SuperAging in HIV-infected Adults: Biopsychosocial Predictors of Neurocognitive Aging Trajectories

HIV 感染者的超级衰老：神经认知衰老轨迹的生物心理社会预测因子

基本信息

批准号：
10214507
负责人：
Rowan Saloner
金额：
$ 4.07万
依托单位：
UNIVERSITY OF CALIFORNIA, SAN DIEGO
依托单位国家：
美国
项目类别：
财政年份：
2019
资助国家：
美国
起止时间：
2019-09-01 至 2022-08-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10214507
关键词：
Acquired Immunodeficiency Syndrome Adult Age Aging Alzheimer&apos s Disease American Archives Atrophic Attention Biological Chronic Classification Clinical Cognitive Cognitive remediation Communication Data Databases Dependence Development Diabetes Mellitus Education Elderly Employment Exercise Geriatric Assessment Goals Growth HIV HIV antiretroviral Health Hepatitis C Heterogeneity Impaired cognition Individual Individual Differences Inflammation Intervention Investigation Lead Life Expectancy Longevity Maintenance Medical Mental Depression Mental Health Modeling Neurobehavioral Manifestations Neurobiology Neurocognition Neurocognitive Neurocognitive Deficit Neurologic Neuronal Plasticity Occupational Older Population Outcome Oxidative Stress Patient Self-Report Pattern Performance Physiological Population Proxy Quality of life Reporting Research Resources Risk Severity of illness Subgroup Syndrome Testing Therapeutic Intervention Time Variant Vulnerable Populations adverse outcome aged antiretroviral therapy archive data archived data biopsychosocial body system brain health cerebral atrophy cognitive reserve combat comorbidity daily functioning early onset experience frailty health related quality of life human old age (65+)improved indexing marijuana use neuroAIDS neuroinflammation neuropathology neuropsychiatry neurotoxic normal aging physical conditioning premature preservation preventive intervention programs relating to nervous system resilience secondary analysis sex stem stressor substance use theories working group

项目摘要

PROJECT SUMMARY/ABSTRACT The life expectancy of people living with HIV (PLWH) receiving antiretroviral therapy (ART) has steadily increased, with an estimated 50% of PLWH in the U.S. aged 50 years and older. Despite increased longevity in the ART-era, older PLWH are at enhanced risk for premature and accelerated development of geriatric syndromes, including neurocognitive impairment (NCI), frailty, and daily functioning dependence. NeuroHIV research preferentially studies adverse outcomes stemming from the combined neurobiological burdens of HIV and aging; however, one to two-thirds of older PLWH do not meet criteria for NCI. Despite the neurocognitive heterogeneity among neurocognitively `unimpaired' older PLWH, inter-individual differences in neurocognitive aging trajectories are poorly understood. We have recently characterized a subgroup of older PLWH with youthful neurocognition akin to that of a healthy 25 year-old, an age at which most neurocognitive capacities peak. These neurocognitively elite individuals, termed SuperAgers (SA), display comparable profiles of HIV disease severity as compared to their cognitively normal non-super and cognitively impaired counterparts, yet have better daily functioning, mental and physical health-related quality of life, fewer comorbidities, and higher premorbid IQ. These findings align with a model of cognitive and physiological reserve, suggesting that robust maintenance of cognitive and physiological resources enables SA to effectively combat the neural and physical stressors of aging with HIV. Nevertheless, these cross-sectional data do not address whether SA maintain maximal neurocognition over time, and whether such neurocognitive resilience converges with holistic indicators of biopsychosocial reserve. Assessing the validity of SA as a construct reflecting resilience against neurocognitive decline is critical toward identifying neuroprotective factors among the vulnerable population of older PLWH. Accordingly, the proposed F31 project aims to 1) characterize neurocognitive aging trajectories and determine their relation to SA in older PLWH; 2) determine biopsychosocial predictors of neurocognitive trajectories; and 3) examine potential effects of demographic, neuropsychiatric, substance use, and daily functioning factors on neurocognitive trajectories. The proposed research will employ latent growth mixture modeling using longitudinal, archival data of older PLWH from the CNS HIV Antiretroviral Therapy Effects Research program. The opportunities afforded via this F31 mechanism will facilitate the applicant's professional development toward becoming an independent academic neuropsychologist dedicated to promoting neurocognitive resilience among older PLWH.

项目概要/摘要接受抗逆转录病毒治疗（ART）的艾滋病毒感染者（PLWH）的预期寿命稳步增长增加，估计美国 50% 的 PLWH 年龄在 50 岁及以上。尽管寿命增加在 ART 时代，老年 PLWH 的老年病过早和加速发展的风险增加综合征，包括神经认知障碍 (NCI)、虚弱和日常功能依赖。神经艾滋病毒研究优先研究艾滋病毒联合神经生物学负担引起的不良后果和老化；然而，一到三分之二的老年 PLWH 不符合 NCI 的标准。尽管神经认知神经认知“未受损”的老年感染者之间的异质性，神经认知的个体差异人们对衰老轨迹知之甚少。我们最近对老年 PLWH 的一个亚组进行了表征年轻的神经认知类似于健康的 25 岁，在这个年龄，大多数神经认知能力顶峰。这些神经认知精英个体，被称为超级老年人（SA），表现出类似的艾滋病病毒特征与认知正常的非超级和认知受损的同行相比，疾病的严重程度，但具有更好的日常功能、精神和身体健康相关的生活质量、更少的合并症以及更高的病前智商。这些发现与认知和生理储备模型相一致，表明稳健的认知和生理资源的维护使 SA 能够有效地对抗神经和身体艾滋病毒带来的衰老压力。然而，这些横截面数据并没有说明 SA 是否维持随着时间的推移，最大的神经认知能力，以及这种神经认知弹性是否与整体收敛生物心理社会储备指标。评估 SA 作为反映抵御能力的结构的有效性神经认知衰退对于确定弱势群体中的神经保护因素至关重要老年感染者。因此，拟议的 F31 项目旨在 1) 表征神经认知衰老轨迹并确定它们与老年 PLWH 中 SA 的关系； 2）确定神经认知的生物心理社会预测因子轨迹； 3) 检查人口统计、神经精神、物质使用和日常活动的潜在影响神经认知轨迹的功能因素。拟议的研究将采用潜在生长混合物使用来自 CNS HIV 抗逆转录病毒治疗效果的老年 PLWH 的纵向档案数据进行建模研究计划。通过此 F31 机制提供的机会将有利于申请人成为一名独立的学术神经心理学家的专业发展致力于促进老年感染者的神经认知弹性。