title: Psychiatric and neurocognitive disorders among HIV-positive and negative veterans in care: Veterans Aging Cohort Five-Site Study.
abstract: BACKGROUND
  The risk for psychiatric and neurocognitive disorders among middle-aged and older individuals with HIV infection has not been well characterized.
  
  
  METHODS
  The Veterans Aging Cohort 5-Site Study enrolled 1803 patients (1047 HIV-positive) from VA infectious disease and general medicine clinics from September 2001 to June 2002. A convenience subset of 10 patients from each site (n = 50) was consented for formal neurocognitive and psychiatric (NCP) testing. Data from this subset were linked to the larger sample.
  
  
  RESULTS
  Kappa scores for agreement beyond chance were fair for available measures when compared with formal NCP testing. Using available measures, depressive symptoms (PHQ-9 and provider reported), alcohol abuse or dependence (ICD-9 codes), and drug abuse or dependence (DAST-10) decreased with age in HIV-negative subjects (P trend <0.05) but did not among HIV-positive subjects (P > 0.05). HIV-positive subjects demonstrated higher prevalence of these conditions with increasing age when compared to HIV-negative subjects. Patient report of memory problems increased with age among both groups after excluding those reporting symptoms of depression (PHQ-9e > or = 10).
  
  
  CONCLUSIONS
  Available measures were no substitute for formal NCP testing. Older HIV-positive veterans demonstrate greater prevalence of depressive symptoms, alcohol abuse or dependence, and drug abuse or dependence than age-matched, HIV-negative veterans. Both groups reported increased memory problems with advancing age. This preliminary work suggests a substantial prevalence of psychiatric and neurocognitive problems among middle-aged and older HIV-infected individuals.
authors.affiliation: Veterans Aging Cohort Study Center, VA Pittsburgh Healthcare System, and University of Pittsburgh Center for Research on Health Care, School of Medicine, Division of General Internal Medicine, Pennsylvania, USA.
authors.forename: Amy C
authors.initials: AC
authors.lastname: Justice
authors.forename: Kathleen A
authors.initials: KA
authors.lastname: McGinnis
authors.forename: J Hampton
authors.initials: JH
authors.lastname: Atkinson
authors.forename: Robert K
authors.initials: RK
authors.lastname: Heaton
authors.forename: Corinna
authors.initials: C
authors.lastname: Young
authors.forename: Joseph
authors.initials: J
authors.lastname: Sadek
authors.forename: Tamra
authors.initials: T
authors.lastname: Madenwald
authors.forename: James T
authors.initials: JT
authors.lastname: Becker
authors.forename: Joseph
authors.initials: J
authors.lastname: Conigliaro
authors.forename: Sheldon T
authors.initials: ST
authors.lastname: Brown
authors.forename: David
authors.initials: D
authors.lastname: Rimland
authors.forename: Steve
authors.initials: S
authors.lastname: Crystal
authors.forename: Michael
authors.initials: M
authors.lastname: Simberkoff
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging / Q000502:physiology; D000428:Alcohol Drinking; D003072:Cognition Disorders / Q000150:complications / Q000453:epidemiology; D015331:Cohort Studies; D003866:Depressive Disorder / Q000150:complications / Q000453:epidemiology; D005260:Female; D018023:HIV Seronegativity; D006679:HIV Seropositivity / Q000150:complications* / Q000453:epidemiology / Q000523:psychology; D006801:Humans; D008297:Male; D008569:Memory Disorders / Q000150:complications / Q000453:epidemiology; D001523:Mental Disorders / Q000150:complications* / Q000453:epidemiology; D008875:Middle Aged; D009483:Neuropsychological Tests; D015995:Prevalence; D019966:Substance-Related Disorders / Q000150:complications / Q000453:epidemiology