Neurocognitive SuperAging in Older Adults Living With HIV: Demographic, Neuromedical and Everyday Functioning Correlates

Objectives:Studies of neurocognitively elite older adults, termedSuperAgers, 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)

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Does the Key Task Measure Prospective Memory? Cautionary Findings from Parallel Studies in HIV Disease and Older Adults

Archives of Clinical Neuropsychology ◽

10.1093/arclin/acz009 ◽

2019 ◽

Vol 34 (8) ◽

pp. 1438-1444

Author(s):

Michelle A Babicz ◽

Kelli L Sullivan ◽

Michael Weinborn ◽

Romola S Bucks ◽

Amanda Ng ◽

...

Keyword(s):

Older Adults ◽

Construct Validity ◽

Prospective Memory ◽

Community Dwelling ◽

Face Validity ◽

Hiv Disease ◽

Everyday Functioning ◽

Parallel Methods ◽

Persons Living With Hiv ◽

Task Measure

Abstract Objective Despite its brevity and face validity, little is known about the construct validity of the naturalistic “Key Task” of prospective memory (PM), in which an examinee is instructed to remind the examiner at a designated time to retrieve keys (or another belonging) placed out of sight. Method Study 1 included 162 HIV+ and 52 HIV− comparison participants who completed the Key Task alongside well-validated measures of PM and a comprehensive neuropsychological battery that included everyday functioning measures. Study 2 used broadly parallel methods in 168 older community-dwelling Australians. Results Overall, the Key Task was not reliably associated with neurocognitive functioning (including clinical and experimental measures of PM), PM symptoms, or everyday functioning in either sample. Conclusions The Key Task did not demonstrate compelling evidence of construct validity among persons living with HIV disease or older adults, which raises doubts regarding its clinical usefulness as a measure of PM.

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Internet Navigation Skills for Financial Management: Associations with Age, Neurocognitive Performance, and Functional Capacity

10.31234/osf.io/q46r8 ◽

2020 ◽

Author(s):

Samina Rahman ◽

Victoria Kordovski ◽

Savanna Tierney ◽

Steven Paul Woods

Keyword(s):

Older Adults ◽

Functional Capacity ◽

Financial Management ◽

Internet Banking ◽

Online Banking ◽

Neurocognitive Performance ◽

Younger Adults ◽

Neurocognitive Functions ◽

Age Related ◽

Use Factors

Objective: Online banking is becoming increasingly common among older adults, whomay experience difficulties effectively navigating this instrumental technology. Thisstudy examined age effects on a performance-based Internet banking task and itsassociation with neurocognitive ability and functional capacity in older and youngeradults. Method: Thirty-five older adults and 50 younger adults completed anexperimenter-controlled online banking measure in which they independentlyperformed a series of naturalistic financial tasks (e.g., account transfers, bill paying).Participants also completed a standardized battery of neuropsychological tests andmeasures of functional capacity. Results: Older adults were markedly slower and lessaccurate in completing the Internet-based banking task, which was not confounded byother demographic, mood, or computer use factors. Higher scores on measures ofneurocognition and financial functional capacity were both strongly associated withhigher Internet-based banking task accuracy scores and quicker completion times inthe older, but not the younger adults. Conclusions: Findings suggest that older adultsexperience difficultly quickly and accurately navigating online banking platforms, whichmay be partly related to age-related declines in neurocognitive functions and basicfinancial capacity. Future studies might examine whether neurocognitive approaches toremediation and compensation can be used to improve online banking capacity inolder adults.

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Comparison of Clinical Outcomes of Persons Living With HIV by Enrollment Status in Washington, DC: Evaluation of a Large Longitudinal HIV Cohort Study (Preprint)

10.2196/preprints.16061 ◽

2019 ◽

Author(s):

Jenevieve Opoku ◽

Rupali K Doshi ◽

Amanda D Castel ◽

Ian Sorensen ◽

Michael Horberg ◽

...

