Cognitive reserve attenuates the association between HIV serostatus and cognitive performance in adults living in the deep South

Abstract

Cognitive reserve has shown evidence of mitigating HIV-related effects on cognition in people living with HIV (PWH). In a sample of adults residing in the Deep South, an underrepresented subgroup in the neuroAIDS literature, we assessed the association between HIV serostatus and age on processing speed, visual attention, executive function, and episodic memory and the attenuating effect of cognitive reserve. Adults (n = 138; 72 PWH; M age = 58.7 years, SD = 7.9 years; 75% nonwhite race) were recruited from a university clinic and the community. Verbal abilities served as a proxy for cognitive reserve. Regressions accounting for race, alcohol usage, and depressive symptoms were conducted for each cognitive outcome. Indirect effects were tested using the PROCESS macro. Being HIV seropositive was associated with worse executive function (b = −1.04, SE = 0.38, p = .007) and episodic memory (b = −39.94, SE = 12.54, p = .002) performance. Every year of age above the mean and nonwhite race was associated with worse cognitive performance (ps < .05). The addition of cognitive reserve to the model attenuated the HIV serostatus associations with executive function (BC 95% CI −0.770, −0.001) along with most associations between race and cognitive outcomes. Age associations remained for all cognitive outcomes (ps < .05). Findings highlight the importance of including verbal ability proxies of cognitive reserve when assessing cognition in PWH. Highlighting modifiable cognitive processes, such as cognitive reserve, will further the development of targeted cognitive interventions in this at-risk population.

Keywords:

• Aging
• cognitive reserve
• episodic memory
• executive function
• HIV/AIDS

Acknowledgment

A special thank you to the UAB Center for Research on Applied Gerontology and UAB, UAB School of Nursing, UAB Department of Psychology, and UAB Translational Research for Injury Prevention (TRIP) Lab. K. Ball owns stock in the Visual Awareness Research Group (formerly Visual Awareness, Inc.), and Posit Science, Inc., the companies that market the Useful Field of View Test and speed of processing training software. Posit Science acquired Visual Awareness, and K. Ball continues to collaborate on the design and testing of these assessments and training programs as a member of the Posit Science Scientific Advisory Board.

Additional information

Funding

This article was supported by funding from the National Institute on Aging [K99 AG 048762-01 PI: Fazeli (A Novel Neurorehabilitation Approach for Cognitive Aging with HIV); P30 AG 022838-11 PI: Ball (Edward R. Roybal Center pilot grant)], National Institute of Mental Health [R25 MH108389 (Sustained Training on Aging and HIV Research; STAHR)], and the U.S. Department of Transportation Federal Highway Administration (FWHA) Dwight D. Eisenhower Graduate Fellowship Program.