Neurocognitive functioning predicts frailty index in HIV

Objective To evaluate the association between a frailty index (i.e., scale of accumulated deficits) and neurocognitive functioning among persons living with HIV/AIDS (PLWHA).

Methods Observational, cross-sectional data were gathered from the University of California, San Diego, HIV Neurobehavioral Research Program from 2002 to 2016. Eight hundred eleven PLWHA aged 18 to 79 years completed comprehensive physical, neuropsychological, and neuromedical evaluations. The frailty index was composed of 26 general and HIV-specific health maintenance measures, and reflects the proportion of accumulated deficits from 0 (no deficits) to 1 (all 26 deficits). Multiple linear regression was used to examine the association between continuous frailty index scores and neurocognitive functioning.

Results Participants had a mean age of 44.6 years (11.2), and were mostly male (86.9%) and white (60.2%) with a mean frailty index of 0.26 (0.11). Over the study period, prevalence of HIV-related components (e.g., low CD4) decreased, while non-HIV comorbidities (e.g., diabetes) increased. There were no changes in the frailty index by study year. Higher frailty index was associated with worse global neurocognitive functioning, even after adjusting for covariates (age, employment, and premorbid intellectual functioning; b = −0.007; 95% confidence interval [CI] = −0.0112 to −0.003; p < 0.001). The cognitive domains of verbal fluency (b = −0.004; 95% CI = −0.006 to −0.002), executive functioning (b = −0.004; 95% CI = −0.006 to −0.002), processing speed (b = −0.005; 95% CI = −0.007 to −0.003), and motor skills (b = −0.006; 95% CI = −0.007 to −0.005) also significantly predicted worse frailty index score (p values <0.001).

Conclusion A frailty index can standardize how clinicians identify PLWHA who may be at higher risk of neurocognitive impairment.