Psychiatric disorder and cognitive impairment in systemic lupus erythematosus.

OBJECTIVES. To determine the point prevalence of psychiatric disorder in patients with systemic lupus erythematosus (SLE). To investigate associations between psychiatric disorder and social stress, cognitive impairment, systemic disease activity, and corticosteroid therapy. METHODS. A cross-sectional study of 73 consecutive patients with SLE assessed using standardized psychiatric and clinical research methods. RESULTS. Current psychiatric disorder was present in 15 patients (20.5%) and was significantly associated with social stress, lack of social support, and impairment on 2 tests of cognitive function (Verbal Fluency Test and Benton Visual Retention Test, Part A, number of errors). There was no association with systemic disease activity or corticosteroid therapy. Cognitive impairment on 2 or more tests was found in 26% and was associated with clinical evidence of central nervous system (CNS) disease, but not systemic disease activity or corticosteroid therapy. CONCLUSIONS. The point prevalence of psychiatric disorder in this cohort of patients with SLE was found to be similar to that observed in patients with rheumatoid arthritis. It was independently associated with social stress and 2 indicators of cognitive impairment, but not with systemic disease activity or corticosteroid therapy. Marked cognitive impairment was present in a significant percentage of patients even when there was no overt evidence of CNS involvement.     

Neuropsychiatric and socioeconomic status impact antiretroviral adherence and mortality in rural Zambia

We conducted a prospective cohort study of 496 adults starting antiretroviral treatment (ART) to determine the impact of neuropsychiatric symptoms and socioeconomic status on adherence and mortality. Almost 60% had good adherence based upon pharmacy records. Poor adherence was associated with being divorced, poorer, food insecure, and less educated. Longer travel time to clinic, concealing one's human immunodeficiency virus (HIV) status, and experiencing side effects predicted poor adherence. Over a third of the patients had cognitive impairment and poorer cognitive function was also associated with poor adherence. During follow-up (mean 275 days), 20% died-usually within 90 days of starting ART. Neuropsychiatric symptoms, advanced HIV, peripheral neuropathy symptoms, food insecurity, and poverty were associated with death. Neuropsychiatric symptoms, advanced HIV, and poverty remained significant independent predictors of death in a multivariate model adjusting for other significant factors. Social, economic, cognitive, and psychiatric problems impact adherence and survival for people receiving ART in rural Zambia.     

Psychiatric disorder and cognitive impairment in systemic lupus erythematosus

Objectives. To determine the point prevalence of psychiatric disorder in patients with systemic lupus erythematosus (SLE). To investigate associations between psychiatric disorder and social stress, cognitive impairment, systemic disease activity, and corticosteroid therapy. Methods. A cross-sectional study of 73 consecutive patients with SLE assessed using standardized psychiatric and clinical research methods. Results. Current psychiatric disorder was present in 15 patients (20.5%) and was significantly associated with social stress, lack of social support, and impairment on 2 tests of cognitive function (Verbal Fluency Test and Benton Visual Retention Test, Part A, number of errors). There was no association with systemic disease activity or corticosteroid therapy. Cognitive impairment on 2 or more tests was found in 26% and was associated with clinical evidence of central nervous system (CNS) disease, but not systemic disease activity or corticosteroid therapy. Conclusions. The point prevalence of psychiatric disorder in this cohort of patients with SLE was found to be similar to that observed in patients with rheumatoid arthritis. It was independently associated with social stress and 2 indicators of cognitive impairment, but not with systemic disease activity or corticosteroid therapy. Marked cognitive impairment was present in a significant percentage of patients even when there was no overt evidence of CNS involvement.     

