Memory loss and cognitive decline is a common concern as we age into our later years. But for long-lived patients with HIV, the process can start earlier than usual.
It's estimated that by 2015, over half of Americans living with HIV will be over the age of fifty. And many of them will have cognitive problems, including issues with memory, attention, and being able to do everyday tasks that require complex thinking.
The current research shows that 52 percent of adults with HIV over the age of 50 already experience some form of cognitive decline. It doesn't happen to everybody, but it is a high risk.
Fortunately, scientists are working to combat cognitive decline and improve the quality of life for people who are living longer with HIV.
dailyRx News spoke with Dr. David Vance, an associate professor of Nursing at the University of Alabama Birmingham. He is trained as a psychologist, and studies cognition and gerontology, the study of old age and aging.
Recently, he did a study that focused on improving cognitive abilities in middle-aged and older adults with HIV.
“Before we considered HIV to be a young person disease,” Dr. Vance told dailyRx. “But now that the medications are so effective, people are living longer and healthier, so we are seeing aging with this disease.”
Why people with HIV age faster
There's growing evidence that HIV speeds up the aging process in some patients. Dr. Brad Hare, medical director of the HIV clinic at the University of California – San Francisco told dailyRx in an interview that he's seen diseases of old age show up in HIV patients ten years earlier than those without HIV.
In fact, there's an entire class of conditions called HIV-associated neurocognitive disorders. So how does HIV accelerate aging?
Dr. David Vance explained, “In some senses, HIV can be considered an inflammatory disease. So you have systematic inflammation of body but also the systematic inflammation of the brain.”
“In some way, that inflammation speeds up the aging process,” he continued.
Inflammation in the body and brain is a completely normal and healthy response to things like stress, immune system activation, and even thoughts. But people with HIV have prolonged inflammation because they are constantly battling attack within their cells, and may be dealing with depression and anxiety as a result of their illness.
Over time, inflammation starts to break down tissues inside our bodies, and we are not as healthy. For HIV patients, that's happening a lot faster.
Symptoms of cognitive problems
It's not always easy to recognize and identify the symptoms of cognitive decline in yourself. But if you're constantly having problems remembering, you might start to notice a pattern.
“Most people automatically notice memory,” said Dr. Vance. “If you don't remember something, that's very noticeable.”
Other problems include a lack of attention, which a friend, partner, or caregiver might notice.
“Sometimes there's a slower processing speed. They can do the same things, but it might take them longer,” said Dr. Vance.
He also said that what's called “executive reasoning” can be affected. That's your ability to balance a checkbook, to remember how to take your medications – every day things that require careful thought and precision.
How to treat cognitive problems?
Many patients are already being treated for cognitive decline. First, doctors try to find out whether there is another problem that could be causing short-term cognitive problems.
Physical exercise, with an emphasis on a healthy body, may help prevent precognitive disorders. Patients with HIV are at high risk for other diseases like diabetes, heart disease and hypertension.
Those diseases put your brain at risk, Dr. Vance said. “So if you address co-morbidities, you address cognitive abilities.”
But Dr. Vance's own research focuses more on mental exercise. In a study published in October 2012, he looked at something called speed of processing training.
Speed of processing training wasn't developed with adults with HIV in mind. It's been used for years to help the general population improve and preserve their cognitive abilities.
The term “speed of processing” refers to how quickly people can perform simple tasks that require attention and decision making. One example is driving.
“We've used it with older adults, and found that adults who undergo training experience visual and attention speed of processing gains,” he said.
The training is like playing games, and it's available to the public now. Posit Science has created these brain fitness training exercises, which have been used in many studies like Dr. Vance's. (Dr. Vance has no financial ties to Posit Science.)
In Dr. Vance's study, 46 HIV-positive middle-aged and older adults were divided into two groups. One had 10 hours of training, and the control group received no training.
Dr. Vance's study focused on improving the skills people need to drive. His team found that four to five weeks after receiving the training, the group had improvements in their useful field of view.
But Dr. Vance was surprised to see gains in another area – tasks of daily living. Those tasks are along the lines of how quickly you can count change, or look up a name in a phone book.
“We were excited to make a change in cognitive functioning and translate that into everyday functioning,” he told dailyRx. In other words, people were more mentally agile than they had been before the training.
The next step is to look at a larger sample size. But Dr. Vance is optimistic, based on his and other studies, that people with HIV – or without – can improve their cognitive abilities and preserve their quality of life with science that is already on the market.
