Aging, Neurocognition, and Medication Adherence in HIV Infection

Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA, USA.
The American journal of geriatric psychiatry: official journal of the American Association for Geriatric Psychiatry (Impact Factor: 4.24). 05/2009; 17(4):281-90. DOI: 10.1097/JGP.0b013e31819431bd
Source: PubMed

ABSTRACT To evaluate the hypothesis that poor adherence to highly active antiretroviral treatment (HAART) would be more strongly related to cognitive impairment among older than among younger HIV-seropositive adults.
A volunteer sample of 431 HIV-infected adult patients prescribed self-administered HAART was recruited from community agencies and university-affiliated infectious disease clinics in the Los Angeles area.
Neurocognitive measures included tests of attention, information processing speed, learning/memory, verbal fluency, motor functioning, and executive functioning. Medication adherence was measured using microchip-embedded pill bottle caps (Medication Event Monitoring System) and self-report. Latent/structural analysis techniques were used to evaluate factor models of cognition and adherence.
Mean adherence rates were higher among older (>or=50 years) than younger (<50 years) HIV-positive adults. However, latent/structural modeling demonstrated that neurocognitive impairment was associated with poorer medication adherence among older participants only. When cognitive subdomains were examined individually, executive functioning, motor functioning, and processing speed were most strongly related to adherence in this age group. CD4 count and drug problems were also more strongly associated with adherence among older than younger adults.
Older HIV-positive individuals with neurocognitive impairment or drug problems are at increased risk of suboptimal adherence to medication. Likewise, older adults may be especially vulnerable to immunological and neurocognitive dysfunction under conditions of suboptimal HAART adherence. These findings highlight the importance of optimizing medication adherence rates and evaluating neurocognition in the growing population of older HIV-infected patients.

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Available from: Mark Ettenhofer, Jan 30, 2014
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    • "Cognitive dysfunctions in elderly cancer patients: A new challenge for oncologists. Cancer Treat Rev (2014), adults (P50 years) [74]. When cognitive subdomains were examined individually, executive functioning, motor functioning and processing speed emerged as the parameters the most strongly related to adherence in this age group. "
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    • "Notwithstanding, several studies have highlighted difficulties in neurocognitive performance at different levels (York et al., 2001; Sacktor et al., 2002; Carey et al., 2006; Iudicello et al., 2008; Woods et al., 2008; Cattie et al., 2012; Giesbrecht et al., 2014) in HIV seropositive (henceforth, HIV+) patients; some authors have argued that such difficulties might be more related to the presence of important covariates, such as drug abuse, cranial traumas, and several psychological alterations rather than to the direct action of HIV virus. The longitudinal observation of these patients has given contrasting results: some studies have not shown any decline in neurocognitive functions (Selnes et al., 1990, 1992; Grassi et al., 1995) while others have (Ayuso-Mateos et al., 2000; Woods et al., 2008; Ettenhofer et al., 2009; Applebaum et al., 2010). "
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    Frontiers in Human Neuroscience 06/2014; 8. DOI:10.3389/fnhum.2014.00470 · 2.99 Impact Factor
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    • "While 20% variance was still a very strong correlation, it was not as robust as in older adults. This study supports the findings of previous studies by Barclay et al. (2007) and Ettenhofer et al. (2009), which found that cognitive ability was the best predictor of medication management in older adults. However, while Barclay et al. (2007) found cognitive ability the only predictor of medication management, the current study found that depressive symptoms and self-efficacy were also predictive of medication management in this population. "
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