title: Effects of HIV-1 infection and aging on neurobehavioral functioning: preliminary findings.
abstract: OBJECTIVE
  The effects of aging on the presentation of HIV-associated neurocognitive disorders are largely unknown. In a cross-sectional observational study, we compared the neuropsychological profiles of 67 HIV-positive patients aged at least 50 years with those of 52 participants aged 35 years or less.
  
  
  METHODS
  Participants received neuropsychological, psychiatric and neuromedical evaluations. Raw neuropsychological test scores were converted to demographically corrected T-scores; all were corrected for the effects of normal aging. Clinical ratings of impairment were assigned to the neuropsychological results.
  
  
  RESULTS
  The two groups did not differ statistically with respect to demographic variables, percentage with AIDS, or CD4 cell counts. The 'younger' group had higher viral burdens in plasma and cerebrospinal fluid (CSF), and fewer were receiving antiretroviral treatment. The proportion of neuropsychologically impaired subjects in the 'older' group was slightly greater than in the younger group, and the older group tended to have higher rates of impairment across most ability domains. When group differences in CSF viral load were modeled statistically, both viral burden and age were significant predictors of neuropsychological impairment, together with a significant interaction between viral burden and age. Older individuals with detectable virus in CSF had twice the prevalence of neuropsychological impairment of those with undetectable levels. Among younger individuals, this proportion was not affected by viral load. Lifetime major depression, substance use disorder, and current depression symptoms were not associated with neuropsychological impairment.
  
  
  CONCLUSIONS
  Although further studies with larger and older samples are needed, this investigation suggests that older adults may be at greater risk of HIV-related neurocognitive dysfunction.
authors.affiliation: Department of Psychiatry, University of California San Diego, La Jolla, 92093-0603, USA.
authors.forename: Marianna
authors.initials: M
authors.lastname: Cherner
authors.forename: Ronald J
authors.initials: RJ
authors.lastname: Ellis
authors.forename: Deborah
authors.initials: D
authors.lastname: Lazzaretto
authors.forename: Corinna
authors.initials: C
authors.lastname: Young
authors.forename: Monica Rivera
authors.initials: MR
authors.lastname: Mindt
authors.forename: J Hampton
authors.initials: JH
authors.lastname: Atkinson
authors.forename: Igor
authors.initials: I
authors.lastname: Grant
authors.forename: Robert K
authors.initials: RK
authors.lastname: Heaton
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000150:complications / Q000503:physiopathology / Q000523:psychology; D000328:Adult; D000375:Aging / Q000502:physiology*; D023241:Antiretroviral Therapy, Highly Active; D002490:Central Nervous System / Q000821:virology; D003072:Cognition Disorders / Q000209:etiology* / Q000503:physiopathology; D003866:Depressive Disorder / Q000209:etiology / Q000503:physiopathology; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000503:physiopathology* / Q000523:psychology; D015497:HIV-1; D006801:Humans; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D019966:Substance-Related Disorders / Q000209:etiology / Q000503:physiopathology; D019562:Viral Load / Q000379:methods