Pariya L. Fazeli

Successful aging and the epidemiology of HIV.

By 2015, it is estimated that nearly half of those living with HIV in the US will be 50 years of age and older. This dramatic change in the demographics of this clinical population represents unique challenges for patients, health care providers, and society-at-large. Fortunately, because of highly active antiretroviral therapy (HAART) and healthy lifestyle choices, it is now possible for many infected with HIV to age successfully with this disease; however, this depends upon one’s definition of successful aging. It is proposed that successful aging is composed of eight factors: length of life, biological health, cognitive efficiency, mental health, social competence, productivity, personal control, and life satisfaction. Unfortunately, HIV and medication side effects can compromise these factors, thus diminishing one’s capacity to age successfully with this disease. This article explores how HIV, medication side effects from HAART, and lifestyle choices can compromise the factors necessary to age successfully. Implications for practice and research are posited.

How Neuroplasticity and Cognitive Reserve Protect Cognitive Functioning

Overall cognitive status can vary across an individuals life span in response to factors that promote either positive or negative neuroplasticity. Positive neuroplasticity refers to he physiological ability of the brain to form and strengthen dendritic connections, produce beneficial morphological changes, and increase cognitive reserve. Negative neuroplasticity refers to the same physiological ability of t he brain to atrophy and weaken dendritic connections, produce detrimental morphological changes, and decrease cognitive reserve. Factors that promote positive neuroplasticity include physical activity, education, social interaction, intellectual pursuits, and cognitive remediation. Factors that promote negative neuroplasticity include poor health, poor sleep hygiene, poor nutrition, substance abuse, and depression and anxiety. Implications for promoting positive neuroplasticity and avoiding negative neuroplasticity across the life span are emphasized to facilitate optimal cognitive health and ensure successful cognitive aging.

Speed of Processing Training With Middle-Age and Older Adults With HIV: A Pilot Study

&NA; Adults with HIV are at risk for deficits in speed of processing that can interfere with performing instrumental activities of daily living. In this pilot study, 46 middle‐age and older adults with HIV were assigned to 10 hours of computerized speed of processing training (n = 22) or to a no‐contact control condition (n = 24). ANCOVAs were used to examine treatment effects on a neurocognitive battery and the Timed Instrumental Activities of Daily Living (TIADL) Test. Treatment effects were detected on the Useful Field of View Test, F(1, 43) = 4.29, p = .04 and the TIADL Test, F(1, 43) = 5.02, p = .03; those in the experimental condition improved on these measures. Many of the participants also indicated that they felt the training improved their cognitive functioning. This study demonstrated that speed of processing training may improve cognitive and everyday functioning in this growing population.

The veterans aging cohort study index is associated with concurrent risk for neurocognitive impairment.

Objective:The Veterans Aging Cohort Study (VACS) Index is predictive of mortality and combines age, traditional HIV biomarkers (HIV-1 plasma RNA and current CD4 count), and non-HIV biomarkers (indicators of renal and liver function, anemia, and hepatitis C coinfection). We examined the association between the VACS Index and HIV-associated neurocognitive impairment (NCI). Design and Methods:Participants included 601 HIV-infected adults enrolled in cohort studies at the University of California, San Diego, HIV Neurobehavioral Research Program (ages: 18–76 years; 88% male; 63% white; median current CD4 = 364 cells/mm3; 63% on antiretroviral therapy; AIDS = 64%). Biomarkers used in calculating the VACS Index were measured in prospectively collected blood samples using conventional laboratory methods. NCI was defined using global and seven domain deficit scores. Results:Higher VACS Index scores were associated with concurrent risk for global NCI [P < 0.001; odds ratio = 1.21, confidence interval (CI): 1.12 to 1.32], even when adjusting for psychiatric comorbidities. This relation was statistically significant for most cognitive domains in adjusted models. Furthermore, the VACS Index predicted concurrent NCI beyond nadir CD4 and estimated duration of infection. Older age, lower hemoglobin, and lower CD4 counts were the VACS components most strongly linked to NCI. Conclusions:The findings extend previous research on the potential usefulness of the VACS Index in predicting HIV-associated outcomes to include NCI. Although the effect size was relatively small, our findings suggest that demographic information, HIV-disease factors, and common comorbidities might each play important roles in the clinical manifestation of cognitive impairment among HIV-infected individuals. Additional research is needed to determine if a more sensitive and specific index can be developed.

The impact of neuropsychological performance on everyday functioning between older and younger adults with and without HIV.

&NA; In this cross‐sectional study, a community‐based sample of 162 younger and older adults with and without HIV was compared on neuropsychological and everyday‐functioning measures. In the HIV sample, the relationship between cognition, everyday functioning, and HIV biomarkers was also examined. A battery of cognitive tests was completed along with two laboratory measures of everyday functioning and one measure of HIV medication adherence. Main effects for age and HIV were found on several neuropsychological measures and on the Timed Instrumental Activities of Daily Living test; those who were older or who had HIV exhibited poorer performance. Although age‐by‐HIV interactions were not observed, older adults with HIV as a group performed worse on eight out of the nine neuropsychological and everyday functioning measures. Few of these neuropsychological and everyday measures were related to HIV biomarkers (e.g., CD4+ T cell count). Implications for nursing practice and research are posited.

