“In older adults with HIV, having multiple health conditions often leads to taking more medications, which can increase the burden of drugs with anticholinergic or sedative effects,” Henry Ukachukwu Michael, BPharm, MSc, notes. “This combination can impair cognitive abilities, leading to concerns about attention, memory, and planning day-to-day activities while contributing to physical frailty. To improve cognitive function and physical function in this population, it may be essential to reduce the use of these medications.”
Michael and colleagues cross-sectionally analyzed data from the inaugural visits of 824 older people living with HIV in Canada taking part in the Positive Brain Health Now study. Eligible participants recruited from five HIV outpatient sites between 2014 and 2016 were 35 years of age or older, diagnosed with HIV for at least one year, and capable of providing informed consent in English or French. Patients with evident dementia, active CNS infections, psychotic disorders, or substance use disorders within the previous year were excluded.
The findings were published in JAIDS.
Study Parameters
The analysis included 824 patients (mean age, 53.0 years; 84.7% men). Participants had been living with HIV for a mean of 16.9 years. The median nadir CD4 T cell count was 215 cells/μL; all patients were on ART. The median number of comorbidities was one, and the mean Charlson Comorbidity Index was 5.22.
The mean cognitive ability measured by the Brief Cognitive Ability Measure (BCAM) was 56.4 out of 100, with higher scores being better. The mean perceived cognitive deficit score, assessed using the Perceived Deficits Questionnaire (PDQ), was 47.3 out of 80, with a higher score indicating more concerns. Frailty was found in 15.5% of the study population.
Overall, polypharmacy affected 19.8% of participants, with 41.4% reporting anticholinergic use with 12.9% reporting high anticholinergic burden, and 38% reporting sedative use with 11.5% high sedative burden.
Using the Wilson-Cleary (W-C) framework as the model for the study, the researchers performed cross-sectional structural equation modeling (SEM) to link comorbidity, polypharmacy, and anticholinergic and sedative burden to cognitive ability, physical frailty, and perceived cognitive deficits.
Polypharmacy’s Effects on Cognition and Frailty
After adjusting the model for age, sex, education, nadir CD4 T-cell count, HIV duration, and anxiety and depression symptoms, they found that:
- Anticholinergic burden had a direct significant negative relationship with cognitive ability (βstd=-0.21; P<0.05) and had indirect effects on perceived cognitive deficits (standardized regression estimates [βstd]=0.16, P<0.01) and frailty (βstd=0.06; P<0.05) through sedative burden.
- Sedative burden was directly associated with perceived cognitive deficits (βstd=0.18; P<0.01) and was indirectly linked with frailty through perceived cognitive deficits (βstd=0.07; P<0.05).
- Comorbidity exerted indirect effects on perceived cognitive deficits (βstd=0.02; P<0.05) and physical frailty (βstd=0.01; P<0.05) through anticholinergic and sedative burden.
- Polypharmacy exerted indirect effects on perceived cognitive deficits (βstd= 0.08, P<0.01) and physical frailty (βstd= 0.03, P<0.05) through anticholinergic and sedative burden.
Michael talked with Physician’s Weekly (PW) about this research and its potential impact on patients who live with HIV along with other medical conditions.
PW: Why was this study important to conduct?
Michael: Older adults with HIV often face complex health challenges, including multiple conditions that require numerous medications, which can have serious side effects. Understanding how these medications, especially those with anticholinergic and sedative effects, impact cognitive and physical health helps design better, safer care. By identifying how medication burden contributes to memory concerns and frailty, this study offers insight into targeted strategies, like careful medication management, to improve the quality of life of this population with unique health needs.
See the full article by the Physician Weekly