Comparative prevalence of mild cognitive impairment of Alzheimer’s Disease sub‐type in Adult Ugandans living with HIV and demographically matched HIV‐negative controls

Abstract

AbstractBackgroundPrevalence rate of mild cognitive impairment (MCI) and Alzheimer’s dementia (AD) in cART treated people living with HIV (PWH) is unknown.Method277 PWH and 189 HIV‐negative Ugandan adults matched by age, sex, and residence were neuropsychologically evaluated i. Impairment in seven domains ‐ including immediate recall, memory and learning (delayed recall, recognition) and others, were defined. Cognitive status – i.e., not impaired, asymptomatic impairment (ANI), minor neurocognitive disorder (MND) or HIV‐associated dementia (i.e., HAD, if HIV+), was defined according to Frascatti criteria. Cognitive dysfunction of the AD subtype was defined per Bondi et al. (2014); MCI included moderate (i.e. ≥1 SD worse in ≥2 tests) or pronounced (i.e. >2.0 SD worse in ≥1 tests) cognitive impairments without functional limitation. AD ‐ i.e., ≥1 pronounced impairment in recognition/delayed recall accompanied with functional limitation. Differences in MCI and AD by HIV status and odds ratios with 95% confidence intervals (CI) were calculated stratified by age (<60 vs. ≥60 years).ResultAmong adults cognitively unimpaired (26.1%) or with ANI (27.8%), amnestic MCI rate was 28.9% (60/204) among PWH and 14.7% (21/133) among HIV‐ controls (OR = 2.18, 95%CI:1.25, 3.84). Similarly, among adults with MND/HAD, prevalent AD was 38.7% (29/75) among PWH and 23% (14/61) among HIV‐ controls (OR = 2.11, 95%CI:0.99, 4.50). Among cognitively unimpaired/ANI affected individuals <60 years old, amnestic MCI prevalence was 16.2% for community controls and 30.3% for PWH (OR = 1.9, 95%CI:1.02, 3.60). Among individuals classified as MND or HAD, prevalent AD was 16.3% for HIV‐ controls vs. 38.6% for PWH (OR = 3.23, 95% CI: 1.23, 8.52) . Among adults 60+ years old with ANI/no impairment, prevalent amnestic MCI was 14.7% for community controls and 41.9% for PWH (OR = 4.04, 95%CI:1.23, 13.40) but the prevalence of AD was identical at 38.9% each for HIV+ and for HIV‐ controls 60+ years old with MND/HAD.ConclusionUgandan PWH are at increased risk for being diagnosed with MCI/AD, and they may be diagnosed at a younger age than HIV‐negative Ugandans. These data highlight the importance of MCI/AD screening in PWH and the need to avail PWH with interventions to mitigate MCI/AD risk.