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To compare the effectiveness of 12 weeks of community-based, in-person, group Tai Chi (TC) and Health Education (HAP-E) in improving health and wellbeing in older adults with hypertension and in promoting psychological resilience during COVID-19.A 12-week randomized controlled trial (RCT) in San Diego County, USA. Self-reported depressive symptoms, anxiety, sleep disturbances, gratitude, resilience, mental and physical health were assessed in-person pre- and post-intervention, and by long-term follow-up surveys during COVID-19. Linear mixed-effects models were used to assess study arm differences over time and logistic regression to identify predictors of positive intervention response.Of 182 randomized participants (72.6 ± 7.9 yrs; 72% female), 131 completed the intervention. Modest improvements in health and wellbeing occurred post-intervention in both arms (Cohen'sTC and HAP-E improved health and wellbeing, though TC conferred greater odds of an improved mental health response. Declines in health and wellbeing were observed at pandemic follow-up, with smaller declines in the TC arm, suggesting increased resilience.

Verbal learning deficits are common among sexually traumatized women who have not been formally diagnosed with posttraumatic stress disorder (PTSD). Aberrant resting-state functional connectivity (rsFC) of the amygdala and hippocampus are implicated in PTSD and verbal memory impairment. We tested rsFC between bilateral dentate gyrus (DG) and both centromedial (CM) and basolateral (BL) nuclei of the amygdala as statistical mediators for the effect of sexual trauma-related symptom severity on delayed verbal recall performance in 63 older women (age: 60-85 years) undiagnosed with PTSD. Participant data were drawn from the NKI-Rockland Study. Individuals completed a 10-min resting-state scan, Rey Auditory Verbal Learning Test (RAVLT), and the Sexual Abuse Trauma Index (SATI) from the Trauma Symptom Checklist. Z-scores indicating rsFC of DG with BL and CM amygdala seeds were evaluated in two separate mediation models. Higher SATI scores were associated with lower RAVLT after controlling for age, β = -.23, 95% CI [.48, .03], p = .039. This effect was negated upon adding a negative path from SATI to rsFC of left DG and right CM, β = -.29, 95% CI [-.52, -.02], p = .022, and a positive path from that seed pair to RAVLT List A recall, β = .28, 95% CI [.03, 0.48], p = .015. Chi-square fit indices supported partial mediation by this seed pair, p = .762. In the absence of PTSD sexual trauma symptoms partially relate to verbal learning deficits as a function of aberrant rsFC between left hippocampus DG and right amygdala CM nuclei.

This study aimed to determine whether subclinical symptoms of depression in postmenopausal women are associated with blood oxygen level-dependent (BOLD) activity within the anterior insula during cardiac interoceptive awareness and whether this association differs for persons living with the human immunodeficiency virus (PWH).Twenty-three postmenopausal (mean [standard deviation] age = 56.5 [4.8] years) and 27 HIV-negative women (mean [standard deviation] age = 56.4 [8.0]) underwent functional magnetic resonance imaging while performing a heartbeat detection task. BOLD activation within the bilateral anterior insula based on the contrast of a heartbeat detection condition with and without a distracting tone was entered along with age, HIV status, and psychological stress into two multivariate regression models with self-reported depressive symptom severity as the outcome.Depressive symptoms did not vary by HIV status, nor was there a main effect or interaction for PWH on insula BOLD activation. Depressive symptoms were positively associated with psychological stress for the left ( β = 0.310, t (49) = 2.352, p = .023) and right brain models ( β = 0.296, t (49) = 2.265, p = .028) as well as the magnitude of BOLD activation in the left insula ( β = 0.290, t (49) = 2.218, p = .032) and right insula ( β = 0.318, t (49) = 2.453, p = .018), respectively. Exploratory analyses revealed that greater magnitude of BOLD activation attributed to exteroceptive noise (tone) was also correlated with self-reported distrust and preoccupation with interoceptive sensations.Results support an active interference model for interoceptive awareness wherein greater BOLD signal in the anterior insula in the presence of distracting exteroceptive stimuli may reflect greater prediction error, a feature of depression.

