Reciprocal prediction of medication adherence and neurocognition in HIV/AIDS
Reciprocal prediction of medication adherence and neurocognition in HIV/AIDS
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DOI：
10.1212/wnl.0b013e3181d8c1ca
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发表时间：
2010-04-13
期刊：
影响因子：
9.9
通讯作者：
Hinkin, Charles H.
中科院分区：
文献类型：
--
作者：
Ettenhofer, Mark L.;Foley, Jessica;Hinkin, Charles H.
背景：抗逆转录病毒药物已被证明有益于艾滋病毒/艾滋病患者的神经认知，神经认知缺陷是不良依从这些药物的危险因素。然而，人们对药物依从性与认知能力之间的预测途径知之甚少。方法：在目前为期6个月的队列研究中，使用电子监测前瞻性地跟踪91名hiv阳性成人的抗逆转录病毒药物依从性。在基线和6个月时进行全面的神经心理学评估。结果：多变量路径分析提供证据表明抗逆转录病毒依从性和认知能力是相互相关的，尽管这种关系的神经认知途径似乎随预测方向而变化。执行功能和学习/记忆最能预测药物依从性的水平，而更高水平的依从性可以预测广泛的额纹状体脑功能的相对改善，包括处理速度、注意力、执行功能和运动功能。结论：这些数据提供了HIV/ AIDS患者认知和依从性相互相关的证据。特别是，执行功能障碍可能在这种关系中起着关键作用。旨在改善或保持执行功能的干预措施有望阻止艾滋病毒/艾滋病患者依从性和神经认知能力的逐渐下降。神经病学(R) 2010；74:1217 - 1222
Background: Antiretroviral medications have been shown to benefit neurocognition in HIV/AIDS, and neurocognitive deficits are a risk factor for poor adherence to these medications. However, little is known about the predictive pathways linking medication adherence with cognitive ability.Methods: In the current 6-month cohort study, antiretroviral medication adherence was tracked prospectively among 91 HIV-positive adults using electronic monitoring. Comprehensive neuropsychological evaluations were performed at baseline and 6 months.Results: Multivariate path analyses provided evidence that antiretroviral adherence and cognitive ability are reciprocally related, although the neurocognitive pathways of this relationship appear to vary by predictive direction. Executive function and learning/ memory were most strongly predictive of levels of medication adherence achieved, whereas higher levels of adherence were predictive of relative improvements in a wide range of frontostriatal brain functions including processing speed, attention, executive functions, and motor functioning.Conclusions: These data provide evidence that cognition and adherence are reciprocally related in HIV/ AIDS. In particular, executive dysfunction may play a key role in this relationship. Interventions aimed at improving or preserving executive functions could hold promise for interrupting progressive declines in adherence and neurocognitive ability in HIV/ AIDS. Neurology (R) 2010;74:1217-1222