Psychiatric morbidity among HIV-infected children and adolescents in a resource-poor Kenyan urban community

The course of HIV/AIDS in children has been transformed from an acute to a chronic one with the advent of Anti-Retroviral Therapy. The aim of this study was to determine the prevalence and pattern of psychiatric morbidity in HIV-infected children and adolescents between 6 and 18 years of age and the relationship between their socio-demographic factors, immune suppression and psychiatric morbidity. The study was conducted at a paediatric HIV clinic in Nairobi, between February and April 2010. One hundred and sixty-two HIV-infected children and adolescents aged between 6 and 18 years and their guardians were interviewed. Seventy-nine (48.8%) of the study participants were found to have psychiatric morbidity. The most prevalent Diagnostic Statistical Manual, 4th Edition TR psychiatric disorders were: Major depression (17.8%), Social phobia (12.8%), Oppositional Defiant Disorder (12.1%) and Attention Deficit Hyperactivity Disorder (12.1%). Twenty-five per cent of the study participants had more than one psychiatric disorder. The prevalence of psychiatric morbidity in HIV-infected children is higher than that found in children in the general population. There is therefore a need to integrate psychiatric services into the routine care of HIV-infected children.     

Postmenopausal hormone therapy and its association with cognitive impairment

BACKGROUND: Cognitive impairment is a common and potentially debilitating medical problem in older women. Postmenopausal hormone therapy (HT) has been associated with better cognitive function, but the literature is conflicting. Results of recent trials suggest that HT is inappropriate for prevention of heart disease, and we sought to determine the role of HT in the risk of cognitive impairment. METHODS: We measured HT use and cognitive function in a population-based cohort of 1462 postmenopausal women participating in the 5-year follow-up examination for the Epidemiology of Hearing Loss Study in 1998-2000. The cohort was defined in 1987-1988 by residency in Beaver Dam, Wis, and an age of 43 to 84 years. Women had also participated in the Beaver Dam Eye Study baseline examination in 1988-1990. Use of HT was assessed at the Beaver Dam Eye Study baseline (1988-1990), 5-year follow-up (1993-1995), and 10-year follow-up (1998-2000) visits. Cognitive impairment was defined as a low Mini-Mental State Examination score or a reported diagnosis of Alzheimer disease. RESULTS: Six percent of participants (n = 94) were impaired; these women were significantly older and less educated than those who were unimpaired. In age- and education-adjusted analysis, current HT use was not significantly associated with cognitive impairment (odds ratio, 0.6; 95% confidence interval, 0.2-1.3). Similarly, cognitive impairment was not associated with past HT use or duration of HT use. CONCLUSION: In this large population-based study, postmenopausal hormone therapy was not significantly associated with better cognitive function.     

Cognitive impairment,depressive symptoms,and functional decline in older people

OBJECTIVES: Although cognitive impairment and depressive symptoms are associated with functional decline, it is not understood how these risk factors act together to affect the risk of functional decline. The purpose of this study is to determine the relative contributions of cognitive impairment and depressive symptoms on decline in activity of daily living (ADL) function over 2 years in an older cohort. DESIGN: Prospective cohort study. SETTING: A U.S. national prospective cohort study of older people, Asset and Health Dynamics in the Oldest Old. PARTICIPANTS: Five thousand six hundred ninety-seven participants (mean age 77, 64% women, 86% white) followed from 1993 to 1995. MEASUREMENTS: Cognitive impairment and depressive symptoms were defined as the poorest scores: 1.5 standard deviations below the mean on a cognitive scale or 1.5 standard deviations above the mean on validated depression scales. Risk of functional decline in participants with depressive symptoms, cognitive impairment, and both, compared with neither risk factor, were calculated and stratified by baseline dependence. Analyses were adjusted for demographics and comorbidity. RESULTS: Eight percent (n = 450) of subjects declined in ADL function. In participants who were independent in all ADLs at baseline, the relative risk (RR) of 2-year functional decline was 2.3 (95% confidence interval (CI) = 1.7-3.1) for participants with cognitive impairment, 1.9 (95% CI = 1.3-2.6) for participants with depressive symptoms, and 2.4 (95% CI = 1.4-3.7) for participants with cognitive impairment and depressive symptoms. In participants who were dependent in one or more ADLs at baseline, RR of 2-year functional decline was 1.9 (95% CI = 1.2-2.8) for participants with cognitive impairment, 0.6 (95% CI = 0.3-1.3) for participants with depressive symptoms, and 1.5 (95% CI = 0.8-2.6) for participants with cognitive impairment and depressive symptoms. CONCLUSIONS: In participants with no ADL dependence at baseline, cognitive impairment and depressive symptoms are risk factors for decline, but that, in participants with dependence in ADL at baseline, cognitive impairment, but not depressive symptoms, is a risk factor for additional decline.     