Keyword(s):

Cohort Study ◽

Health Outcomes ◽

Odds Ratio ◽

Adjusted Odds Ratio ◽

Hiv Care ◽

Disease Stage ◽

People Living With Hiv ◽

Hiv Disease ◽

Persons Living With Hiv ◽

Living With Hiv

BACKGROUND HIV cohort studies have been used to assess health outcomes and inform the care and treatment of people living with HIV disease. However, there may be similarities and differences between cohort participants and the general population from which they are drawn. OBJECTIVE The objective of this analysis was to compare people living with HIV who have and have not been enrolled in the DC Cohort study and assess whether participants are a representative citywide sample of people living with HIV in the District of Columbia (DC). METHODS Data from the DC Health (DCDOH) HIV surveillance system and the DC Cohort study were matched to identify people living with HIV who were DC residents and had consented for the study by the end of 2016. Analysis was performed to identify differences between DC Cohort and noncohort participants by demographics and comorbid conditions. HIV disease stage, receipt of care, and viral suppression were evaluated. Adjusted logistic regression assessed correlates of health outcomes between the two groups. RESULTS There were 12,964 known people living with HIV in DC at the end of 2016, of which 40.1% were DC Cohort participants. Compared with nonparticipants, participants were less likely to be male (68.0% vs 74.9%, P<.001) but more likely to be black (82.3% vs 69.5%, P<.001) and have a heterosexual contact HIV transmission risk (30.3% vs 25.9%, P<.001). DC Cohort participants were also more likely to have ever been diagnosed with stage 3 HIV disease (59.6% vs 47.0%, P<.001), have a CD4 <200 cells/µL in 2017 (6.2% vs 4.6%, P<.001), be retained in any HIV care in 2017 (72.9% vs 59.4%, P<.001), and be virally suppressed in 2017. After adjusting for demographics, DC Cohort participants were significantly more likely to have received care in 2017 (adjusted odds ratio 1.8, 95% CI 1.70-2.00) and to have ever been virally suppressed (adjusted odds ratio 1.3, 95% CI 1.20-1.40). CONCLUSIONS These data have important implications when assessing the representativeness of patients enrolled in clinic-based cohorts compared with the DC-area general HIV population. As participants continue to enroll in the DC Cohort study, ongoing assessment of representativeness will be required.

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HIV-Associated Neurocognitive Disorders

The Oxford Handbook of Adult Cognitive Disorders ◽

10.1093/oxfordhb/9780190664121.013.3 ◽

2019 ◽

pp. 27-60

Author(s):

Jennifer E. Iudicello ◽

Erin E. Morgan ◽

Mariam A. Hussain ◽

Caitlin Wei-Ming Watson ◽

Robert K. Heaton

Keyword(s):

Differential Diagnosis ◽

Neurocognitive Impairment ◽

Hiv Treatment ◽

People Living With Hiv ◽

Neurocognitive Disorder ◽

Diagnostic Systems ◽

Neurocognitive Performance ◽

Everyday Functioning ◽

Asymptomatic Neurocognitive Impairment ◽

Age Related

Human immunodeficiency virus enters the central nervous system (CNS) early after systemic infection, and may cause neural injury and associated neurocognitive impairment through multiple direct and indirect mechanisms. An international conference of multidisciplinary neuroAIDS experts convened in 2005 to propose operationalized research criteria for HIV-related cognitive and everyday functioning impairments. The resulting classification system, known as the Frascati criteria, defined three types of HIV-associated neurocognitive disorder (HAND): asymptomatic neurocognitive impairment, mild neurocognitive disorder, and HIV-associated dementia (HAD). Consideration of comorbid conditions that can influence neurocognitive performance, such as developmental disabilities, non-HIV forms of CNS compromise (neurological and systemic), severe psychiatric conditions, and substance use disorders, is essential to differential diagnosis. Since the introduction of combination antiretroviral therapy (ART), rates of severe HAND (i.e., HAD) have greatly declined, although the milder forms of HAND remain quite prevalent, even in virally suppressed people living with HIV (PLWH). Beyond ART, clinical management of HAND includes behavioral interventions focused on neurocognitive and functional improvements. This chapter covers a range of HAND-related topics, such as the neuropathological mechanisms of HIV-related CNS injury, assessment and diagnostic systems for neurocognitive and everyday functioning impairment in HIV, treatment and protective factors, aging with HIV, HAND in international settings, and ongoing challenges and controversies in the field. Future needs for progress with HAND include advances in early detection of mild cognitive deficits and associated functional impairment in PLWH; biomarkers that may be sensitive to its underlying pathogenesis; and differential diagnosis of HAND versus age-related, non-HIV-associated disorders.

