LATEBREAKER
Neurology
Cumulative Burden of Depression and Domain-Specific Cognitive Impairment in the Women’s Interagency HIV Study: A Marginal Structural Model Approach Cesar Higgins Tejera* Cesar Higgins Tejera Priya Duggal Adaora Adimora Elizabeth Topper Debora Gustafson Beth Jamieson Pauline M. Maki Anjali Sharma Amanda B. Spence Kathleen Weber Andrea Weinstein Deborah Jones Weiss Pariya Wheeler Gina Wingood Linda A. Teplin Leah H Rubin Kathryn Fitzgerald
Background: Chronicity of depression correlates with memory, attention deficits, and task completion challenges, indicating that the burden of depression has broad cognitive repercussions. Large prospective studies with repeated measures of depressive symptomatology and domain-specific cognitive function are lacking. We estimated the association between cumulative depressive symptomatology and domain-specific cognitive impairment among women with HIV (WWH) and without (WWoH) in the Women’s Interagency HIV Study.
Methods: Participants were followed-up from enrollment to cognitive impairment onset. Cumulative depression burden was calculated using Center for Epidemiologic Studies Depression scale (CES-D) scores: CES-D ≥33 = 1, CES-D ≤9 = 0, CES-D 10-32 interpolated to proportions between 0 and 1. We multiplied these proportions and the time elapse between visits to obtain our depression burden measure. Domain-specific cognitive impairment was defined as 1-SD below mean performance in attention, memory, executive function, learning, or speed. We used inverse probability of exposure and censoring weights to estimate incidence rate ratios (IRR) from marginal structural Poisson models.
Results: Among 2,576 participants (1,781 WWH), average age was 45.7, with 13.8% cumulative depression burden over 12.8 years. WWH had higher depression burden (14.23%) than WWoH (12.9%), and 46% of women were censored. In the overall sample, 1-SD above mean cumulative depression burden was associated with 1.56 (95%CI: 1.33, 1.83) times higher risk of attention/working memory impairment. Similar associations were found for verbal memory (IRR = 1.26; 95%CI: 1.15, 1.38), executive function (IRR = 1.45; 95%CI: 1.34, 1.73), verbal learning (IRR = 1.32; 95%CI: 1.21, 1.43), processing speed (IRR = 1.34; 1.17, 1.52), and in models stratified by HIV-serostatus.
Conclusions: Addressing high depression burden among women could positively impact cognitive health.