Neurocognitive performance and activities of daily living in older people with HIV: a cross-sectional study in Uganda

Neurocognitive impairment is prevalent among older people living with HIV (OPLWH) ≥ 60 years despite effective antiretroviral therapy (ART). We aimed to investigate low cognitive performance and its association with functional status among OPLWH ≥ 60 years in Uganda. We conducted a cross-sectional study of OPLWH aged ≥ 60 years receiving ART at a specialist HIV clinic in Kampala, Uganda. A total of 433 participants were included in the present analysis. Instrumental activities of daily living (IADL) and neurocognitive performance were evaluated using the Lawton scale and the Montreal Cognitive Assessment (MoCA), respectively. The threshold for low cognitive performance on the MoCA was set at < 24/30, while disability cutoffs for IADL were defined as < 5 for men and < 8 for women. Multivariable linear and logistic regression models were used to study the associations between neurocognitive performance and IADL. Of the 500 OPLWH screened, 433 were included in the analysis; 47 were excluded due to lack of formal education and 20 due to depression. The mean age was 65 years (SD ± 5), and 209 (48.3%) were female. The mean duration of ART was 13 years (SD ± 4). Most (275; 64%) had low cognitive performance without IADL disability, and cognitive impairment was more frequent among women (54% vs. 47%; p < 0.001). A minority (33; 7.6%) had both low cognitive performance and IADL disability. Factors associated with lower cognitive performance included female sex (multivariable β = -2.48, 95% CI: -3.60, -1.36; p < 0.001), risk of malnutrition (multivariable β = -1.54, 95% CI: -2.77, -0.31; p = 0.01), frailty (multivariable β = -2.27, 95% CI: -3.97, -0.57; p = 0.009), and older age (multivariable β = -0.25 per year, 95% CI: -0.33, -0.17; p < 0.001). Older age (aOR 1.11 per year, 95% CI: 1.04, 1.18; p = 0.004), having at least three noncommunicable diseases (aOR 5.05, 95% CI: 1.09, 23.29; p = 0.04), and frailty (aOR 48.11, 95% CI: 13.07, 117.10; p < 0.001) were associated with higher odds of IADL disability. The integration of the MoCA and IADL enabled the detection of a minority of OPLWH ≥ 60 years with low cognitive performance and functional disability. Interventions targeting modifiable factors such as malnutrition, comorbidities, and frailty are needed to improve cognition and maintain functional capacity in resource-limited settings.