Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2010 Sep 7;75(10):864-73.
doi: 10.1212/WNL.0b013e3181f11bd8. Epub 2010 Aug 11.

Cardiovascular risk factors associated with lower baseline cognitive performance in HIV-positive persons

E J Wright  1 , B Grund, K Robertson, B J Brew, M Roediger, M P Bain, F Drummond, M J Vjecha, J Hoy, C Miller, A C Penalva de Oliveira, W Pumpradit, J C Shlay, W El-Sadr, R W Price; INSIGHT SMART Study Group
Affiliations
Randomized Controlled Trial

Cardiovascular risk factors associated with lower baseline cognitive performance in HIV-positive persons

E J Wright et al. Neurology. .

Abstract

Objective: To determine factors associated with baseline neurocognitive performance in HIV-infected participants enrolled in the Strategies for Management of Antiretroviral Therapy (SMART) neurology substudy.

Methods: Participants from Australia, North America, Brazil, and Thailand were administered a 5-test neurocognitive battery. Z scores and the neurocognitive performance outcome measure, the quantitative neurocognitive performance z score (QNPZ-5), were calculated using US norms. Neurocognitive impairment was defined as z scores <-2 in two or more cognitive domains. Associations of test scores, the QNPZ-5, and impairment with baseline factors including demographics and risk factors for HIV-associated dementia (HAD) and cardiovascular disease (CVD) were determined in multiple regression.

Results: The 292 participants had a median CD4 cell count of 536 cells/mm(3), 88% had an HIV viral load < or =400 copies/mL, and 92% were taking antiretrovirals. Demographics, HIV, and clinical factors differed between locations. The mean QNPZ-5 score was -0.72; 14% of participants had neurocognitive impairment. For most tests, scores and z scores differed significantly between locations, with and without adjustment for age, sex, education, and race. Prior CVD was associated with neurocognitive impairment. Prior CVD, hypercholesterolemia, and hypertension were associated with poorer neurocognitive performance but conventional HAD risk factors and the CNS penetration effectiveness rank of antiretroviral regimens were not.

Conclusions: In this HIV-positive population with high CD4 cell counts, neurocognitive impairment was associated with prior CVD. Lower neurocognitive performance was associated with prior CVD, hypertension, and hypercholesterolemia, but not conventional HAD risk factors. The contribution of CVD and cardiovascular risk factors to the neurocognition of HIV-positive populations warrants further investigation.

PubMed Disclaimer

Figures

None
Figure z Scores and summary QNPZ-5 for 5 neuropsychological tests, by location Box plots show the distributions of baseline z scores of 292 participants; 102 participants were enrolled in Australia and North America, 45 in Brazil, and 145 in Thailand. Brackets below the location labels connect pairs of locations where mean scores are not significantly different. Boxes show the interquartile range; the horizonta line in the box denotes the median; the diamond denotes the mean. Whiskers extend 1.5 times the interquartile range above and below the z score quartiles. Circles denote outliers. Au = Australia; Br = Brazil; CT = Color Trails Test; FT = Finger Tapping Test; GPB = Grooved Pegboard Test; NA = North America; QNPZ-5 = quantitative neurocognitive performance z score; TG = Timed Gait Test; Thai = Thailand.
See this image and copyright information in PMC

Comment in

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. McArthur JC Hoover DR Bacellar H et al. Dementia in AIDS patients: incidence and risk factors: Multicenter AIDS Cohort Study. Neurology. 1993;43:2245–2252. - PubMed
    1. Bhaskaran K Mussini C Antinori A et al. Changes in the incidence and predictors of human immunodeficiency virus-associated dementia in the era of highly active antiretroviral therapy. Ann Neurol. 2008;63:213–221. - PubMed
    1. El-Sadr WM Lundgren JD Neaton JD et al. CD4+ count-guided interruption of antiretroviral treatment. N Engl J Med. 2006;355:2283–2296. - PubMed
    1. Anstey KJ von Sanden C Salim A O'Kearney R Smoking as a risk factor for dementia and cognitive decline: a meta-analysis of prospective studies. Am J Epidemiol. 2007;166:367–378. - PubMed
    1. Hayden KM Zandi PP Lyketsos CG et al. Vascular risk factors for incident Alzheimer disease and vascular dementia: the Cache County study. Alzheimer Dis Assoc Disord. 2006;20:93–100. - PubMed

Publication types

MeSH terms