Self-perceived cognitive fluctuations and their relationship to everyday functioning in older adults with and without HIV disease

Abstract

Objective: HIV is associated with elevated performance-based cognitive intra-individual variability (IIV) in the laboratory that can reflect difficulty regulating cognitive resources over time (i.e., cognitive fluctuations) and disrupt everyday functioning. Whether persons living with HIV (PLWH) experience appreciable cognitive fluctuations in their daily lives is unclear. This study examined the presence of cognitive fluctuations and their relationship to everyday functioning in PLWH. Methods: Participants were 145 PLWH and 61 seronegative individuals age ≥ 50 years who completed a self-report version of the Mayo Fluctuations Scale (MFS), structured psychiatric interview, medical evaluation, and well-validated measures of mood, cognitive symptoms, and activities of daily living (ADLs). A confirmatory factor analysis of the MFS yielded three factors, including a 7-item cognitive fluctuations scale. Results: Univariable analyses showed that HIV was associated with moderately higher MFS Cognitive Fluctuation subscale scores (d = 0.46), but this effect was no longer significant a multiple regression model that included medical comorbidities and affective disorders, which emerged as unique predictors. Of clinical relevance, higher MFS Cognitive Fluctuation subscale scores were independently associated with more frequent cognitive symptoms and dependence in ADLs in the full sample. Conclusions: Higher frequency of self-perceived cognitive fluctuations disrupts management of ADLs among middle-aged and older adults independent of HIV status and general cognitive symptoms. Future studies are needed to understand the full clinical significance of self-perceived cognitive fluctuations among PLWH and their impact on daily life.

Keywords:

• Neuropsychological assessment
• infectious disease
• daily functioning
• geropsychology
• psychometric

Acknowledgments

We are especially grateful to Donald Franklin, Dr. Erin Morgan, Clint Cushman, and Stephanie Corkran for their assistance with data processing, Marizela Verduzco for her assistance with study management, Dr. Scott Letendre and Dr. Ronald J. Ellis for their assistance with the neuromedical aspect of the parent project, and Dr. J. Hampton Atkinson and Jennifer Marquie Beck for their assistance with participant recruitment and retention. The views written in this article are those of the authors and do not reflect the official policy or position of the Department of the Navy, Department of Defense, or the United States Government. The authors also thank the study volunteers for their participation. Dr. Kiselica has protected time for research under a National Institute on Aging IMPACT Collaboratory Career Development Award (UC401).

Disclosure statement

No potential conflict of interest was reported by the authors.

Notes

1 Simple pair-wise correlations were 0.74 and 0.59 between the Cognitive Fluctuations and Attention/Executive Function subscales and the Cognitive Fluctuations and Confusion/Arousal subscales, respectively.

2 Exploratory post hoc analyses demonstrated that HIV status did not interact with any of the covariates included in the model (ps > 0.20).

Additional information

Funding

This research was supported by National Institutes of Health grants R01-MH073419 and P30-MH062512. We would like to thank the University of California, San Diego HIV Neurobehavioral Research Program (HNRP) Group (I. Grant, PI) for their infrastructure support of the parent R01.