Evaluating Prevalence of Cognitive Impairment in Older People Living with HIV Served by a Community‐Based Organization in Colorado, USA

Abstract

AbstractBackgroundOlder people living with HIV (PLWH) experience unique pathophysiology contributing to accelerated and accentuated aging when compared to older adults living without HIV. Indeed, cognitive dysfunction is a significant age‐related risk exacerbated by HIV. This study investigated prevalence of Mild Cognitive Impairment (MCI) in older PLWH by employing the Montreal Cognitive Assessment (MoCA), which has a high sensitivity for assessing cognitive performance, and its relationship with HIV health, socioeconomic status, and functional aptitude.MethodA cross‐sectional study was conducted in older PLWH ≥50 years receiving HIV‐related care and services at a Community‐Based Organization (CBO) between June and October 2022. The MoCA English Version (8.1) was used to screen cognitive performance. MCI was defined as MoCA scores 18‐26; 10‐17 for moderate cognitive impairment (MoCI); and ≤9 for dementia. Functional aptitude was measured by participants’ Ryan White Part A Wellness acuity scores (0‐41), where higher scores are indicative of lower functional aptitude.ResultDuring the study period, 31 participants were screened; 64.5% were male and 88.9% had virologic suppression. The median age was 60.7 (standard deviation [SD] 6.3) and the median years living with HIV was 23 years (SD 8.9). The median MoCA score was 23 (SD 3.5): 21 (67.7%) with MCI; 3 (9.7%) with MoCI. The median acuity score was 18 (SD 11.9): 21 (SD 11.8) for MCI; 28 (SD 8.5) for MoCI. Multivariable linear regression analysis revealed that a lower MoCA score was associated with lower educational attainment (≤12 years) (r = 0.671, p = 0.0276) and low annual income (r = 0.789, p = 0.0043). A higher acuity score was not significantly associated with MoCA scores.ConclusionA majority of older PLWH screened were within range for M/MoCI. Thus, it is both necessary and ethically responsible for CBO’s serving older PLWH to integrate routine cognitive screening to identify early and pre‐symptomatic stages of impairment, providing prompt services to reduce symptoms and improve health outcomes.