A controlled neuropsychological study of HIV-seropositive and HIV-seronegative adolescent haemophiliacs

Sixty-four males with haemophilia were assessed with a series of neuropsychological tests and a structured interview for psychiatric symptoms. Thirty-one had been infected with human immunodeficiency virus (HIV) before the age of 18 and were in various stages of the disease at the time of testing and 33 were HIV negative. Sixteen male control subjects were recruited to match in age with the haemophilia group. The HIV-seropositive group were older than the HIV-negative group due to the cohort effect of the time of infection. Contrary to predictions from the known effects of HIV on the central nervous system the HIV-seropositive group performed better on many of the tests than the HIV-seronegative group. In some but not all of the tests this may have been an age effect. There was very little psychiatric morbidity, consistent with the view that high levels of psychological support provided by the haemophilia units can alleviate the effects of the illness on emotions and behaviour. These findings form a baseline for a 2-year follow-up study which is in progress.     

A prospective study of psychiatric disorder and cognitive function in systemic lupus erythematosus.

OBJECTIVES--To investigate change in psychiatric disorder and change in cognitive function in patients with systemic lupus erythematosus (SLE) assessed on two occasions two years apart. METHODS--A prospective cohort study of 49 patients with SLE using standardised psychiatric and clinical research methods. RESULTS--The point prevalence of psychiatric disorder (20% and 24%), and of cognitive impairment (23% and 18%), was similar at first and second interview for the whole group. There was, however, considerable change in individual patient's psychiatric status and cognitive function: only 1/9 patients with impairment on two or more cognitive tests at first interview was still impaired at second interview. Change in cognitive function appeared to mirror change in psychiatric status. CONCLUSIONS--These findings suggest that the previously reported high prevalence of cognitive impairment in SLE may be explained by coexisting psychiatric disorder, rather than reflecting subclinical central nervous system (CNS) involvement.     

Long-Term Function in an Older Cohort—The Cardiovascular Health Study All Stars Study

OBJECTIVES: To evaluate shared and unique risk factors for maintaining physical and cognitive function into the ninth decade and beyond.
DESIGN: Longitudinal cohort study.
SETTING: Four U.S. communities.
PARTICIPANTS: One thousand six hundred seventy-seven participants in the Cardiovascular Health Study All Stars Study, assessed in 2005/06. Median age was 85 (range 77–102), 66.5% were women, and 16.6% were black.
MEASUREMENTS: Intact function was defined as no difficulty with any activities of daily living and a score of 80 or higher on the Modified Mini-Mental State Examination. Baseline characteristics assessed in 1992/93 included demographics, behavioral health factors, chronic disease history, subclinical disease markers, cardiovascular risk factors, and inflammatory markers. Multinomial logistic regression was used to compare risk for physical disability, cognitive impairment,and combined impairments with no functional impairment.
RESULTS: Of the 1,677 participants evaluated in both domains, 891 (53%) were functionally intact. Continuous measures of function, including the Digit Symbol Substitution Test and gait speed, showed that all groups, including the most functional, had declined over time. The functional group had less decline but also tended to have higher starting values. Functional individuals had a higher baseline health profile than those with either or cognitive impairment or both impairments combined. Women and individuals with greater weight had higher rates of physical impairment but not cognitive impairment. Risk factors common to both types of impairment included cardiovascular disease and hypertension.
CONCLUSION: Intact function was found in only approximately half of these older adults in the ninth decade and beyond. High baseline function and low vascular disease risk characterized functional aging.     

