Successful aging is something most of us strive for. But with aging comes a pervasive condition called fatigue that, for many older adults, interferes with daily functioning, mental health, social support and overall quality of life.
The relationship between fatigue and cognitive and functional impairment is of particular interest to people living with HIV (PLHIV), a patient population disproportionately affected but whose lifespan now matches that of the general population.
“Among people living with HIV, fatigue prevalence rates range from 30% to over 88%,” said Raeanne Moore, PhD, associate professor of psychiatry at the University of California, San Diego (UCSD). Health and co-author of a study examining fatigue. -enigma of cognition at PWH, says Medscape Medical News.
Moore and lead researcher Laura Campbell, a graduate student in clinical psychology at UCSD Health, were determined to unravel that relationship.
“Even though fatigue and changes in cognition are among the most reported symptoms in people living with HIV, there is not much information about the relationship, especially in older people living with HIV. “, explained Campbell.
HIV-related neurocognitive disorders also frequently interfere with independence and quality of life in this population.
Most affected processing speed
Investigators asked a cohort of 105 adults, 69 of whom were PWH and 36 HIV-negative, to complete a series of tests assessing cognitive domains, performance-based functional ability, and the ability to independently engage in daily tasks, and to self-report on measures of fatigue, depression, anxiety, sleep quality, and social functioning over a 4-week period. The participants were between 50 and 74 years old.
The results of the study, which were published in the journal AIDS confirmed that not only was fatigue significantly higher among PWH (particularly among the 94.2% on antiretroviral therapy) compared to their HIV-negative peers (P P = 0.003). This relationship remained strong even after controlling for current depression, anxiety, and sleep quality (P = .005).
Fatigue in PWH was largely driven by cognitive measures related to processing speed.
“When we think of processing speed, we really think of how quickly and accurately a person can complete a task presented to them,” Campbell explained. “Our processing speed tasks have both a motor and a non-motor component, and typically in people with depressive disorders or sleep disorders we see psychomotor retardation or… very slow processing speed” , she said.
The same seems to be true for HIV.
Significant fatigue-related cognitive deficits were observed in tests involving a speed or timed component and remained after adjustment for other disorders. Sample tests included Category Fluency, Letter Fluency, and Stroop’s Color-Word Test Interference Test (all P
Fatigue also affected the self-reported daily functioning of HIV-positive participants, even after adjusting for covariates, with results indicating a higher odds ratio (OR, 1.66) for each 10-point increase in fatigue (P = 0.039) for impaired ability to perform daily tasks independently (such as taking medication or managing finances).
Biological foundations, clinical interventions
Although the biological underpinnings of fatigue in HIV are still unclear, Campbell points to three theories: 1) modulation by thalamo-striato-cortical circuits that involve the basal ganglia, 2) inflammation (which is often elevated in PWH) and 3) mitochondrial inflammation. dysfunction. However, without a better understanding of the underlying mechanisms, it could be difficult to design specific treatments or treatment strategies.
Even without specific pharmacological treatments approved for fatigue in older PWH, it is important to address it and cognition during routine clinical visits.
“The association between fatigue and cognition and daily functioning is really meaningful to our patients; it impacts their daily lives every day,” said Judith Lee, NP, adult gerontology nurse practitioner at the Institute of human virology from the University of Maryland THRIVE (Together, Heal, Achieve, Inspire to Win Victory over Disease and Embrace Life) Program in Baltimore. Lee did not participate in the study.
“In our practice, we always ask patients if they experience fatigue as part of their systems review,” she said, noting that after ruling out other causes such as vitamin deficiency D or hypothyroidism, “patients were referred to outside sites for neuropsychological testing.”
But Lee acknowledged that, without more research, HIV-related fatigue is “a hard fix.”
Behavioral strategies may help. “Even though at this stage [there are] biological treatment for fatigue that we know is effective, there are useful behavioral strategies that have been applied to other populations,” Moore said.
Having patients identify their own fatigue patterns throughout the day and reserving cognitively stimulating activities or tasks for times of day when patients feel most rested can be beneficial, as can taking 10-minute breaks every hour for a snack or a walk.
“There are also a number of things that can keep the brain healthy or support overall brain health,” Campbell added; “Things like physical activity, healthy eating and regular good sleep.”
Currently, PWH aged 50 or older make up nearly 50% of the total HIV population in the United States. By 2030, this number is expected to increase by approximately 25%, further underscoring the need not only to learn more about the impact of fatigue on cognition in this group, but also to leverage these learnings so that PWH can achieve high physical and psychological functioning that defines successful aging.
AIDS. 2022 May 1;36(6):763-772. Summary
Moore is a consultant at NeuroUX and co-founder of KeyWise Inc. Campbell and Lee report no relevant financial relationship. The study was supported by the NIH.
Liz Scherer is a freelance journalist specializing in infectious and emerging diseases, cannabinoid therapeutics, neurology, oncology and women’s health. You can find her on Twitter @lizscherer
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