Although decline of cognitive abilities in late life is regarded as a common facet of aging, there is inter-individual variability in this decline. Possible contributors are cardiometabolic risk factors associated with cerebrovascular dysfunction, but a dearth in unifying health-cognition models confound exactly how these risk factors mediate age-related changes in executive function (EF) and episodic memory. This study investigated the indirect effect of age on these cognitive abilities via cardiometabolic risk factors using a structural equation modeling approach. Participants included 738 adults (64% female) ranging from 21 to 85 years of age (M = 47.47, SD = 18.28). An exploratory factor analysis was applied to an EF battery yielding a two-factor solution, consisting of inhibition and cognitive flexibility, that showed acceptable fit (χ(2)(48) = 101.84, p < .001, CFI = .980, RMSEA = .039, SRMR = .035). The EF latent factors were then included in a confirmatory factor analysis exploring the indirect role of age on episodic memory and EF via blood pressure, cholesterol, triglycerides and body mass index. The theoretical model demonstrated acceptable fit, χ(2)(108) = 204.071, p < .001, CFI = .972, RMSEA = .035, SRMR = .035. Blood pressure was associated with lower cognitive flexibility (β = −.20, p < .001) and there was a significant indirect effect of age on episodic memory through cognitive flexibility (β = .07, p = .021). Results support the “Executive Decline Hypothesis” of age-related episodic memory decline and specifically implicate lower blood pressure control and cognitive flexibility in these changes.

Central regulation of heart rate and blood pressure provides the bases for a neurogenic mechanism of hypertension (HTN). Post menopause (PM) age coincides with changes in resting state functional brain connectivity (rsFC) as well as increased risk for HTN. Whether the neural networks underpinning cardioautonomic control differ between PM women with and without HTN is unclear. Phenotypic and functional neuroimaging data from the Nathan Kline Institute was first evaluated for group differences in intrinsic network connectivity between 22 HTN post menopausal women and 22 normotensive controls. Intrinsic rsFC of the midbrain-brainstem-cerebellar network with bilateral mid-anterior insula was lower in women with HTN (FWE-corrected, p

Given the co-occurrence of memory impairment in HIV-associated neurocognitive disorders (HAND) and amnestic mild cognitive impairment/Alzheimer’s disease (aMCI/AD), biomarkers are needed that can disentangle these conditions among people with HIV (PWH). We assessed whether cerebrospinal fluid (CSF) markers of AD could help in this effort by determining their relationship to learning and memory deficits versus cognitive deficits more characteristic of HAND than aMCI/AD (processing speed and complex visual/motor coordination) among 31 older PWH. CSF amyloid-β(42.) phosphorylated-Tau, amyloid-β(40)/amyloid-β(42) and phosphorylated-Tau/amyloid-β(42) ratio related to learning/memory performance but not HAND-related deficits, suggesting that these biomarkers may have utility in disentangling aMCI/AD from HAND.

Despite the neurocognitive risks of aging with HIV, initial cross-sectional data suggest a subpopulation of older people with HIV (PWH) possess youthful neurocognition (NC) characteristic of SuperAgers (SA). Here we characterize longitudinal NC trajectories of older PWH and their convergent validity with baseline SA status, per established SuperAging criteria in PWH, and baseline biopsychosocial factors. Growth mixture modeling (GMM) identified longitudinal NC classes in 184 older (age ≥ 50-years) PWH with 1-5 years of follow-up. Classes were defined using 'peak-age' global T-scores, which compare performance to a normative sample of 25-year-olds. 3-classes were identified: Class 1A pesar de los riesgos neurocognitivos de envejecer con VIH, datos transversales iniciales sugieren que una subpoblación de personas con VIH (PCV) de edad mayor posee neurocognición (NC) juvenil, característica de los Súper-Ancianos (SA). Aquí nosotros caracterizamos trayectorias longitudinales de NC en PCV mayores y su validez convergente con su status de referencia de SA, según los criterios establecidos en PCV, y factores biopsicosociales en la base de referencia. El modelo de mezclas Gaussianas (GMM) identificó clases longitudinales de NC en 184 PCV mayores (edad ≥ 50-años) con 1–5 años de seguimiento. Las clases fueron definidas utilizando puntuaciones-T (T-scores) globales de “edad pico”, que comparan el desempeño con una muestra normativa de personas de 25 años de edad. 3-clases fueron identificadas: Clase 1