Cognitive impairment, psychiatric disorders, and problematic behaviors in a tribal nursing home

OBJECTIVE: Residents' cognitive, psychiatric, and behavioral statuses were examined as part of a larger study of care in a nursing home (NH) owned and operated by a Northern Plains American Indian tribe. METHOD: Reviews of 45 medical records and semistructured interviews with 36 staff were completed. RESULTS: Creekside residents had considerable psychiatric and behavioral morbidity. High prevalences of non-Alzheimer's disease dementia, cognitive impairment, anxious symptomatology, and resistance to care were met with psychopharmacotherapy, reorientation, and informal techniques for behavior management. Significant depressive, anxious, psychotic, and behavioral symptoms remained. Staff interpretations of resident problems consisted of an ethnopsychological schema emphasizing resident loneliness, grumpiness, and propensity to "fight" rather than formal psychiatric nosology. DISCUSSION: Tribal NH residents were likely underdiagnosed for dementia and anxiety. Residual behavioral and psychiatric symptomatology suggest room for improvement in the NH's behavioral management regimen. Need for greater attention to conceptual, diagnostic, clinical, and documentation processes in the NH setting is noted.     

Morbidity profiles of centenarians: survivors,delayers, and escapers

BACKGROUND: The compression of morbidity hypothesis predicts that, in order to achieve their extreme old age, centenarians markedly delay or even escape diseases that would otherwise be lethal at younger ages. Phenotypic studies have not adequately characterized the prevalence and timing of age-related illnesses among those who achieve exceptional old age. Thus, we conducted a retrospective cohort study of centenarians to explore the timing of such diseases among centenarians. METHODS: Health history questionnaires were completed by 424 centenarians (aged 97-119 years) or their proxies. Lifetime (to-date) diagnoses of 10 major lethal illnesses (hypertension, heart disease, diabetes, stroke, nonskin cancer, skin cancer, osteoporosis, thyroid condition, Parkinson's disease, and chronic obstructive pulmonary disease) and one ocular disease (cataracts) that befall the elderly population, approximate age of diagnosis, level of alcohol and tobacco use, and presence or absence of cognitive impairment were assessed. Because of the retrospective nature of the study, the typically imprecise age of onset of cognitive impairment negated the ability to include age of onset of cognitive impairment in this aspect of the analyses. RESULTS: Examining the ages of onset for the 10 age-associated diseases and excluding cognitive impairment, we found that the centenarians fit into three morbidity profiles-Survivors, Delayers, and Escapers. 24% of male subjects and 43% of female subjects fit the Survivor profile, or those who had a diagnosis of an age-associated illness prior to the age of 80. Delayers were individuals who delayed the onset of age-associated illness until at least the age of 80, and 44% of male and 42% of female subjects fit this profile. Escapers were individuals who attained their 100th year of life without the diagnosis of common age-associated illnesses, and 32% of male and 15% of female subjects fit the Escaper profile. When examining only the most lethal diseases of the elderly population, heart disease, nonskin cancer, and stroke, we found that 87% of male and 83% of female subjects delayed or escaped these diseases. Subjects with and without cognitive impairment did not differ in terms of the profile to which they belonged. CONCLUSIONS: These results suggest there may be multiple routes to achieving exceptional longevity and that there are sex differences according to which route is taken. These routes represent different phenotypes and thus likely different genotypes of centenarians. The identification of three types of centenarians, Survivors, Delayers, and Escapers, provides direction for future study into the factors that determine exceptional longevity.     

Cardiovascular disease and cognitive dysfunction in systemic lupus erythematosus

Objective

Cognitive dysfunction and cardiovascular disease are common and debilitating manifestations of systemic lupus erythematosus (SLE). In this study, we evaluated the relationship between cardiovascular events, traditional cardiovascular risk factors, and SLE‐specific risk factors as predictors of cognitive dysfunction in a large cohort of participants with SLE.

