits via activation of neurological and other biological mechanisms.
METHOD
PLWH (n = 122) and persons without HIV (n = 95), 35-65 years of age, completed four questionnaires that were used to generate a trauma, economic hardship (food insecurity and low socioeconomic status), and stress composite variable (TES). Participants also completed a comprehensive neuropsychological battery and standardized self-reports of activities of daily living (ADLs). We examined the independent and interactive effects of TES and HIV status on neurocognitive performance and ADL declines.
RESULTS
PLWH had more traumatic events, more food insecurity, lower socioeconomic status, and higher perceived stress compared with HIV- individuals (all ps < .0001). Among PLWH, a higher composite TES score was associated with worse executive functioning (p = .02), worse learning (p = .02), worse working memory (p = .02), and more ADL declines (p < .0001), even after controlling for relevant demographic, psychiatric, substance use, and HIV disease covariates. On their own, individual TES components did not predict these outcomes. Conversely, no significant relationships were observed between TES and cognitive domains nor ADL declines among HIV- individuals.
CONCLUSIONS
A composite score of trauma, economic hardship, and stress was significantly associated with worse neurocognitive performance and functional declines among PLWH. These adverse experiences may contribute to neurocognitive and daily functioning difficulties commonly observed among PLWH. Longitudinal studies are needed to elucidate the relationships between economic/psychosocial adversities and cognitive/functional outcomes over time, and examine potential mediators, such as inflammatory biomarkers. (PsycINFO Database Record (c) 2018 APA, all rights reserved).
目的
导致老年艾滋病毒感染者（PLWH）认知和日常功能受损的原因是多因素的。压力和创伤的暴露可通过激活神经和其他生物机制导致认知缺陷。
方法
PLWH（n = 122）和无 HIV 个体（n = 95），年龄 35-65 岁，完成了四个问卷，用于生成创伤、经济困难（食物不安全和低社会经济地位）和压力综合变量（TES）。参与者还完成了全面的神经心理测试和日常活动（ADL）的标准化自我报告。我们检查了 TES 和 HIV 状态对认知表现和 ADL 下降的独立和交互影响。
结果
PLWH 经历了更多的创伤事件、更多的食物不安全、更低的社会经济地位和更高的感知压力，与 HIV-个体相比（所有 p 值均<.0001）。在 PLWH 中，更高的 TES 评分与执行功能更差（p =.02）、学习能力更差（p =.02）、工作记忆更差（p =.02）和更多的 ADL 下降（p <.0001）相关，即使在控制了相关的人口统计学、精神科、物质使用和 HIV 疾病协变量后也是如此。单独来看，TES 的各个组成部分并不能预测这些结果。相反，在 HIV-个体中，TES 与认知领域或 ADL 下降之间没有显著关系。
结论
创伤、经济困难和压力的综合评分与 PLWH 的认知功能下降和功能下降显著相关。这些不良经历可能是 PLWH 常见的认知和日常功能障碍的原因。需要进行纵向研究，以阐明随着时间的推移，经济/心理社会逆境与认知/功能结果之间的关系，并研究潜在的中介因素，如炎症生物标志物。（PsycINFO 数据库记录（c）2018 APA，保留所有权利）。
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