The relationship between computer experience and computerized cognitive test performance among older adults.

OBJECTIVE This study compared the relationship between computer experience and performance on computerized cognitive tests and a traditional paper-and-pencil cognitive test in a sample of older adults (N = 634). METHOD Participants completed computer experience and computer attitudes questionnaires, three computerized cognitive tests (Useful Field of View (UFOV) Test, Road Sign Test, and Stroop task) and a paper-and-pencil cognitive measure (Trail Making Test). Multivariate analysis of covariance was used to examine differences in cognitive performance across the four measures between those with and without computer experience after adjusting for confounding variables. RESULTS Although computer experience had a significant main effect across all cognitive measures, the effect sizes were similar. After controlling for computer attitudes, the relationship between computer experience and UFOV was fully attenuated. DISCUSSION Findings suggest that computer experience is not uniquely related to performance on computerized cognitive measures compared with paper-and-pencil measures. Because the relationship between computer experience and UFOV was fully attenuated by computer attitudes, this may imply that motivational factors are more influential to UFOV performance than computer experience. Our findings support the hypothesis that computer use is related to cognitive performance, and this relationship is not stronger for computerized cognitive measures. Implications and directions for future research are provided.

Predictors of Cognition in Adults with HIV: Implications for Nursing Practice and Research

The objective of this study was to identify predictors of cognitive performance among adults with HIV. Participants completed demographic, psychosocial, and mental and physical health questionnaires as well as cognitive measures of speed of processing, psychomotor ability and visuomotor coordination, attention and working memory, reasoning, and executive function. Hierarchical regression analyses were used to examine predictors of cognitive performance for each cognitive measure. Possible predictors included age, gender, socioeconomic status, Wide Range Achievement Test 3 Reading score (quality of education), social networks score, hardiness score, mood disturbance score, medical problems composite score, psychoactive drug use composite score, HIV chronicity, CD4+ lymphocyte cell count, and HIV medication usage. Model 1 examined demographic factors, and model 2 examined the contribution of the remaining variables on cognitive performance. Results revealed that several factors were predictive of cognitive functioning, with the individual regression models for each measure explaining 8% to 48% of the variability in performance. Overall, this study posits that among adults with HIV, the most consistent predictors of poorer cognition included older age, poorer reading ability, more depressed mood, CD4+ lymphocyte cell count less than 200, and lack of HIV medication usage. Results suggest that those aging with HIV are subject to decreases in cognitive functioning.

Complex interplay between health and successful aging: role of perceived stress, resilience, and social support.

Psychological and psychosocial resources, including resilience and social support, have traditionally been studied in the context of the stress paradigm and, more recently, in the context of successful aging. This study used moderated mediation analyses to examine the role of perceived stress in the relationships between physical and mental health functioning and self-rated successful aging (SRSA) and whether differences between people in level of resilience and social support changes the role of perceived stress in these relationships. A cross-sectional study of 1,006 older adults (mean age: 77 years) completed scales addressing SRSA, physical and mental health functioning, perceived stress, resilience, and social support. Results indicated that the strength of relationships between both physical and mental health functioning and SRSA were reduced after accounting for variation in level of perceived stress. The role of perceived stress in the association between mental health functioning and SRSA was found to be stronger among participants with the highest levels of resilience, and the influence of perceived stress on the degree of relationship between physical health functioning and SRSA was stronger among those with greatest social support. These findings suggest that interventions to reduce perceived stress may help break the link between disability and poor well-being in older adults. The findings further suggest that the impact of such interventions might differ depending on psychological resources (i.e., resilience) for mental health disabilities and external resources (i.e., social support) for those with physical health problems. The complex interplay of these factors should be taken into account in clinical settings.

Cognitive Functioning and Driving Simulator Performance in Middle-aged and Older Adults With HIV

&NA; Nearly half of people living with HIV experience cognitive deficits that may impact instrumental activities of daily living. As the number of people aging with HIV increases, concerns mount that disease‐related cognitive deficits may be compounded by age‐related deficits, which may further compromise everyday functions such as driving. In this cross‐sectional pilot study, during a 2.5‐hour visit, 26 middle‐aged and older adults (40 + years) were administered demographic, health, psychosocial, and driving habits questionnaires; cognitive assessments; and driving simulator tests. Although CD4+ T lymphocyte count and viral load were unrelated to driving performance, older age was related to poorer driving. Furthermore, poorer visual speed of processing performance (i.e., useful field of view) was related to poorer driving performance (e.g., average gross reaction time). Mixed findings were observed between driving performance and cognitive function on self‐reported driving habits of participants. Implications for these findings on nursing practice and research are posited.

Cognitive Prescriptions: A Nursing Approach to Increasing Cognitive Reserve

Nonpathological cognitive declines occur with aging and negatively affect everyday functioning and reduce quality of life. Many older adults, aware of such cognitive changes, seek ways to bolster their cognitive functioning. Evidence based on the cognitive aging literature supports a number of factors associated with cognitive functioning. These factors include physical exercise, intellectual exercise, nutrition, sleep hygiene, social interaction, and mood and emotional state. These factors can be manipulated and woven together by nurses and other health professionals to develop an easy-to-use, non-invasive cognitive prescription for improving the cognitive health of older adults. An example and directions for developing and implementing cognitive prescriptions are described.