Veterans Aging Cohort Study Index 2.0 Shows Improved Discrimination of Neurocognitive Impairment and Frailty in People with HIV

Abstract

Objective: This study examined whether the revised VACS2.0 index (including serum albumin, body mass index (BMI), and white blood cell (WBC) count) had stronger correlations with cognitive function, brain volume, and frailty in PWH ≥ 50 years compared to the VACS1.0. Design and Methods: Neuropsychological performance (NP) Z-scores (learning, retention, executive functioning (EF), psychomotor function/processing speed (PM/PS), language, and global cognition), and neuroimaging measures (brain volumetrics) were analyzed in PWH (n = 162). A subset of the sample (n = 159) was defined as either frail (n = 18) or non-frail (n = 141) according to the Fried phenotype criteria. Brain volumes, NP scores, and frailty subgroups were analyzed with both VACS scores, albumin, BMI, and WBC count using Pearson's significance tests and independent T-tests. Results: Higher VACS scores significantly correlated with lower brain volumes. Higher VACS2.0 scores were associated with lower NP in the EF and PM/PS domains and were primarily driven by albumin. VACS1.0 scores did not correlate with cognition Z-scores. There was no relationship between frailty status and VACS1.0. PWH who were frail had significantly greater VACS2.0 scores than non-frail PWH. Conclusions: The addition of albumin to the VACS index improved its correlations with NP and frailty in PWH. While low albumin levels may contribute to cognitive decline or frailty, the reverse causality should also be considered. These findings suggest that the VACS2.0 index (especially albumin) is a valuable measure for clinicians to improve outcomes in PWH.