Methods

Subjects included 694 participants from the Lupus Outcomes Study (LOS), a longitudinal study of SLE outcomes based on an annual telephone survey querying demographic and clinical variables. The Hopkins Verbal Learning Test‐Revised and the Controlled Oral Word Association Test were administered to assess cognitive function. Multiple logistic regression was used to identify cardiovascular events (myocardial infarction, stroke), traditional cardiovascular risk factors (hypertension, hyperlipidemia, diabetes mellitus, obesity, smoking), and SLE‐specific risk factors (antiphospholipid antibodies [aPL], disease activity, disease duration) associated with cognitive impairment in year 7 of the LOS.

Results

The prevalence of cognitive impairment as measured by verbal memory and verbal fluency metrics was 15%. In adjusted multiple logistic regression analyses, aPL (odds ratio [OR] 2.10, 95% confidence interval [95% CI] 1.3–3.41), hypertension (OR 2.06, 95% CI 1.19–3.56), and a history of stroke (OR 2.27, 95% CI 1.16–4.43) were significantly associated with cognitive dysfunction. In additional analyses evaluating the association between these predictors and severity of cognitive impairment, stroke was significantly more prevalent in participants with severe impairment when compared to those with mild or moderate impairment (P = 0.036).

Conclusion

These results suggest that the presence of aPL, hypertension, and stroke are key variables associated with cognitive impairment, which may aid in identification of patients at greatest risk.     

Changes in Neuropsychological Functioning with Progression of HIV-1 Infection: Results of an 8-Year Longitudinal Investigation

Despite the advent of more effective treatments for HIV-1 infection, cognitive impairment is still frequent and questions remain regarding which areas of impairment are more common in the different disease stages. This study investigated cognitive performance over an 8-year period of time in 59 HIV-1 seropositive (HIV-1+) men who were clinically asymptomatic at study entry, in comparison to a cohort of 55 HIV-1 seronegative (HIV-1-) men. Every 6 months we examined cognitive functioning in 5 domains-fine motor speed, attention, verbal memory, executive functioning, and speed of information processing. We found that patients with AIDS scored significantly worse on fine motor speed and speed of information processing than HIV-1- individuals and the HIV-1+ non-AIDS patients. In addition, the HIV-1+ non-AIDS patients performed more poorly than the HIV-1- group on speed of information processing. Depressive symptoms were also associated with diminished performance on measures of attention, executive functioning, and speed of information processing. Further research is needed to examine the effects of disease stage and depression on cognitive impairment in the era of new HIV treatments.     

A Lifetime Alcohol or Other Drug Use Disorder and Specific Psychiatric Symptoms Predict Sexual Risk for HIV Infection Among People With Severe Mental Illness

To clarify the relative contributions of psychiatric and alcohol or other drug (AOD) use disorders on sexual risk for HIV infection among people with severe mental illness, we interviewed 195 psychiatric patients. In the prior 6 months the 100 (51%) sexually active patients had a mean of 3.9 sex partners and 27.5 sex episodes; 49% had known high-risk sex partners; 34% used AOD during sex; 28% traded sex; and 59% never used condoms. The likelihood of being sexually active decreased with age and cognitive symptoms, increased with excited symptoms, and was more than twice as high for African-American patients as others. The likelihood of trading sex increased with cognitive symptoms. The likelihood of having a sexually transmitted disease history (reported by 32% of all patients) increased with depressed/anxious symptoms, a lifetime AOD use diagnosis (obtained for 57% of patients), and was more than twice as high for African-American patients as others. HIV prevention interventions that address specific psychiatric conditions and developmental and cultural issues of psychiatric patients should be developed and tested.     

One for all,all for one: neuro-HIV multidisciplinary platform for the assessment and management of neurocognitive complaints in people living with HIV

Background

With ageing, comorbidities such as neurocognitive impairment increase among people living with HIV (PLWH). However, addressing its multifactorial nature is time-consuming and logistically demanding. We developed a neuro-HIV clinic able to assess these complaints in 8 h using a multidisciplinary approach.

Methods

People living with HIV with neurocognitive complaints were referred from outpatient clinics to Lausanne University Hospital. Over 8 h participants underwent formal infectious disease, neurological, neuropsychological and psychiatric evaluations, with opt-out magnetic resonance imaging (MRI) and lumbar puncture. A multidisciplinary panel discussion was performed afterwards, with a final report weighing all findings being produced.

