March 25, 2009

Neurocognitive Disorders, Poor Adherence in Older HIV-Positive Adults

Neurocognitive disorders—problems with thinking, memory and coordination—may lead to, and be caused by, poor adherence in older HIV-positive adults, according to a study published in the April issue of The American Journal of Geriatric Psychiatry.

A number of studies have found that, on average, older HIV-positive adults are less likely to miss doses of their antiretroviral (ARV) medication than adults who are younger. An increasing number of studies, however, are finding high rates of neurocognitive disorders in older people with HIV. To determine whether neurocognitive problems may affect adherence to ARV therapy, Mark Ettenhofer, PhD, from the Department of Psychiatry and Behavioral Sciences at the University of California in Los Angeles, and his colleagues conducted neurological tests and assessed adherence in 431 HIV-positive adults in the LA area.

Neurocognitive function was assessed by measuring participants’ information processing speed, their ability to learn and memorize, their aptitude with language and their physical coordination. Medication adherence was measured using microchip-embedded pill bottle caps.

As with previous studies, Ettenhofer and his colleagues found that participants older than 50 had better treatment adherence, on average, than participants younger than 50. They also found, however, that reduced neurocognitive function was strongly associated with poor adherence in older adults, but not in younger adults. Older adults were also more likely to have lower CD4 counts and report drug use.

The authors conclude that health care providers and people with HIV older than 50 should be on the lookout for neurocognitive problems and carefully evaluate and manage adherence. They point out that although cognitive problems might lower adherence, the converse might also be true: that poor adherence might exacerbate or lead to neurocognitive problems.

NEW! Scroll down to comment on this story.

Previous Comments:

Jae, Sydney, 2009-03-25 19:04:23
This is a great article. Is there any way of asking if the researchers looked at different medications in terms of their ability to penetrate the CNS?