The Role of Cardiovascular Risk and Aging in Memory Performance in a Sample of Veterans with HIV

Transcription

1 The Role of Cardiovascular Risk and Aging in Memory Performance in a Sample of Veterans with HIV LYNN KAKOS, PH.D. VA MARYLAND HEALTH CARE SYSTEM (VAMHCS)

2 OBJECTIVES HIV in the VA Neurocognitive profile of HIV Examination of associations between age, cardiovascular disease (CVD) risk factors, infectious disease & neurocognitive function Future directions

3 HIV IN THE VA VA is the largest provider of HIV/AIDS care in the U.S. Over 24,000 Veterans receive care for HIV VA Capitol Health Care Network treats approximately 1600 Veterans with HIV/AIDS

4 HIV AND AGE IN THE VA Increase in older (i.e., over age 50) Veterans with HIV: 60% in % in % of Veterans infected with HIV are between the ages of 50 and 69.

5 HIV IMPACT ON THE BRAIN HIV Enters the brain through the BBB by way of infected immune cells Causes inflammation and damage to the neurons, tissue, and structures of the brain Most commonly affected areas include the subcortical and fronto-striatal regions, including: Basal ganglia Deep white matter Hippocampus

6 HIV-RELATED NEUROCOGNITIVE DISORDERS Mild neuropsychological impairments exist in 30% of individuals with asymptomatic HIV and 50% with AIDS Prevalence of mild neurocognitive dysfunction has increased over time despite treatment Rule out neurocognitive impairment due to comorbidities (i.e. CVD) HIV may affect the following: Motor skills Information processing Psychomotor speed Memory Attention Executive functioning Speech and language

7 PREVIOUS FINDINGS Steinberg et al. (2013) examined the influence of infectious disease vs. non-infectious disease factors on neurocognitive function Non-ID health burden accounted for significant variance in most neurocognitive domains after controlling for the influence of ID related burden CVD factors were most implicated

8 AGE, CVD, AND COGNITION IN INDIVIDUALS WITH HIV HAART (Highly Active Antiretroviral Therapy): Promotes longer life span for individuals with HIV. Increased risk for CVD Previous studies have identified a negative association between both age, CVD risk, & cognitive function, including memory performance.

9 CURRENT STUDY Aim Examine the potential associations between age, CVD risk factors, and memory function in an HIV sample Hypotheses Increased age & CVD risk will be negatively associated with memory function CVD risk will account for unique variance in memory dysfunction

10 DEMOGRAPHICS n=62 M (SD) / % of Sample Age (years) 54.4 (9.4) Sex 98% Male Race Education (years) 12.2 (2.3) 77% African American 23% Caucasian

11 NEUROCOGNITIVE VARIABLES Memory BVMT-R HVLT-R

12 CVD RISK & MEMORY FUNCTION Cognitive Variable z-scores r (p-value) Immediate Recall (<0.01) Delayed Recall Verbal Memory Mean Non-Verbal Memory Mean (p<0.01) (p<0.05) (p<0.01)

13 AGE & MEMORY FUNCTION Cognitive Variable z-scores r (p-value) Immediate Recall (<0.05) Delayed Recall Verbal Memory Mean Non-Verbal Memory Mean (p<0.01) -.12 (NS) (p<0.01)

14 Hierarchical Multiple Regressions (HMR) DV: Memory Step 2: CVD Risk Factors Step: 1 Age

15 Results Step R R 2 β Significance Dependent Variable: Immediate Recall Dependent Variable: Delayed Recall Dependent Variable: Verbal Memory Dependent Variable: Non-Verbal Memory

16 SUMMARY OF RESULTS As expected, increased CVD risk and increased age were negatively correlated with memory. CVD risk factors accounted for significant variance in memory performances, after controlling for the influence of age. The reverse relationship was not supported by data (i.e., controlling for CVD risk, age did not account for significant variance in neurocognitive function).

17 IMPLICATIONS Unique aspects of aging and CV factors within the HIV population: Increased lifespan for patients with HIV due to advancements in treatment efficacy Greater risk of CV factors in this population Future research and clinical directives should focus on: Interventions to limit the onset of CV risk factors Diet Exercise

18 FUTURE DIRECTIONS Successful Aging for Veterans with Immunodeficiency (SAVI Clinic) Address the complex needs of aging Veterans with HIV Components: Brief clinical interview Neurocognitive Testing Physical examination & assessment of overall health status Assessment of infectious disease status Physical performance testing (research only)

19 FUTURE DIRECTIONS We are also planning to examine the effects of a hybrid exercise intervention (60 minutes moderate aerobic & 30 minutes strength training; 3 X/week for 16 weeks) on health function in Veterans with HIV/AIDS

20 ACKNOWLEDGEMENTS Moira Dux, Ph.D. Terry Lee-Wilk, Ph.D. Tara Steinberg, Ph.D. Infectious Disease/GRECC Staff Veterans