Publication Abstract Display
Type: Poster
Title: Impact of Emotional Health on Cognition amongst Hispanic and Non-Hispanic White People Living With HIV.
Authors: Guarena LA, Kamalyan L, Morgan EE, Watson WM, Umlauf A, Heaton RK, Marquine MJ
Date: 02-03-2021
Abstract:Objective: Stress and adverse emotional health have been linked to worse neurocognitive outcomes among persons living with HIV (PLWH). Hispanic/Latino/a/x (henceforth Hispanic) PLWH are at increased risk for HIV-associated neurocognitive impairment and are likely to face greater adverse life circumstances than non-Hispanic White (henceforth White) PLWH. We examined whether the relationship between emotional health and cognition was moderated by Hispanic ethnicity. Participants and methods: Two-hundred PLWH (Age: M=51.55, SD=11.98; Education: M=13.68, SD=2.98; 10% Women, 54% AIDS, 94% on antiretroviral therapy), including 76 Hispanics (41% tested in Spanish) and 124 Whites completed the NIH Toolbox (NIH-TB) Emotion and Cognition Modules. NIH-TB Emotion battery summary T-scores of negative affect (i.e. anger affect, anger hostility, sadness, fear affect, perceived stress), social satisfaction (i.e. friendship, loneliness, emotional support, instrumental support, perceived rejection) and psychological well-being (i.e. life satisfaction, meaning, positive affect) were computed based on established methods. The main outcome was demographically-adjusted fluid cognition T-score from the NIH-TB Cognition Module. Covariates considered included demographic characteristics, HIV disease characteristics, lifetime psychiatric diagnoses, and lifetime substance use disorders. Covariates that differed by ethnic group were included in models examining the association of emotion and cognition. Three separate multivariable regression models analyzed two-way interaction effects of each Emotion summary T-score and ethnicity on fluid cognition. Significant interaction effects (p<0.10) were followed up with models stratified by ethnicity, while non-significant effects were removed and the model rerun. Results: Hispanics had significantly fewer years of formal education, were more likely to be women (ps<0.0001), less likely to have lifetime major depression disorder or substance use diagnoses (ps<0.05), and had fewer years of estimated duration of infection and months of exposure to antiretroviral drugs (ps<0.05) than Whites. Hispanics had higher social satisfaction than Whites (p=0.02), with no significant group differences on negative affect (p=0.41) or psychological well-being (p=0.13). We found a significant interaction between negative affect and ethnicity on cognition (p=0.05), such that higher negative affect was significantly associated with lower cognition among Whites (b=-0.29, SE=0.10, p<0.01), but not among Hispanics. Higher social satisfaction was associated with better cognition across ethnic groups (b=0.18, SE=0.06, p<0.01), and there was no significant association between psychological well-being and cognition (p>0.10). Post hoc analyses investigating whether the relationship between emotion and cognition differed among English- and Spanish-speaking Hispanics showed no significant interactions. Conclusion: Greater negative affect was related to worse cognition among White PLWH, but not among Hispanic PLWH, indicating that there may be factors associated with Hispanic ethnicity that buffer the adverse impact of negative affect on cognition. Higher social satisfaction appears to have cognitive benefits for PLWH across ethnicity, underscoring its importance in the development of prevention/intervention approaches aimed at reducing HIV- associated neurocognitive impairment. Future longitudinal studies that include culturally-relevant measures, such as familism, fatalism, resilience, or nativity, may reveal whether these or other factors associated with Hispanic ethnicity buffer the adverse effect of negative affect on cognitive change over time.

return to publications listing