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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
Article

Abstract

Objective

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.

Design

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

Setting

HIV clinics at 5 Canadian sites.

Subjects

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.

Results

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.

Conclusion

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.

Keywords

Cognition Quality of life Disability Health outcomes Multivariable models 

Abbreviations

ADI

AIDS-defining illnesses

B-CAM©

Brief Cognitive Ability Measure

cART

Combination antiretroviral therapy

CFI

Comparative Fit Index

CNS

Central nervous system

EQ-5D-3L

EuroQol 5 dimensions with 3 levels

EQ-5D-VAS

Visual analogue scale for health rating from EuroQol

HADS

Hospital Anxiety and Depression Scale

HADS-A

HADS anxiety items

HADS-D

HADS depression items

HIV_S&S

HIV-specific signs and symptoms

HP

Health perception

HRQL

Health-related quality of life

IAKL

Instrumental activities of daily living

ICF

International classification of functioning, disability and health

MHI

Mental Health Index

MHI-A

Anxiety items from MHI

MHI-D

Depression items from MHI

MLM

Maximum likelihood

MOT

Motivation

NP

Neuropsychological

PDQ

Perceived Deficits Questionnaire

PF

Physical function

PGI

Patient Generated Index

PRO

Patient-reported outcome

QOL

Quality of life

RAND-36 GHP

General health perception

RMSEA

Root mean square error of approximation

SD

Standard deviation

SEM

Structural equation model

SRM

Standardized root mean squared residual

STDXY

Standardized regression coefficient

TICS

Trier inventory for chronic stress

TLI

Tucker–Lewis Fit Index

WHO

World Health Organization

W–C

Wilson–cleary

WHO5

World Health Organization 5-item well-being index

Notes

Acknowledgements

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).

Funding

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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