Accepted for/Published in: JMIR Public Health and Surveillance
Date Submitted: Aug 17, 2021
Date Accepted: Jun 26, 2022
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Depressive symptoms and level of physical activity mediate the associations between HIV sero-status and neurocognitive functions among individuals aged at least 50 years in China
ABSTRACT
Background:
Neurocognitive impairment are prevalent among older people. It is more problematic among older people living with HIV (PLWH). This study was to explore whether the association between HIV sero-status and neurocognitive performance was mediated by depressive symptoms and/or level of physical activity.
Objective:
Neurocognitive impairment are prevalent among older people in China. It is more problematic among older people living with HIV (PLWH). This study was to compare neurocognitive performance between older PLWH and HIV-negative controls, and to explore whether the association between HIV sero-status and neurocognitive performance was mediated by depressive symptoms and/or level of physical activity.
Methods:
A cross-sectional study was conducted in Yongzhou, China. All PLWH aged ≥50 years listed in the registry were invited. Frequency matching was used to sample HIV-negative controls according to the distribution of age, sex, and years of formal education of older PLWH. A total of 315 older PLWH and 350 HIV-negative controls completed the face-to-face interview and comprehensive neuropsychological assessment of seven domains (learning, memory, working memory, verbal fluency, processing speed, executive function and motor skills).
Results:
As compared to HIV-negative controls, older PLWH performed worse in global score and all seven domains (P<.05). Positive HIV sero-status was associated with higher depressive symptoms (P<.001) and lower level of physical activity (P<.001). Depressive symptoms and physical activity were negatively correlated (P<.001). Depressive symptoms and/or level of physical activity mediated the association between HIV sero-status and global score and four domain-specific neurocognitive performance (learning, memory, verbal fluency, and processing speed).
Conclusions:
Change in mental health and physical activity after HIV infection may partially explain why older PLWH are more susceptible to neurocognitive impairment. Promoting mental health and physical activity are potential entry points to slow down the progress of neurocognitive impairment among older PLWH.
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