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Relationship Between Brain Arterial Pathology and Neurocognitive Performance Among Individuals With Human
Jose Gutierrez1, Desiree Byrd2, Michael T Yin3
1Department of Neurology, Stroke Division, New York Presbyterian/Columbia University Medical Center, New York.
Insights
Thicker brain arteries are linked to cognitive decline in people with HIV. This study suggests that managing cerebrovascular disease may help prevent or slow HIV-associated neurocognitive disorders (HAND).
Area of Science:
- Neuroscience
- Neurology
- Vascular Biology
Background:
- Individuals with Human Immunodeficiency Virus (HIV) exhibit increased prevalence of cognitive impairment and cerebrovascular disease.
- Cerebrovascular disease, particularly large artery disease in the brain, is hypothesized to contribute to HIV-associated neurocognitive disorders (HAND).
Purpose of the Study:
- To investigate the association between brain large artery characteristics and cognitive function in HIV-positive individuals.
- To determine if cerebrovascular disease, specifically arterial wall thickness and lumen diameter, correlates with the development or progression of HAND.
Main Methods:
- Analysis of autopsy data from 94 HIV-positive individuals from the Manhattan HIV Brain Bank study.
- Assessment of ante mortem cognitive performance across five domains using repeated neuropsychological examinations.
- Quantification of brain large artery lumen diameter and arterial wall thickness, with HAND diagnoses based on established criteria.
- Statistical modeling (generalized linear mixed models) adjusted for relevant demographic, clinical, and vascular factors.
Main Results:
- An association was found between increased arterial wall thickness and lower global cognitive scores, processing speed, and verbal fluency.
- Participants with incident or worsening HAND showed significantly thicker brain arterial walls and smaller arterial lumen diameters.
- Adjusted models confirmed the link between arterial wall thickness and cognitive performance (P = .03) and HAND progression (P = .03).
Conclusions:
- A novel association between brain arterial wall thickening and impaired cognitive performance, as well as incident or worsening HAND, is reported.
- These findings suggest that interventions targeting arterial wall thickening or lumen preservation could be beneficial for managing HAND.
- Further research into vascular health strategies is warranted for individuals living with HIV.
Background:
Human immunodeficiency virus-positive (HIV+) individuals have higher rates of cognitive impairment and cerebrovascular disease compared with uninfected populations. We hypothesize that cerebrovascular disease, specifically brain large artery disease, may play a role in HIV-associated neurocognitive disorders (HAND).
Methods:
Participants (N = 94) in the Manhattan HIV Brain Bank study were followed on average 32 ± 33 months with repeated neuropsychological examinations until death. We used five cognitive domains (motor, processing speed, working memory, verbal fluency, and executive functioning) to assess ante mortem performance. We quantified the diameter of the lumen and arterial wall thickness obtained during autopsy. The diagnoses of HAND were attributed using the American Academy of Neurology nosology. We used generalized linear mixed model to account for repeated measures, follow-up time, and codependence between arteries. Models were adjusted for demographics, viral loads, CD4 counts, history of opportunistic infections, and vascular risks.
Results:
We included 94 HIV+ individuals (mean age 56 ± 8.3, 68% men, 54% African American). In adjusted models, there was an association between arterial wall thickness and global cognitive score (B = -0.176, P value = .03), processing speed (B = -0.175, P = .05), and verbal fluency (B = -0.253, P = .02). Participants with incident or worsening HAND had thicker brain arterial walls (B = 0.523 ± 0.234, P = .03) and smaller arterial lumen (B = -0.633 ± 0.252, P = .01).
Conclusions:
We report here a novel association between brain arterial wall thickening and poorer ante mortem cognitive performance and diagnosis of incident or worsening HAND at death. Strategies to preserve the arterial lumen or to prevent wall thickening may impact HAND.
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