Results

Between 2011 and 2019, a total of 185 PLWH (median age 54 years) were evaluated. Of these, 37 (27%) had HIV-associated neurocognitive impairment, but they were mainly asymptomatic (24/37, 64.9%). Most participants had non-HIV-associated neurocognitive impairment (NHNCI), and depression was prevalent across all participants (102/185, 79.5%). Executive function was the principal neurocognitive domain affected among both groups (75.5% and 83.8% of participants impaired, respectively). Polyneuropathy was found in 29 (15.7%) participants. Abnormalities in MRI were found in 45/167 participants (26.9%), being more common among NHNCI (35, 77.8%), and HIV-1 RNA viral escape was detected in 16/142 participants (11.2%). Plasma HIV-RNA was detectable in 18.4% out of 185 participants.

Conclusions

Cognitive complaints remain an important problem among PLWH. Individual assessment from a general practitioner or HIV specialist is not enough. Our observations show the many layers of HIV management and suggest that a multidisciplinary approach could be helpful in determining non-HIV causes of NCI. A 1-day evaluation system is beneficial for both participants and referring physicians.     

Neuropsychological aspects of HIV infection.

There is considerable consensus regarding the entity, aetiology, and assessment of HIV-1-caused cognitive impairment. Early fears that this would be very common, and early in onset, have not been realized. Research and clinical criteria should reflect current statistical standards. The large cohorts, broad test batteries and repeated testing of population samples provide a special opportunity to resolve perennial questions regarding the relationship between mood, health, and cognitive functions. It appears that AZT prevents mild cognitive impairment associated with HIV-1, though there is no strong evidence that it treats frank HIV-1 dementia complex. The management of patients with dementia requires proper consideration, as even if the incidence of HIV-1 dementia complex is only 5-10%, this is still a substantial number of patients for population centres with large numbers of people with HIV and AIDS. The distressing nature of this condition, combined with the specialized management required for HIV itself, make it advisable that more nurses with psychiatric training are employed in wards or units specializing in HIV.     

Factors affecting cognitive functioning in a sample of human immunodeficiency virus-positive injection drug users

Injection drug users represent a major vector of human immunodeficiency virus (HIV) infection in the nation's inner cities, and are an important population for harm reduction treatment interventions to target. However, there has been relatively little research examining the specific contribution of the multiple factors contributing to cognitive functioning among injection drug users that may affect engagement in, and response to, addiction and HIV-related interventions. The current study examined the independent contributions to neuropsychological (NP) test performance of premorbid educational attainment, medical and psychiatric history, long- and short-term drug use, assessed by laboratory, observation, and self-report measures, and HIV disease, assessed by plasma HIV-1 RNA viral load and CD4+ count, in a sample of 90 HIV-positive injection drug users dually addicted to heroin and cocaine. Fully 88% of the sample showed evidence of impairment (>1 standard deviation below the population mean) on an NP test battery selected to assess processes associated with successful engagement in the treatment of substance abuse and HIV, such as learning and memory of verbal information, capacity to solve new problems and deal with more than one stimulus at a time, visual-motor coordination, and visual tracking and cognitive flexibility. In addition to drug use, independent predictors of NP test performance were HIV viral load, educational attainment, and premorbid medical and psychiatric problems. Findings underscore the multiplicity of factors that contribute to cognitive impairment in HIV-positive drug-abusing individuals in addition to drug use. Clinical implications are discussed.     