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Spontaneous Eye Blinks Predict Executive Functioning in Seniors

Journal of Cognitive Enhancement ◽

10.1007/s41465-021-00217-4 ◽

2021 ◽

Author(s):

Jessika I. V. Buitenweg ◽

Jaap M. J. Murre ◽

K. Richard Ridderinkhof

Keyword(s):

Older Adults ◽

Working Memory ◽

Executive Functioning ◽

Cognitive Training ◽

Functional Decline ◽

Future Research ◽

Blink Rate ◽

Memory Updating ◽

Age Related ◽

Working Memory Updating

AbstractAs the world’s population is aging rapidly, cognitive training is an extensively used approach to attempt improvement of age-related cognitive functioning. With increasing numbers of older adults required to remain in the workforce, it is important to be able to reliably predict future functional decline, as well as the individual advantages of cognitive training. Given the correlation between age-related decline and striatal dopaminergic function, we investigated whether eye blink rate (EBR), a non-invasive, indirect indicator of dopaminergic activity, could predict executive functioning (response inhibition, switching and working memory updating) as well as trainability of executive functioning in older adults. EBR was collected before and after a cognitive flexibility training, cognitive training without flexibility, or a mock training. EBR predicted working memory updating performance on two measures of updating, as well as trainability of working memory updating, whereas performance and trainability in inhibition and switching tasks could not be predicted by EBR. Our findings tentatively indicate that EBR permits prediction of working memory performance in older adults. To fully interpret the relationship with executive functioning, we suggest future research should assess both EBR and dopamine receptor availability among seniors.

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Strategies and cognitive reserve to preserve lexical production in aging

GeroScience ◽

10.1007/s11357-021-00367-5 ◽

2021 ◽

Author(s):

Monica Baciu ◽

Sonja Banjac ◽

Elise Roger ◽

Célise Haldin ◽

Marcela Perrone-Bertolotti ◽

...

Keyword(s):

Older Adults ◽

Cognitive Aging ◽

Individual Variability ◽

Future Research ◽

Aging Effects ◽

Main Hypothesis ◽

Compensatory Strategies ◽

Age Related ◽

Complementary Domain

AbstractIn the absence of any neuropsychiatric condition, older adults may show declining performance in several cognitive processes and among them, in retrieving and producing words, reflected in slower responses and even reduced accuracy compared to younger adults. To overcome this difficulty, healthy older adults implement compensatory strategies, which are the focus of this paper. We provide a review of mainstream findings on deficient mechanisms and possible neurocognitive strategies used by older adults to overcome the deleterious effects of age on lexical production. Moreover, we present findings on genetic and lifestyle factors that might either be protective or risk factors of cognitive impairment in advanced age. We propose that “aging-modulating factors” (AMF) can be modified, offering prevention opportunities against aging effects. Based on our review and this proposition, we introduce an integrative neurocognitive model of mechanisms and compensatory strategies for lexical production in older adults (entitled Lexical Access and Retrieval in Aging, LARA). The main hypothesis defended in LARA is that cognitive aging evolves heterogeneously and involves complementary domain-general and domain-specific mechanisms, with substantial inter-individual variability, reflected at behavioral, cognitive, and brain levels. Furthermore, we argue that the ability to compensate for the effect of cognitive aging depends on the amount of reserve specific to each individual which is, in turn, modulated by the AMF. Our conclusion is that a variety of mechanisms and compensatory strategies coexist in the same individual to oppose the effect of age. The role of reserve is pivotal for a successful coping with age-related changes and future research should continue to explore the modulating role of AMF.

