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Baseline neurocognitive impairment (NCI) is associated with incident frailty but baseline frailty does not predict incident NCI in older persons with HIV.
Clin Infect Dis. 2021 Feb 13 [Online ahead of print]CI

Abstract

BACKGROUND

Neurocognitive impairment (NCI) and frailty are more prevalent among persons with HIV (PWH) compared to those without HIV. Frailty and NCI often overlap with one another. Whether frailty precedes declines in neurocognitive function among PWH or vice versa has not been well-established.

SETTING

AIDS Clinical Trials Group (ACTG) A5322 is an observational cohort study of older PWH. Participants undergo annual assessments for NCI and frailty.

METHODS

ACTG A5322 participants who developed NCI as indexed by tests of impaired executive functioning and processing speed during the first 3 years were compared to persons who maintained normal cognitive function; those who demonstrated resolution of NCI were compared to those who had persistent NCI. Participants were similarly compared by frailty trajectory. We fit multinomial logistic regression models to assess associations between baseline covariates (including NCI) and frailty, and associations between baseline covariates (including frailty) and NCI.

RESULTS

929 participants were included with a median age of 51 years (IQR 46-56). At study entry, 16% had NCI and 6% were frail. Over 3 years, 6% of participants developed NCI; 5% developed frailty. NCI was associated with development of frailty (odds ratio [OR]=2.06; 95% confidence interval [CI]=0.94, 4.48; p=0.07). Further adjustment for confounding strengthened this association (OR=2.79; 95% CI=1.21, 6.43; p=0.02). Baseline frailty however was not associated with NCI development.

CONCLUSIONS

NCI was associated with increased risk of frailty, but frailty was not associated with development of NCI. These findings suggest that the presence of NCI in PWH should prompt monitoring for the development of frailty and interventions to prevent frailty in this population.

Authors+Show Affiliations

No affiliation info availableJeremiah Perez, PhD, Harvard T. H. Chan School of Public Health, Boston, MA, USA.Kunling Wu, MS, Harvard T. H. Chan School of Public Health, Boston, MA, USA.Ronald J. Ellis, MD, PhD, University of California, San Diego, CA, USA.Karl Goodkin, MD, PhD, University of Nebraska Medical Center, Omaha, NE, USA.Susan L. Koletar, MD, The Ohio State University, Columbus, OH, USA.Adriana Andrade, MD, DHHS/NIH/NIAID/DAIDS, Rockville, MD, USA.Jingyan Yang, DrPH, Columbia University, New York, NY, USA.Todd T. Brown, MD, PhD, Johns Hopkins University, Baltimore, MD, USA.Frank J. Palella, MD, Division of Infectious Diseases, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.Ned Sacktor, MD, Johns Hopkins University, Baltimore, MD, USA.Katherine Tassiopoulos, DSc, MPH, Harvard T. H. Chan School of Public Health, Boston, MA, USA.Kristine M. Erlandson, MD, University of Colorado- Anschutz Medical Campus, Aurora, CO, USA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

33580258

Citation

Masters, Mary Clare, et al. "Baseline Neurocognitive Impairment (NCI) Is Associated With Incident Frailty but Baseline Frailty Does Not Predict Incident NCI in Older Persons With HIV." Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America, 2021.
Masters MC, Perez J, Wu K, et al. Baseline neurocognitive impairment (NCI) is associated with incident frailty but baseline frailty does not predict incident NCI in older persons with HIV. Clin Infect Dis. 2021.
Masters, M. C., Perez, J., Wu, K., Ellis, R., Goodkin, K., Koletar, S. L., Andrade, A., Yang, J., Brown, T. T., Palella, F. J., Sacktor, N., Tassiopoulos, K., & Erlandson, K. M. (2021). Baseline neurocognitive impairment (NCI) is associated with incident frailty but baseline frailty does not predict incident NCI in older persons with HIV. Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America. https://doi.org/10.1093/cid/ciab122
Masters MC, et al. Baseline Neurocognitive Impairment (NCI) Is Associated With Incident Frailty but Baseline Frailty Does Not Predict Incident NCI in Older Persons With HIV. Clin Infect Dis. 2021 Feb 13; PubMed PMID: 33580258.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Baseline neurocognitive impairment (NCI) is associated with incident frailty but baseline frailty does not predict incident NCI in older persons with HIV. AU - Masters,Mary Clare, AU - Perez,Jeremiah, AU - Wu,Kunling, AU - Ellis,Ronald, AU - Goodkin,Karl, AU - Koletar,Susan L, AU - Andrade,Adriana, AU - Yang,Jingyan, AU - Brown,Todd T, AU - Palella,Frank J, AU - Sacktor,Ned, AU - Tassiopoulos,Katherine, AU - Erlandson,Kristine M, Y1 - 2021/02/13/ PY - 2020/08/12/received PY - 2021/2/13/entrez PY - 2021/2/14/pubmed PY - 2021/2/14/medline KW - Frailty KW - HIV and aging KW - neurocognitive impairment JF - Clinical infectious diseases : an official publication of the Infectious Diseases Society of America JO - Clin Infect Dis N2 - BACKGROUND: Neurocognitive impairment (NCI) and frailty are more prevalent among persons with HIV (PWH) compared to those without HIV. Frailty and NCI often overlap with one another. Whether frailty precedes declines in neurocognitive function among PWH or vice versa has not been well-established. SETTING: AIDS Clinical Trials Group (ACTG) A5322 is an observational cohort study of older PWH. Participants undergo annual assessments for NCI and frailty. METHODS: ACTG A5322 participants who developed NCI as indexed by tests of impaired executive functioning and processing speed during the first 3 years were compared to persons who maintained normal cognitive function; those who demonstrated resolution of NCI were compared to those who had persistent NCI. Participants were similarly compared by frailty trajectory. We fit multinomial logistic regression models to assess associations between baseline covariates (including NCI) and frailty, and associations between baseline covariates (including frailty) and NCI. RESULTS: 929 participants were included with a median age of 51 years (IQR 46-56). At study entry, 16% had NCI and 6% were frail. Over 3 years, 6% of participants developed NCI; 5% developed frailty. NCI was associated with development of frailty (odds ratio [OR]=2.06; 95% confidence interval [CI]=0.94, 4.48; p=0.07). Further adjustment for confounding strengthened this association (OR=2.79; 95% CI=1.21, 6.43; p=0.02). Baseline frailty however was not associated with NCI development. CONCLUSIONS: NCI was associated with increased risk of frailty, but frailty was not associated with development of NCI. These findings suggest that the presence of NCI in PWH should prompt monitoring for the development of frailty and interventions to prevent frailty in this population. SN - 1537-6591 UR - https://www.unboundmedicine.com/medline/citation/33580258/Baseline_neurocognitive_impairment__NCI__is_associated_with_incident_frailty_but_baseline_frailty_does_not_predict_incident_NCI_in_older_persons_with_HIV_ L2 - https://academic.oup.com/cid/article-lookup/doi/10.1093/cid/ciab122 DB - PRIME DP - Unbound Medicine ER -
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