老年 HIV 感染者的神经认知超强老化：人口统计学、神经医学和日常功能的相关性。
Neurocognitive SuperAging in Older Adults Living With HIV: Demographic, Neuromedical and Everyday Functioning Correlates.
机构信息
1San Diego State University/University of California,San Diego Joint Doctoral Program in Clinical Psychology,San Diego,California.
2Department of Psychiatry,University of California,San Diego,San Diego,California.
出版信息
J Int Neuropsychol Soc. 2019 May;25(5):507-519. doi: 10.1017/S1355617719000018. Epub 2019 Mar 20.
OBJECTIVES
Studies of neurocognitively elite older adults, termed SuperAgers, have identified clinical predictors and neurobiological indicators of resilience against age-related neurocognitive decline. Despite rising rates of older persons living with HIV (PLWH), SuperAging (SA) in PLWH remains undefined. We aimed to establish neuropsychological criteria for SA in PLWH and examined clinically relevant correlates of SA.
METHODS
734 PLWH and 123 HIV-uninfected participants between 50 and 64 years of age underwent neuropsychological and neuromedical evaluations. SA was defined as demographically corrected (i.e., sex, race/ethnicity, education) global neurocognitive performance within normal range for 25-year-olds. Remaining participants were labeled cognitively normal (CN) or impaired (CI) based on actual age. Chi-square and analysis of variance tests examined HIV group differences on neurocognitive status and demographics. Within PLWH, neurocognitive status differences were tested on HIV disease characteristics, medical comorbidities, and everyday functioning. Multinomial logistic regression explored independent predictors of neurocognitive status.
RESULTS
Neurocognitive status rates and demographic characteristics differed between PLWH (SA=17%; CN=38%; CI=45%) and HIV-uninfected participants (SA=35%; CN=55%; CI=11%). In PLWH, neurocognitive groups were comparable on demographic and HIV disease characteristics. Younger age, higher verbal IQ, absence of diabetes, fewer depressive symptoms, and lifetime cannabis use disorder increased likelihood of SA. SA reported increased independence in everyday functioning, employment, and health-related quality of life than non-SA.
CONCLUSIONS
Despite combined neurological risk of aging and HIV, youthful neurocognitive performance is possible for older PLWH. SA relates to improved real-world functioning and may be better explained by cognitive reserve and maintenance of cardiometabolic and mental health than HIV disease severity. Future research investigating biomarker and lifestyle (e.g., physical activity) correlates of SA may help identify modifiable neuroprotective factors against HIV-related neurobiological aging. (JINS, 2019, 25, 507-519).
目的
对神经认知能力超群的老年人（即超级老人）进行研究，已经确定了抵抗与年龄相关的神经认知能力下降的临床预测因子和神经生物学指标。尽管感染艾滋病毒的老年人（PLWH）的比例不断上升，但 PLWH 的超级老化（SA）仍未得到定义。我们旨在为 PLWH 建立 SA 的神经心理学标准，并研究 SA 的临床相关相关性。
方法
734 名 PLWH 和 123 名未感染 HIV 的 50 至 64 岁参与者接受了神经心理学和神经医学评估。SA 被定义为在年龄校正（即性别、种族/民族、教育）方面，全球认知表现处于 25 岁年轻人的正常范围内。其余参与者根据实际年龄被标记为认知正常（CN）或受损（CI）。卡方检验和方差分析检验了 HIV 组在神经认知状态和人口统计学方面的差异。在 PLWH 中，对 HIV 疾病特征、合并症和日常功能方面的神经认知状态差异进行了测试。多项逻辑回归探讨了神经认知状态的独立预测因子。
结果
PLWH（SA=17%；CN=38%；CI=45%）和未感染 HIV 的参与者（SA=35%；CN=55%；CI=11%）的神经认知状态率和人口统计学特征不同。在 PLWH 中，神经认知组在人口统计学和 HIV 疾病特征方面具有可比性。年轻、较高的言语智商、无糖尿病、较少的抑郁症状和终生大麻使用障碍增加了 SA 的可能性。SA 报告在日常功能、就业和健康相关生活质量方面的独立性更高，而非 SA。
结论
尽管存在老化和 HIV 的联合神经学风险，但老年 PLWH 仍有可能表现出年轻的神经认知能力。SA 与改善现实世界的功能有关，可能比 HIV 疾病严重程度更好地用认知储备和维持心血管代谢和心理健康来解释。未来研究调查 SA 的生物标志物和生活方式（例如，体育活动）相关性可能有助于确定针对 HIV 相关神经生物学老化的可改变神经保护因素。（JINS，2019，25，507-519）。
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