The Maryland Assisted Living Study: prevalence, recognition, and treatment of dementia and other psychiatric disorders in the assisted living population of central Maryland

OBJECTIVES: To obtain a direct estimate of the prevalence of dementia and other psychiatric disorders in residents of assisted living (AL) in Central Maryland, and their rates of recognition and treatment. DESIGN: Comprehensive review of history and cognitive and neuropsychiatric evaluations using widely accepted instruments in a randomized cohort of AL residents, stratified by facility size. An expert multidisciplinary consensus panel determined diagnoses and appropriateness of treatment. SETTING: Twenty-two (10 large and 12 small) randomly selected AL facilities in the city of Baltimore and seven Maryland counties. PARTICIPANTS: One hundred ninety-eight volunteers who were residents of AL, 75% were aged 80 and older, and 78% were female. Potential participants were randomly chosen by room number. There was a 67% participation rate. MEASUREMENTS: Overall rate of dementia, noncognitive active psychiatric disorders, and recognition and adequate treatment of dementia and psychiatric disorders, as determined by consensus panel. RESULTS: Two-thirds (67.7%) of participants had dementia diagnosable according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (81% small facilities and 63% large). Family or caregivers recognized 78% to 80% of dementias. Seventy-three percent of dementias were adequately evaluated, and 52% were adequately treated. Of the 26.3% of participants who had an active noncognitive psychiatric disorder, 58% to 61% were recognized and 52% adequately treated. CONCLUSION: Dementia and psychiatric disorders are common in AL and have suboptimal rates of recognition and treatment. This may contribute to morbidity and interfere with the ability of residents to age in place.     

Positive Psychological Factors are Linked to Successful Cognitive Aging Among Older Persons Living with HIV/AIDS

We aimed to characterize successful cognitive aging (SCA) among older HIV-infected (HIV+) and HIV-uninfected (HIV?) adults, and to determine associations with positive psychological factors and health-related quality of life (HRQoL). Ninety-nine HIV+ and 46 HIV? older adults (≥ 50 years) completed measures of neurocognition, positive psychological factors, and HRQoL. Using study-defined SCA criteria (i.e., no cognitive or everyday impairment or major depressive disorder), we compared positive psychological factors and HRQoL across four groups: HIV+/SCA+, HIV+/SCA?, HIV?/SCA+, HIV?/SCA?. SCA was identified in 29% of the HIV+ sample compared to 61% of the HIV? sample (p < 0.01). HIV+/SCA+ participants had higher scores on 8 of 10 measures of positive psychological factors as well as better HRQoL (ps < 0.05) as compared to the HIV+/SCA? group. Furthermore, the HIV+/SCA+ participants had comparable scores on these factors as HIV? adults. Fewer HIV+ than HIV? participants met SCA criteria; however, the level of positive psychological factors among the HIV+/SCA+ group was comparable to the HIV? sample. Our findings present opportunities for interventions to optimize positive psychological factors and potentially improve SCA among older HIV+ adults.     

Does physical activity protect older persons with frailty and cognitive impairment from excess all-cause mortality?

ObjectivesThe main aim of this study was to examine how physical activity in combination with physical frailty and cognitive impairment affects risk of mortality in older adults.Study DesignA national sample of community-dwelling Taiwanese aged 65 years or older (n=2678) was followed for 5 years.Main outcome measuresFrailty was determined based on the Fatigue, Resistance, Ambulation, Illness, and Loss of weight (FRAIL) scale. The Mini-Mental State Examination was used to assess cognitive impairment. Information on self-reported physical activity was collected at baseline. The study cohort was followed until the date of death or the end of the study period (31 December 2018). Deaths were confirmed by the computerized data files of the National Register of Deaths.ResultsA total of 417 deaths were recorded after 12415.2 person-years of follow-up. After adjustment for other factors, compared with active participants who were physically robust with normal cognition, inactive participants who were with either frail/pre-frail or cognitively impaired had hazard ratios for mortality of 2.65 (95% CI=[1.88-3.74]) and 3.09 (95% CI=[2.08-4.59]), respectively. Inactive participants with coexisting frailty/pre-frailty and cognitive impairment had the highest hazard ratio for mortality of 3.85 (95% CI=[2.73-5.45]). Being active was associated with a mortality reduction of 31%, 38%, and 42% in physically robust participants with normal cognition, those who were frail/pre-frail only, and those with cognitive impairment only, respectively.ConclusionsHaving a physically active life style has beneficial effects on survival in older persons with either frailty/pre-frailty or cognitive impairment.