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Health Among Sexual Minority Older Adults: Individual Differences and Implications for Improving Health

Innovation in Aging ◽

10.1093/geroni/igaa057.3170 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 860-860

Author(s):

Britney Wardecker ◽

Cara Exten

Keyword(s):

Older Adults ◽

Individual Differences ◽

Sexual Minority ◽

Health Care Access ◽

Psychological Health ◽

Negative Mood ◽

Health Problems ◽

Future Research ◽

Care Access ◽

Age Related

Abstract The number of sexual minority (SM) older adults is increasing rapidly, yet this population continues to be underrepresented in research (Fredriksen-Goldsen & Kim, 2017) and experiences significant disparities in health and health care access (Fredriksen-Goldsen, 2016; Wallace et al., 2011). In the current symposium, we analyze data from U.S. national probability samples of middle-aged and older adults (MIDUS, HRS, NESARC-III) to consider how age-related concerns and challenges may be experienced differently by SM individuals compared to their heterosexual counterparts. This symposium includes novel methods and statistical tools, such as daily diary assessments, multilevel modeling, and time-varying effects models. Individual presentations evaluate how: (1) SM women, compared to heterosexual women, may respond differently to menopause through norms and values surrounding womanhood; (2) midlife and older SM individuals use alcohol and cigarettes more frequently across a typical week than their heterosexual counterparts, though their substance use may not be tied to common triggers (e.g., negative mood, stress); (3) despite bisexual older adults reporting more health problems compared to lesbian and gay counterparts, they are less prepared for health concerns and crises (e.g., reporting a lower number of valid wills); and (4) the prevalence of depression and anxiety varies across age, such that older SM adults—especially women—are particularly vulnerable to psychological health problems. These presentations collectively examine complex issues facing older SM adults while emphasizing individual differences (i.e., women’s concerns, bisexual people’s issues). We discuss challenges in researching this growing at-risk population, and we highlight areas of future research and intervention.

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Intersectionality and Cognitive Impairment Risk in Older Persons With HIV: Age, Ethnicity, and LGBT Status

Innovation in Aging ◽

10.1093/geroni/igaa057.2564 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 724-724

Author(s):

Monica Rivera Mindt ◽

Micah Savin ◽

Angela Summers ◽

Jordan Stiver ◽

Alex Slaughter

Keyword(s):

Working Memory ◽

Cognitive Impairment ◽

Executive Functioning ◽

Hiv Infection ◽

Older Persons ◽

Neurocognitive Impairment ◽

Future Research ◽

Multiple Regressions ◽

Persons Living With Hiv ◽

Living With Hiv

Abstract The Latinx population is disproportionately affected by HIV-infection and older Latinx persons living with HIV (PLWH) are at greater risk for neurocognitive impairment (NCI). However, no studies have examined whether intersectionality (including Lesbian Gay Bisexual Transgender [LGBT] status) increases NCI risk. This study investigated whether LGBT status increases NCI risk in 126 PLWH (Ages 19-73 years; 74% Male; 66% Latinx, 34% NHW) who completed a comprehensive NC battery. Domain average T-scores were based on demographically-corrected norms. Multiple regressions revealed that after accounting for covariates (cocaine use, premorbid IQ) and other dimensions of intersectionality (age, ethnicity), LGBT status significantly contributed to NCI risk in attention/working memory (B=-4.50, p=.01) and executive functioning (trend-level; B=-3.67, p=.06). LGBT status, a key dimension of intersectionality, should be considered in NC assessment of PLWH. Future research is needed to identify factors (e.g., discrimination) that may confer increased NCI risk in this population.

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Web-Based Data Collection for Older Adults Living With HIV in a Clinical Research Setting: Pilot Observational Study

Journal of Medical Internet Research ◽

10.2196/18588 ◽

2020 ◽

Vol 22 (11) ◽

pp. e18588

Author(s):

Katherine Tassiopoulos ◽

Carla Roberts-Toler ◽

Carl J Fichtenbaum ◽

Susan L Koletar

Keyword(s):

