Riassunto analitico
Objective
The objective of this study was to give an operative description of cognitive frailty in People Living With HIV, defining its prevalence in patients aged > 50, risk factors and association with geriatric syndromes, namely falls, polypharmacy (PP), physical status and performance evaluated with short performance physical battery (SPPB).
Methods
This was an observational cross-sectional study including ART-experienced PLWH attending Modena HIV Metabolic Clinic (MHMC) from 2016. PLWH with at least two available neurocognitive and frailty assessments were included. Neurocognitive function was measured with Cogstate battery that comprises six domains: simple speed processing, complex speed processing, attention/working memory, visual learning memory, verbal learning and verbal memory. Each individual CogState raw score was transformed into z-score correcting for age and gender. A global NF performance score was defined as the mean of z-score by averaging individual task z-scores. Neurocognitive impairment was defined by total global deficit score > 0.5. and further classified as normal, mild and moderate/severe impairment. Frailty was assessed by 16-Item frailty index (FI) generated by a standardized comprehensive geriatric assessment, previously validated at MHMC and constructed from health variables collected at the same study visit. Each variable included in the FI was coded with a value of 1 when a deficit was present, and 0 when it was absent. The FI for each patient visit was calculated as the ratio between the number of deficits present and the total number of deficits assessed. We categorized PLWH according to FI score as fit (<0.36) and frail (>0.37). Cognitive frailty was defined as contemporary presence of neurocognitive impairment and frailty. The outcome of the study were geriatric syndromes, disability and functional performance. Geriatric syndromes included falls in the last year, polypharmacy, defined as use of >5 non-antiretroviral medications per day.
Results
1812 PLWH were included, 1333 (73.6%) were males, mean age was 58 years, Mean body mass index was 25 (SD= 4) kg/m2, median time since HIV diagnosis was 25 (IQR: 12) years. Cognitive frailty was present in 247 (13.6%) and incidence was 4.5 x 100 persons/years. PLWH with cognitive frailty had higher prevalence of obesity (18% vs.10%; p<0.001) and higher levels of chronic inflammation, depicted by C-reactive protein (0.3 vs 0.2 mg/dl; p<0.001) and D-dimer (315 vs 270 ng/ml; p=0.008). Polypharmacy was also higher in this group (31% vs 16%; p<0.001). Regarding antiretroviral drugs, use of DTG was higher (40% vs 32%; p=0.03) in PLWH with cognitive frailty. In the multivariate logistic regression model, SPPB (OR=0.46, 0.30, 0.66 p<0.001) and polypharmacy (OR=4.75, 1.24, 18.9 p=0.023) were associated with higher risk of cognitive frailty.
Conclusion
In conclusion, cognitive frailty was highly prevalent in PLWH >50 years, similarly to what is observed in the general population > 65 years, and it was associated with SPPB score and polypharmacy but not with falls. Further studies are needed to explore CF in relation to mortality and traditional geriatric outcomes, such as falls, disability. The role of HIV related variables and ART therapy should be further investigated in order to introduce appropriate intervention.
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