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Factors associated with anxiety, depression and cognitive impairment in elderly patients receiving HAART

Background

Although depression, anxiety and cognitive impairment are commonly seen in HIV-positive patients, to date most studies have not focused on aging subjects. We examined frequency and determinants of depression, anxiety and cognitive impairment in patients aged >50 years.

Methods

Cross-sectional study of 169 HAART-treated HIV-infected patients aged >50 years. Patients were administered the IPAT Anxiety Scale Questionnaire (ASQ), the IPAT Depression Scale Questionnaire (CDQ), and a battery of 17 standardized neuropsychological tests (NPT) as part of psychiatric, medical, and laboratory assessment.

Summary of results

Patient characteristics: age 56.8 years (mean, range 50–85), male gender 82.8%, CD4 count 555/cmm (mean, SD +347), subjects with HIV-RNA <50 cp/mL 70.7%, patients with previous AIDS events 43.8%, current HAART schemes: EFV-based 32.5%, PI-based 63.3%, and NVP-based 4.1% patients. Overall, scores consistent with anxiety (ASQ score>6) and depression (CDQ score>5) were observed in 66.9% and in 54.4% of patients. Cognitive impairment (<1 SD from the normative mean on >2 age and gender adjusted NPT, or <2 SD from the mean on >1 adjusted NPT) was present in 46.8% patients. Cognitive performance was not influenced by anxiety and depression scores. Similarly, age, sex, risk factors, CDC stage, plasma HIV-RNA, duration of HAART exposure were not related to anxiety and depression scores. Patients aged >60 years had greater impairment at NPT than patients aged 50–60 years (mean NPT-Z4 score: -2.0 vs. -0.7; p = 0.002). Moreover, patients with ASQ scores consistent with anxiety had CD4 counts lower than patients reporting no anxiety (mean CD4 count/cmm 447 vs. 598; p = 0.026). Finally, EFV-treated patients were more likely to show summary scores consistent with absence of both depression (CDQ<5: 41.8% vs. 60.5%; p = 0.022) and anxiety (ASQ<6: 54.5% vs. 72.8%; p = 0.018) than PI-treated subjects.

Conclusion

Anxiety and depression were reported in nearly two-thirds of patients aged >50 years. Anxiety was associated with low CD4 cell count. Cognitive impairment was present in almost 50% of patients aged >50 years. Cognitive decline increased with increasing age. By contrast, anxiety and depression did not influence cognitive performance. Anxiety and depression were less common in EFV-treated patients, suggesting a prescription bias. Physicians must be aware of the high prevalence of psychiatric and cognitive disturbances in HIV patients aged >50 years.

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Open Access This article is published under license to BioMed Central Ltd. This is an Open Access article is distributed under the terms of the Creative Commons Attribution 2.0 International License (https://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Liuzzi, G., Menichetti, S., Libertone, R. et al. Factors associated with anxiety, depression and cognitive impairment in elderly patients receiving HAART. JIAS 11, P292 (2008). https://doi.org/10.1186/1758-2652-11-S1-P292

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  • DOI: https://doi.org/10.1186/1758-2652-11-S1-P292

Keywords

  • Cognitive Impairment
  • Cognitive Performance
  • Depression Score
  • Cognitive Disturbance
  • Standardize Neuropsychological Test