Older Adults ◽

Data Collection ◽

Data Quality ◽

Older Persons ◽

Web Based ◽

Persons Living With Hiv ◽

Paper And Pencil ◽

Living With Hiv

Background Longitudinal follow-up of older persons living with HIV is essential for the ascertainment of aging-related clinical and behavioral outcomes, and self-administered questionnaires are necessary for collecting behavioral information in research involving persons living with HIV. Web-based self-reported data collection results in higher data quality than paper-and-pencil questionnaires in a wide range of populations. The option of remote web-based surveys may also increase retention in long-term research studies. However, the acceptability and feasibility of web-based data collection in clinical research involving older persons living with HIV have never been studied. Objective This study aims to assess the acceptability and feasibility of a web-based survey to collect information on sexual, substance use, and physical activity behaviors; compare the data quality of the web-based survey with that of a paper-and-pencil questionnaire; and summarize web-based survey metrics. Methods This pilot study took place within the AIDS Clinical Trials Group A5322 study, a longitudinal cohort of men and women living with HIV (aged ≥40 years), followed at 32 clinical sites in the United States and Puerto Rico. A total of 4 sites participated in this study. A web-based survey was created using self-administered questionnaires typically completed in A5322 via paper and pencil. Pilot study participants completed these questionnaires via web-based survey at one research visit in lieu of paper-and-pencil administration. Two questions were added to assess feasibility, defined as participants’ perception of the ease of web-based survey completion (very hard, hard, easy, very easy), and their preferred format (computer or tablet, paper and pencil, no preference) for completing the questions in the future (acceptability). Feasibility and acceptability were summarized overall and by demographic and clinical characteristics; the proportion of evaluable data by web-based survey versus previously administered paper-and-pencil questionnaires (data quality) was compared for each question. Results Acceptability and feasibility were high overall: 50.0% (79/158) preferred computer or tablet, 38.0% (60/158) reported no preference, and 12.0% (19/158) preferred paper and pencil; 93.0% (147/158) reported survey completion easy or very easy. Older age was associated with lower odds of preferring computer or tablet to paper and pencil (odds ratio per 1-year increase in age: 0.91, 95% CI 0.85-0.98). Individuals who found the survey hard or very hard had a lower median neurocognitive test score than those who found it easy or very easy. Data quality with web-based survey administration was similar to or higher than that with paper-and-pencil administration for most questions. Conclusions Web-based survey administration was acceptable and feasible in this cohort of older adults living with HIV, and data quality was high. Web-based surveys can be a useful tool for valid data collection and can potentially improve retention in long-term follow-up studies.

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Exploring Early Detection of Frailty Syndrome in Older Adults: Evaluation of Oxi-Immune Markers, Clinical Parameters and Modifiable Risk Factors

Antioxidants ◽

10.3390/antiox10121975 ◽

2021 ◽

Vol 10 (12) ◽

pp. 1975

Author(s):

Armanda Teixeira-Gomes ◽

Blanca Laffon ◽

Vanessa Valdiglesias ◽

Johanna M. Gostner ◽

Thomas Felder ◽

...

Keyword(s):

Older Adults ◽

Immune Activation ◽

Future Research ◽

Clinical Parameters ◽

Frailty Syndrome ◽

Immune Markers ◽

Frailty Phenotype ◽

Age Related ◽

Inflammatory Molecules ◽

The Relationship

Ageing is accompanied with a decline in several physiological systems. Frailty is an age-related syndrome correlated to the loss of homeostasis and increased vulnerability to stressors, which is associated with increase in the risk of disability, comorbidity, hospitalisation, and death in older adults. The aim of this study was to understand the relationship between frailty syndrome, immune activation, and oxidative stress. Serum concentrations of vitamins A and E were also evaluated, as well as inflammatory biomarkers (CRP and IL-6) and oxidative DNA levels. A group of Portuguese older adults (≥65 years old) was engaged in this study and classified according to Fried’s frailty phenotype. Significant increases in the inflammatory mediators (CRP and IL-6), neopterin levels, kynurenine to tryptophan ratio (Kyn/Trp), and phenylalanine to tyrosine ratio (Phe/Tyr), and significant decreases in Trp and Tyr concentrations were observed in the presence of frailty. IL-6, neopterin, and Kyn/Trp showed potential as predictable biomarkers of frailty syndrome. Several clinical parameters such as nutrition, dependency scales, and polypharmacy were related to frailty and, consequently, may influence the associations observed. Results obtained show a progressive immune activation and production of pro-inflammatory molecules in the presence of frailty, agreeing with the inflammageing model. Future research should include different dimensions of frailty, including psychological, social, biological, and environmental factors.

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