Fitzpatrick-Schmidt Taylor, Oral Evrim, Welsh David A, Molina Patricia E, Ferguson Tekeda F, Edwards Scott
Comprehensive Alcohol-HIV/AIDS Research Center, LSU Health Sciences Center, New Orleans, Louisiana, USA.
Department of Physiology, School of Medicine, LSU Health Sciences Center, New Orleans, Louisiana, USA.
Alcohol Clin Exp Res (Hoboken). 2024 Jul;48(7):1405-1416. doi: 10.1111/acer.15378. Epub 2024 Jun 2.
Human immunodeficiency virus (HIV) profoundly impacts the nervous system, leading to neurological deficits including HIV-associated neurocognitive disorder (HAND). HAND represents the most common neurological comorbidity among people with HIV (PWH), and alcohol use may exacerbate cognitive deficits, especially in vulnerable populations. This study investigated relationships between alcohol use and cognition in an underserved cohort of PWH, on the hypothesis that alcohol misuse exacerbates cognitive deficits.
Data collected from participants (n = 259; 66.7% male; mean age 52 ± 10 years) enrolled in the New Orleans Alcohol Use in HIV (NOAH) study were utilized for cross-sectional analysis. Cognitive function was assessed using the Montreal Cognitive Assessment (MoCA), and alcohol use was comprehensively measured using four metrics: the Alcohol Use Disorders Identification Test (AUDIT), 30-day timeline follow back (TLFB), lifetime drinking history, and phosphatidylethanol (PEth) levels.
The average MoCA score among participants was 20.7 ± 4.5, with 86.5% demonstrating cognitive impairment (MoCA < 26). Individuals with MoCA scores below 18 (moderately or severely cognitively impaired) had a higher frequency of recent severe alcohol misuse and greater lifetime alcohol consumption. Participants at increased risk for AUD (AUDIT ≥ 16) also had worse global cognition and memory task performance than those with lower AUDIT scores; this was particularly true among those aged 50 and older. Analysis of the MoCA sub-score data indicated that participants with increased AUD risk had impairments in the cognitive domains of language and memory.
Our findings demonstrate a high prevalence of cognitive impairment in the NOAH cohort and suggest that alcohol misuse contributes to global cognitive deficits in PWH, especially among individuals aged 50 and older. Further exploration of the impact of alcohol use on specific cognitive domains, including memory and language, should incorporate additional cognitive tasks. These findings highlight the importance of considering alcohol use and AUD risk as significant factors that may exacerbate cognitive deficits in vulnerable populations, including older PWH.
人类免疫缺陷病毒（HIV）对神经系统有深远影响，会导致包括HIV相关神经认知障碍（HAND）在内的神经功能缺损。HAND是HIV感染者（PWH）中最常见的神经合并症，饮酒可能会加剧认知缺陷，尤其是在易感人群中。本研究调查了在医疗服务不足的PWH队列中饮酒与认知之间的关系，假设酒精滥用会加剧认知缺陷。
从参与新奥尔良HIV人群饮酒情况（NOAH）研究的参与者（n = 259；66.7%为男性；平均年龄52±10岁）收集的数据用于横断面分析。使用蒙特利尔认知评估量表（MoCA）评估认知功能，并使用四种指标全面测量饮酒情况：酒精使用障碍识别测试（AUDIT）、30天时间线追溯法（TLFB）、终生饮酒史和磷脂酰乙醇（PEth）水平。
参与者的平均MoCA评分为20.7±4.5，86.5%表现出认知障碍（MoCA＜26）。MoCA评分低于18（中度或重度认知障碍）的个体近期严重酒精滥用的频率更高，终生饮酒量更大。酒精使用障碍（AUD）风险增加的参与者（AUDIT≥16）与AUDIT评分较低的参与者相比，整体认知和记忆任务表现也更差；50岁及以上人群尤其如此。对MoCA子评分数据的分析表明，AUD风险增加的参与者在语言和记忆认知领域存在损伤。
我们的研究结果表明，NOAH队列中认知障碍的患病率很高，并表明酒精滥用会导致PWH出现整体认知缺陷，尤其是在50岁及以上的个体中。进一步探索饮酒对包括记忆和语言在内的特定认知领域的影响，应纳入更多认知任务。这些发现凸显了将饮酒和AUD风险视为可能加剧易感人群（包括老年PWH）认知缺陷的重要因素的重要性。
