Effect of ageing on neurocognitive function by stage of HIV infection: evidence from the Multicenter AIDS Cohort Study
Effect of ageing on neurocognitive function by stage of HIV infection: evidence from the Multicenter AIDS Cohort Study
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DOI：
10.1016/s2352-3018(17)30098-x
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发表时间：
2017-09-01
期刊：
影响因子：
16.1
通讯作者：
Sacktor, Ned C.
中科院分区：
文献类型：
--
作者：
Goodkin, Karl;Miller, Eric N.;Sacktor, Ned C.
背景美国艾滋病流行的人口统计学特征已向老年转移。我们的目的是建立衰老过程和HIV感染在神经认知功能障碍中的关系。方法多中心艾滋病队列研究的纵向数据，一项长期的前瞻性队列研究，研究了美国男男性行为者HIV感染的自然和治疗史，我们研究了衰老、HIV感染（按疾病阶段），以及它们在五个神经认知领域的相互作用：信息处理速度、执行功能、情景记忆、工作记忆和运动功能。我们在亚组分析中控制了血清状态的持续时间，以及合并症和其他影响认知的因素。结果5086名参与者（47886次访问）被纳入分析样本（2278名HIV血清阳性参与者贡献了20477次访问，2808名HIV血清阴性对照参与者贡献了27409次访问）。在一项先验多变量分析中，控制变量包括合并症和血清转换后的时间，在所有神经认知领域都观察到了衰老的显著、直接的负面影响（所有p< 0.0001）。晚期HIV疾病进展对信息处理速度（p= 0.002）、执行功能（p< 0.0001）、运动功能（p <0.0001）和工作记忆（p= 0.001）也有类似的影响。在情节记忆（p= 0.03）和运动功能（p= 0.02）的领域中也注意到有害的相互作用效应。解释随着HIV感染的晚期，年龄对情节记忆和运动功能的影响大于预期，这表明这两个领域最容易受到HIV感染个体中由年龄引起的神经认知障碍的进展的影响。这种缺陷模式表明海马和基底神经节（特别是黑质纹状体通路）的不同损伤。感染HIV的老年人应定期筛查HIV相关的神经认知障碍，特别是可用于情景记忆和运动领域的测试。
Background The demographics of the HIV epidemic in the USA have shifted towards older age. We aimed to establish the relationship between the processes of ageing and HIV infection in neurocognitive impairment.Methods With longitudinal data from the Multicenter AIDS Cohort Study, a long-term prospective cohort study of the natural and treated history of HIV infection among men who have sex with men in the USA, we examined the effect of ageing, HIV infection (by disease stage), and their interaction on five neurocognitive domains: information processing speed, executive function, episodic memory, working memory, and motor function. We controlled for duration of serostatus in a subanalysis, as well as comorbidities and other factors that affect cognition. Analyses were by linear mixed models for longitudinal data.Findings 5086 participants (47 886 visits) were included in the analytic sample (2278 HIV-seropositive participants contributed 20 477 visits and 2808 HIV-seronegative control participants contributed 27 409 visits). In an a-priori multivariate analysis with control variables including comorbidities and time since seroconversion, significant, direct negative effects of ageing were noted on all neurocognitive domains (p< 0.0001 for all). Similar effects were noted for late-stage HIV disease progression on information processing speed (p= 0.002), executive function (p< 0.0001), motor function (p< 0.0001), and working memory (p= 0.001). Deleterious interaction effects were also noted in the domains of episodic memory (p= 0.03) and motor function (p= 0.02).Interpretation A greater than expected effect of ageing on episodic memory and motor function with advanced stages of HIV infection suggests that these two domains are most susceptible to the progression of neurocognitive impairment caused by ageing in individuals with HIV. This deficit pattern suggests differential damage to the hippocampus and basal ganglia (specifically nigrostriatal pathways). Older individuals with HIV infection should be targeted for regular screening for HIV-associated neurocognitive disorder, particularly with tests referable to the episodic memory and motor domains.