To investigate joint contributions of cognitive and physiologic reserve to neurocognitive SuperAging in older persons with HIV (PWH).Participants included 396 older PWH (age range: 50-69 years) who completed cross-sectional neuropsychological and neuromedical evaluations. Using published criteria, participants exhibiting global neurocognition within normative expectations of healthy 25-year-olds were classified as SuperAgers (SA; n = 57). Cognitively normal (CN; n = 172) and impaired (n = 167) participants were classified with chronological age-based norms. Cognitive reserve was operationalized with an estimate of premorbid verbal intelligence, and physiologic reserve was operationalized with a cumulative index of 39 general and HIV-specific health variables. Analysis of variance with confirmatory multinomial logistic regression examined linear and quadratic effects of cognitive and physiologic reserve on SA status, adjusting for chronological age, depression, and race/ethnicity.Univariably, SA exhibited significantly higher cognitive and physiologic reserve compared with CN and cognitively impaired ( d s ≥ 0.38, p s0.05). Both reserve factors independently predicted SA status in multinomial logistic regression; higher physiologic reserve predicted linear increases in odds of SA, and higher cognitive reserve predicted a quadratic "J-shaped" change in odds of SA compared with CN (ie, odds of SACN only above 35th percentile of cognitive reserve).Each reserve factor uniquely related to SA status, which supports the construct validity of our SA criteria and suggests cognitive and physiologic reserve reflect nonoverlapping pathways of neuroprotection in HIV. Incorporation of proxy markers of reserve in clinical practice may improve characterization of age-related cognitive risk and resilience among older PWH, even among PWH without overt neurocognitive impairment.

Depression and chronic inflammation are common in persons infected with the human immunodeficiency virus (HIV+). Although depression and response to inflammatory challenge are shown to reflect activity in common neural networks, little is known regarding sub-clinical presentation in persons chronically infected with HIV. The relationship of resting-state functional connectivity (rsFC) between the subgenual anterior cingulate cortex (sgACC) and bilateral amygdala to Beck Depression Inventory-1 (BDI) scores were compared within a group of 23 HIV+ and 23 HIV-negative comparison adults. An interaction was found wherein lower rsFC between the sgACC and both right and left amygdala was associated with higher BDI scores in HIV+ individuals. Total BDI scores and plasma levels of IL-6, IL-8, TNF-α, and IL-10 made available from 10 of the HIV+ patients were regressed upon an index of spontaneous whole-brain activity at rest; i.e., the amplitude of low-frequency fluctuations (ALFFs). Elevated levels of depression and IL-6 were associated with increased ALFF in a cluster of voxels on the medial portion of the ventral surface of the frontal lobe (Brodmann Area 11). Within this sample of HIV+ individuals lower rsFC of the sgACC with subcortical limbic regions predicts greater burden of depressive symptomology whereas elevated activity in the adjacent BA 11 may reflect sickness, indexed by elevated IL-6, and associated depressive behaviors.

The increasing prevalence of cardiovascular disease comorbidity in persons infected with the HIV has become a global concern. The electrocardiogram (ECG) is increasingly being utilized to provide clinically relevant information regarding cardiac arrhythmias and cardio-autonomic dysfunction. The purpose of this review is to summarize the latest research comparing QT and R-to-R interval length as a function of HIV+ status or antiretroviral therapy (ART) regimen.Prolongation of the corrected QTc interval may be acquired in HIV+ ART-naive individuals, exacerbated by various classes of ART drugs, and is generally predictive of lethal cardiac arrhythmias, with effects observed from childhood to adulthood. Recent literature also suggests the trend of lower heart rate variability in HIV is indicative of cardiorespiratory and inflammatory-immune dysfunction.These emergent studies support the clinical relevance of the ECG across the age and HIV disease spectrum. Furthermore, the reported findings have implications for the management of cardiovascular and chronic inflammatory disease comorbidity in persons living with HIV.

Peripheral blood mononuclear cell derived endothelial progenitor cells (EPCs) are associated with cardiovascular function and their numbers decline with older age hypertensive risk and HIV infectionisease burden. Emergent evidence suggests that their functionality and presence may be related to cardio-autonomic and psychological functioning. This study examined whether in a sample of post-menopausal (PM) women (n = 5 HIV+/HTN + mean PM age = 53, n = 11 HIV+/HTN- mean PM age = 57, n = 6 HIV-/HTN + mean PM age = 53, or n = 14 HIV-/HTN- mean PM age = 53) ex vivo expansion of EPC counts derived from peripheral blood mononuclear cells covary with measures of high and low frequency heart rate variability. Mononuclear cells were isolated from each subject’s blood sample and incubated for 15 days in a fibronectin coated flask at 37 degrees Celsius, with the EPC medium changed every 2–3 days. Total cell, cluster, and spindle counts were recorded every 5 days for 2 weeks at 3 different time points labeled (t1, t2, and t3). After 10 days, EPC counts were significantly lower in HIV + HTN + and HIV + HTN- women compared to HIV-HTN+ (ps

