Relationships between cognition, function, and quality of life among HIV+ Canadian men

  • Nancy E. MayoEmail author
  • Marie-Josée Brouillette
  • Susan C. Scott
  • Marianne Harris
  • Fiona Smaill
  • Graham Smith
  • Réjean Thomas
  • Lesley K. Fellows
  • and investigators from the Positive Brain Health Now Study



To estimate the extent to which HIV-related variables, cognition, and other brain health factors interrelate with other HIV-associated symptoms to influence function, health perception, and QOL in older HIV+ men in Canada.


Cross-sectional structural equation modelling (SEM) of data from the inaugural visit to the Positive Brain Health Now Cohort.


HIV clinics at 5 Canadian sites.


707 men, age ≥ 35 years, HIV+ for at least one year, without clinically diagnosed dementia.

Main outcome measures

Five latent and 21 observed variables from the World Health Organization’s biopsychosocial model for functioning and disability and the Wilson–Cleary Model were analysed. SEM was used to link disease factors to symptoms, impairments, function, health perception, and QOL with a focus on cognition.


QOL was explained directly by depression, social role, health perception, social support, and quality of the environment. Measured cognitive performance had direct effects on activity/function and indirect effects on participation, HP and QOL, acting through self-reported cognitive difficulties and meaningful activities.


The biopsychosocial model showed good fit, with RMSEA < 0.05. This is the first time the full model has been tested in HIV. All of the domains included in the model are theoretically amenable to intervention and many have evidence-based interventions that could be harnessed to improve QOL.


Cognition Quality of life Disability Health outcomes Multivariable models 



AIDS-defining illnesses


Brief Cognitive Ability Measure


Combination antiretroviral therapy


Comparative Fit Index


Central nervous system


EuroQol 5 dimensions with 3 levels


Visual analogue scale for health rating from EuroQol


Hospital Anxiety and Depression Scale


HADS anxiety items


HADS depression items


HIV-specific signs and symptoms


Health perception


Health-related quality of life


Instrumental activities of daily living


International classification of functioning, disability and health


Mental Health Index


Anxiety items from MHI


Depression items from MHI


Maximum likelihood






Perceived Deficits Questionnaire


Physical function


Patient Generated Index


Patient-reported outcome


Quality of life


General health perception


Root mean square error of approximation


Standard deviation


Structural equation model


Standardized root mean squared residual


Standardized regression coefficient


Trier inventory for chronic stress


Tucker–Lewis Fit Index


World Health Organization




World Health Organization 5-item well-being index



We want to thank the participants of the Positive Brain Health Now cohort study as well as the community members of the research team and the organizations. They represent COCQ -Sida (Ken Monteith); Aids Committee of Toronto (Sarah Schultz); Positive Living BC (Hesham Ali).


This project was supported by grants from the Canadian Institutes of Health Research (LKF, MJB, NM, TCO-125272), the CIHR Canadian HIV Trials Network (CTN 273), and salary support from the Fonds de Recherche Santé du Québec (LKF) and the Research Institute of the McGill University Health Centre (MJB). None of these funding agencies played any role in the design, data collection, analysis, or interpretation of the study.

Compliance with ethical standards

Conflict of interest

Authors declare that they have no conflicts of interest.

Ethical approval

All procedures performed were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The project was approved by the Research Ethics Board of each of the participating institutions.

Informed consent

All participants provided informed consent.

Supplementary material

11136_2019_2291_MOESM1_ESM.pptx (104 kb)
Supplementary Figure. The full model in five panels (PPTX 103 kb)


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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Nancy E. Mayo
    • 1
    • 2
    • 3
    Email author
  • Marie-Josée Brouillette
    • 4
    • 5
    • 6
    • 7
  • Susan C. Scott
    • 2
  • Marianne Harris
    • 8
    • 9
  • Fiona Smaill
    • 10
  • Graham Smith
    • 11
  • Réjean Thomas
    • 12
  • Lesley K. Fellows
    • 7
    • 13
  • and investigators from the Positive Brain Health Now Study
  1. 1.Department of Medicine, School of Physical and Occupational TherapyMcGill UniversityMontrealCanada
  2. 2.Division of Clinical Epidemiology, McGill University Health Centre (MUHC), Center for Outcomes Research and EvaluationMUHC-RIMontrealCanada
  3. 3.Division of Geriatrics, McGill University Health Centre (MUHC), Center for Outcomes Research and EvaluationMUHC-RIMontrealCanada
  4. 4.Department of PsychiatryMcGill UniversityMontrealCanada
  5. 5.Chronic Viral Illness ServiceMcGill University Health Centre (MUHC)MontrealCanada
  6. 6.Infectious Diseases and Immunity in Global Health ProgramMUHC-RIMontrealCanada
  7. 7.Canadian Institutes of Health Research Canadian HIV Trials NetworkVancouverCanada
  8. 8.Department of Family Practice, Faculty of MedicineUniversity of British ColumbiaVancouverCanada
  9. 9.BC Centre for Excellence in HIV/AIDSVancouverCanada
  10. 10.Special Immunology ServicesMcMaster UniversityHamiltonCanada
  11. 11.Maple Leaf Medical ClinicTorontoCanada
  12. 12.Clinique Médicale l’ActuelMontrealCanada
  13. 13.Department of Neurology and Neurosurgery, Montreal Neurological InstituteMcGill UniversityMontrealCanada

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