Prevalence of cognitive disorders differs as a function of
age in HIV virus infection
James T. Becker, Oscar L. Lopez, Mary Amanda Dew and
Howard J. Aizenstein
Objectives: Ten per cent of all new cases of AIDS in the United States are in persons
older than 50 years. This is particularly problematical in the case of the neuropsychia-
tric consequences of HIV, because there are neuropsychiatric disorders which become
common in older individuals in the absence of HIV. The purpose of this report is to
describe the prevalence and incidence of cognitive impairment in HIV-infected
individuals enrolled in a community-based study.
Design: The study consisted of community-based, sentinel survey physician referrals
of HIV-infected patients, with volunteer recruitment of risk-appropriate seronegative
controls. One-year longitudinal follow-up study.
Methods: Detailed neuropsychiatric evaluations were performed at study entry and
after one year. A brief, interim visit tracked incident change. Each subject’s neuropsy-
chological test performance was classified as normal, demented, or cognitive impair-
ment (not demented).
Results: The prevalence of cognitive disorder among HIV-positive individuals over 50
years was significantly greater than in individuals younger than 50 years. Among older
participants, dementia was the more common classification (23%), whereas among
younger participants, a milder form of cognitive impairment was more prevalent
(22%). Alcohol abuse/dependence was a significant risk factor for a disorder, whereas
greater education was a protective factor. The one-year incidence of disorder in the
sample overall was low (7.3%), and age was not a significant risk factor. However,
HIV viral load at study entry was significantly higher among those participants who
had developed cognitive impairment one year later.
Conclusion: Age is a significant risk modifier for prevalent neuropsychological
& 2004 Lippincott Williams & Wilkins
AIDS 2004, 18 (suppl 1):S11–S18
Keywords: AIDS, aging, neuropsychology, dementia, mild cognitive impairment
The vast majority of neurobehavioral HIV research has
focused on individuals younger than 50 years, in spite
of the fact that 10% of all new cases are older. Older
age is an important predictor of poor survival [1–3],
and since the introduction of highly active antiretrovir-
al therapy (HAART), age may be even more important
to our understanding of the clinical manifestations of
HIV infection. With the longer survival of AIDS
patients, and the unrelenting increase in new cases of
AIDS, the number of AIDS patients over 50 years of
age is growing. Our lack of understanding about how
age and HIV interact is becoming increasingly proble-
matical, no more so than in the area of the neuropsy-
chological manifestations of AIDS, because age is an
Copyright © Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
From the Departments of Psychiatry, Neurology, Psychology, and Epidemiology, University of Pittsburgh School of Medicine,
Pittsburgh, PA, USA.
Correspondence to James T. Becker, PhD, Neuropsychology Research Program, Suite 830, 3501 Forbes Avenue, Pittsburgh, PA
Tel: +1 412 624 0142; fax: +1 412 383 1755
ISSN 0269-9370 & & 2004 Lippincott Williams & Wilkins
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AIDS 2004, Vol 18 (suppl 1)S18