title: Combined effects of aging and HIV infection on semantic verbal fluency: a view of the cortical hypothesis through the lens of clustering and switching.
abstract: The profile of HIV-associated neurocognitive disorders (HAND) has classically been characterized as "subcortical," but questions have arisen as to whether aging with HIV in the antiretroviral therapy era has subtly shifted the expression of HAND into a more "cortical" disorder (e.g., decay of semantic memory stores). We evaluated this hypothesis by examining semantic fluency and its component processes (i.e., clustering and switching) in 257 individuals across four groups stratified by age (<40 and ≥50 years) and HIV serostatus. Jonckheere-Terpstra tests revealed significant monotonic trends for the combined effects of HIV and aging on overall semantic (and letter) fluency and switching, but not cluster size, with greatest deficits evident in the older adults with HIV infection. Within the older HIV-infected cohort, poorer switching was uniquely associated with self-reported declines in instrumental activities of daily living and deficits in learning and executive functions, but not semantic memory. Results suggest that HIV infection and aging may confer adverse additive effects on the executive components of semantic fluency (i.e., switching), rather than a degradation of semantic memory stores (i.e., cluster size), which is a profile that is most consistent with combined frontostriatal neuropathological burden of these two conditions.
authors.affiliation: Department of Psychiatry, University of California, San Diego, San Diego, CA 92103, USA. jiudicello@ucsd.edu
authors.forename: Jennifer E
authors.initials: JE
authors.lastname: Iudicello
authors.forename: Steven Paul
authors.initials: SP
authors.lastname: Woods
authors.forename: Reena
authors.initials: R
authors.lastname: Deutsch
authors.forename: Igor
authors.initials: I
authors.lastname: Grant
mesh_terms: D000203:Activities of Daily Living / Q000523:psychology; D000328:Adult; D000368:Aged; D000375:Aging; D003072:Cognition Disorders / Q000175:diagnosis / Q000209:etiology*; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000473:pathology / Q000523:psychology; D006801:Humans; D007806:Language Disorders / Q000175:diagnosis / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D012660:Semantics; D014705:Verbal Behavior / Q000502:physiology*