Paolillo Emily W, Inkelis Sarah M, Heaton Anne, Saloner Rowan, Moore Raeanne C, Moore David J
San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA.
Department of Psychiatry, University of California, San Diego, HIV Neurobehavioral Research Program, San Diego, CA, USA.
Alcohol Alcohol. 2019 Mar 1;54(2):139-147. doi: 10.1093/alcalc/agz008.
Older persons living with HIV (PLWH) and past alcohol use disorder (AUD) are at higher risk for neurocognitive deficits compared to those with either condition alone; however, factors underlying this relationship are unknown. Given that aging potentiates multi-system damage from alcohol misuse, the current study examined whether neurocognitive functioning among older adults relates to the age at which they last met criteria for AUD (i.e. 'age of last AUD'), and whether this relationship differed by HIV serostatus.
All participants (aged between 50 and 75 years) were grouped by HIV/AUD status: 345 HIV+/AUD+, 148 HIV-/AUD+, 273 HIV+/AUD-, and 206 HIV-/AUD-. Neurocognitive functioning was assessed globally and within seven domains. Among only the two AUD+ groups, multivariable linear regressions examined the interaction between age of last AUD and HIV status on neurocognitive functioning, controlling for demographics and clinical characteristics.
Older age of last AUD related to worse processing speed among PLWH (b = -0.03; P = 0.006); however, this relationship was not significant among persons without HIV (b = 0.01; P = 0.455). The interaction between age of last AUD and HIV status did not predict neurocognitive functioning in other domains. Processing speed appeared clinically important, as slower speed related to worse everyday functioning, including more reported cognitive difficulties (r = -0.26, P < 0.001) and higher rates of functional dependence (OR = 0.87, 95%CI = 0.80-0.95, P = 0.002).
Our novel findings, demonstrating slower processing speed when a past AUD occurred at an older age in PLWH, highlight the value in assessing older PLWH for processing speed deficits, even if other cognitive domains appear to be intact.
与仅患有人类免疫缺陷病毒（HIV）或既往酒精使用障碍（AUD）的人群相比，同时患有HIV和既往AUD的老年人出现神经认知缺陷的风险更高；然而，这种关系背后的因素尚不清楚。鉴于衰老会加剧酒精滥用对多系统的损害，本研究调查了老年人的神经认知功能是否与他们最后一次符合AUD标准的年龄（即“末次AUD年龄”）有关，以及这种关系是否因HIV血清学状态而异。
所有参与者（年龄在50至75岁之间）按HIV/AUD状态分组：345名HIV阳性/AUD阳性、148名HIV阴性/AUD阳性、273名HIV阳性/AUD阴性和206名HIV阴性/AUD阴性。对神经认知功能进行整体评估，并在七个领域内进行评估。仅在两个AUD阳性组中，多变量线性回归分析了末次AUD年龄与HIV状态之间的相互作用对神经认知功能的影响，并对人口统计学和临床特征进行了控制。
末次AUD年龄较大与HIV感染者的处理速度较差有关（b = -0.03；P = 0.006）；然而，在未感染HIV的人群中，这种关系并不显著（b = 0.01；P = 0.455）。末次AUD年龄与HIV状态之间的相互作用并未预测其他领域的神经认知功能。处理速度在临床上似乎很重要，因为速度较慢与日常功能较差有关，包括更多报告的认知困难（r = -0.26，P < 0.001）和更高的功能依赖率（OR = 0.87，95%CI = 0.80 - 0.95，P = 0.002）。
我们的新发现表明，HIV感染者在年龄较大时发生既往AUD会导致处理速度较慢，这突出了评估老年HIV感染者处理速度缺陷的价值，即使其他认知领域似乎完好无损。
