The influence of family history of dementia on neuropsychological functioning among HIV infected persons across the lifespan.

Type: Poster
Title: The influence of family history of dementia on neuropsychological functioning among HIV infected persons across the lifespan.
Authors: Moore D, Arce M, Moseley S, McCutchan JA, Letendre SL, Vaida F, Achim CL, McArthur J, Morgello S, Simpson D, Gelman B, Collier A, Marra C, Clifford D, Grant I, the CHARTER Group, and the HNRC Group
Date: 2010
Abstract:Background: Since the introduction of combination antiretroviral therapy (ART), HIV infected individuals are living longer and healthier lives. Although ART has increased lifespan and decreased incidence of HIV-associated dementia (HAD), the most severe form of HIV-associated Neurocognitive Disorders (HAND), several milder forms of HAND remain common. In addition, as people live longer with HIV, the risk of developing neuropsychological (NP) difficulties associated with traditional neurodegenerative disorders (e.g., Alzheimer’s disease) or the combination of neurodegenerative disorders and HIV may increase. Many studies have shown that neurodegenerative diseases are partially inherited, and that HIV-negative individuals with a family history of dementia (FHD) are more likely to develop dementia than those without a FHD. Since no studies have specifically evaluated FHD as a potential risk factor for HAND, the current study assesses whether NP functioning was worse among HIV-infected persons with FHD as compared to those without such a history, and also examines whether FHD may be a differential predictor of NP impairment among younger (40 and under) and older (50 and older) HIV+ individuals. Materials and Methods: Participants were 1106 HIV seropositive (HIV+/with FHD: n=190; HIV+/without FHD: n=916) individuals who were currently participating in a multi-site study of HAND. We captured FHD with a free-response, self-report question, and assessed NP performance with a comprehensive battery of tests designed to measure different NP domains: verbal fluency, executive functioning, processing speed, attention, learning, memory, and motor skills. Raw NP test scores were converted into T-scores corrected for age, education, gender, and where available ethnicity. These T-scores were then summarized into a 0- to 5-point deficit scale and both domain deficit scores (DDS) and a global deficit score (GDS) were calculated. The comparison between the FHD and non-FHD groups used Wilcoxon rank test for continuous variables (e.g., CD4 counts, GDS), and Fisher''''s exact test for binary variables (e.g., NP impairment). Results: Despite the fact that the FHD group had factors typically associated with better NP performance (e.g., higher CD4 counts), persons with FHD had significantly worse NP ability than those without FHD as measured by a GDS (FHD mean=0.66; No FHD mean=0.55; p<0.05). The FHD group also showed significantly worse NP ability in the domains of executive functioning, verbal skills, and speeded fine motor skills. Follow up analysis comparing the effect of FHD on NP functioning in older (50 and over) and younger (40 and under) participants separately did not reveal any significant effect of FHD on NP functioning. Conclusions: In the current study we observed worse neuropsychological functioning among HIV+ persons with FHD as compared to those without FHD. Future studies should employ a standardized questionnaire of FHD, as well as studying the relationship of FHD with other covariates for HAND such as genetic markers of dementia risk. In conclusion, our study provides evidence that FHD exerts a modest effect on likelihood that a person with HIV will develop HAND. As individuals with HIV gradually increase in age with improved survival, FHD may be considered as one of several clinical risk factors for HAND