HIV-positive individuals are susceptible to expansion of the non-classical and intermediate pool of peripheral blood mononuclear cells (PBMCs). Persistent HIV-related inflammation contributes to neurodegeneration but effects on limbic brain centers are not well understood. Here, we compare PBMCs and their expression of pro-inflammatory cytokines to resting brain activity and mood within and between 19 HIV + and 19 HIV- (mean age = 54.5, SD = 5.68) post-menopausal women. Mean amplitude of low-frequency fluctuations (mALFF), Profile of Mood States Questionnaire (POMS) and PBMCs immunophenotyped by flow cytometry were collected on consecutive days. PBMCs were classified into classical (CD14++ CD16−), intermediate (CD14++ CD16+) and non-classical (CD14low/+ CD++) monocyte subsets. PBMCs underwent intracellular staining for IL-6, TNF-a, IL1-b and IL-10 cytokines. One sample t-tests indicated that, compared to classical PBMCs, there was greater nonclassical IL-6 and intermediate IL-6, IL1-b and IL-10 expression. Total mood disturbance correlated with intermediate (r = .474, p = .003) and non-classical (r = .425, p = .010) PBMCs (Bonferroni corrected). Percentage of intermediate PBMCs also predicted greater activity within the subgenual anterior cingulate cortex (sgACC), (T = 3.35, k = 50 p=.002, cluster thresholded), a region associated with sickness behavior and depression. However, using a 5-mm sphere surrounding the sgACC parameter estimates failed to correlate with mood disturbance (r = .196, p > .05). Our findings suggest that expansion of the intermediate monocyte pool may reflect increased activation within neurovisceral limbic regions.

Chronic infection with HIV is associated with impaired endothelial function and altered cerebral blood flow (CBF). Using fMRI Arterial Spin Labeling, we sought to determine 1) whether CBF in HIV+ postmenopausal women (n = 8, mean age = 55.13, SD = 5.38) differs from that of HIV- controls (n = 13, mean age = 53.77, SD = 6.41), and 2) whether a marker of angiogenic potential, i.e. endothelial progenitor cell (EPC) cluster formation, and time since HIV infection covary with CBF in HIV+ women (n = 8). After controlling for age, HIV+ individuals showed increased ventral perfusion extending from the inferior frontal lobes through the basal ganglia and cerebellar regions, k = 105271, p = .001, FWE-corrected (cluster). However, longer disease duration was associated with reduced perfusion to the right parahippocampal gyrus, k = 4,916, p = .001, uncorrected. Paradoxically, higher EPC clusters predicted greater CBF to the right parahippocampal gyrus, k = 10791, p .05, uncorrected. Post hoc correlational analyses revealed a trend towards lower numbers of ex vivo EPC clusters with longer disease duration in the HIV+ group, r = .576, p > .05. While longer disease duration places postmenopausal HIV+ women at risk of lower CBF to the parahippocampal gyrus, this effect may be mitigated by the angiogenic potential of peripheral blood mononuclear cell derived EPCs.

Human Immunodeficiency Virus (HIV-1) infection is associated with expansion of the non-classical monocyte pool. These monocytes transmigrate across the blood-brain-barrier and induce proliferation of pro-inflammatory cytokines. Although this expansion has been linked to HIV-associated neurocognitive impairment, associations with psychological functioning are unclear. Flow cytometric analysis yielded the proportion of gated non-classical, intermediate and classical monocytes in 22 post-menopausal women (11 HIV+ and 11 HIV-negative) aged 55.77 years (SD = 6.32). A regression model tested variance in the proportion of non-classical monocytes accounted for by HIV status and scores on the Profile of Mood States questionnaire. Accounting for HIV status, mood disturbance accounted for 28% of the variance in non-classical monocytes, R2 = 0.275, F(2,21) = 3.69, p = 0.047. For every 1 unit increase in mood disturbance, the proportion of non-classical monocytes increased by nearly 10%, B = 0.096, SE = 0.04, t = 2.59 p = 0.018. However, HIV status did not predict variance in the proportion of mononuclear cells B = 1.18, SE = 2.37, t = 0.498, p > 0.05, suggesting expansion of the non-classical monocyte pool is associated with increasing levels of mood disturbance, independent of HIV infection. More work is needed to determine whether peripheral or neural-inflammation resulting from activation of non-classical monocytes potentially drives and/or may be driven by distress in HIV positive individuals.