Mindfulness-Based Stress Reduction for Symptom Management in Older Individuals with HIV-Associated Neurocognitive Disorder

Judith T Moskowitz; Brijesh Sharma; Shireen Javandel; Patricia Moran; Robert Paul; Victor De Gruttola; Dimitre Tomov; Haleem Azmy; Rodrigo Sandoval; Madeline Hillis; Karen P Chen; Torie Tsuei; Elizabeth L Addington; Peter D Cummings; Joanna Hellmuth; Isabel Elaine Allen; Beau M Ances; Victor Valcour; Benedetta Milanini

doi:10.1007/s10461-024-04295-1

Mindfulness-Based Stress Reduction for Symptom Management in Older Individuals with HIV-Associated Neurocognitive Disorder

AIDS Behav. 2024 Mar 16. doi: 10.1007/s10461-024-04295-1. Online ahead of print.

Authors

Judith T Moskowitz^#^{1

2

3}, Brijesh Sharma^#^{4

5}, Shireen Javandel⁴, Patricia Moran⁶, Robert Paul⁷, Victor De Gruttola⁸, Dimitre Tomov⁹, Haleem Azmy⁹, Rodrigo Sandoval⁴, Madeline Hillis⁴, Karen P Chen⁴, Torie Tsuei⁴, Elizabeth L Addington^{10

11}, Peter D Cummings^{10

11}, Joanna Hellmuth⁴, Isabel Elaine Allen¹², Beau M Ances⁹, Victor Valcour^{4

13}, Benedetta Milanini¹⁴

Affiliations

¹ Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA. Judith.moskowitz@northwestern.edu.
² Osher Center for Integrative Health, Northwestern University, Chicago, IL, USA. Judith.moskowitz@northwestern.edu.
³ Northwestern University Feinberg School of Medicine, 625 N. Michigan Ave, Suite 2700, Chicago, IL, 60611, USA. Judith.moskowitz@northwestern.edu.
⁴ Department of Neurology, Memory and Aging Center, University of California San Francisco, San Francisco, CA, USA.
⁵ College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, CA, USA.
⁶ Osher Center for Integrative Health, University of California, San Francisco, CA, USA.
⁷ Missouri Institute of Mental Health, University of Missouri-St. Louis, St. Louis, MO, USA.
⁸ Division of Biostatistics, Herbert Wertheim School of Public Health, University of California San Diego, San Diego, CA, USA.
⁹ Department of Neurology, School of Medicine, Washington University in St. Louis, St. Louis, MO, USA.
¹⁰ Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
¹¹ Osher Center for Integrative Health, Northwestern University, Chicago, IL, USA.
¹² Department of Epidemiology & Biostatistics, University of California, San Francisco, CA, USA.
¹³ Global Brain Health Institute, University of California, San Francisco, CA, USA.
¹⁴ Inovigate GmbH, Basel, Switzerland.

^# Contributed equally.

PMID: 38493283
DOI: 10.1007/s10461-024-04295-1

Abstract

The growing number of people aging with HIV represents a group vulnerable to the symptom burdens of HIV-associated neurocognitive disorder (HAND). Among younger groups, Mindfulness-Based Stress Reduction (MBSR) has been shown to help people living with HIV manage HIV-related and other life stress, and although there is some theoretical and empirical evidence that it may be effective among those with cognitive deficits, the approach has not been studied in older populations with HAND. Participants (n = 180) 55 years or older with HIV and cognitive impairment were randomly assigned to either an 8-week MBSR arm or a waitlist control. We assessed the impact of MBSR compared to a waitlist control on psychological outcomes [stress, anxiety, depression, and quality of life (QOL)] and cognitive metrics (e.g., speed of information processing, working memory, attention, impulsivity) measured at baseline, immediately post intervention (8 weeks) and one month later (16 weeks). Intent to treat analyses showed significant improvement in the MBSR group compared to control on symptoms of depression from baseline to 8 weeks, however, the difference was not sustained at 16 weeks. The MBSR group also showed improvement in perceived QOL from baseline to 16 weeks compared to the waitlist control group. Cognitive performance did not differ between the two treatment arms. MBSR shows promise as a tool to help alleviate the symptom burden of depression and low QOL in older individuals living with HAND and future work should address methods to better sustain the beneficial impact on depression and QOL.

Keywords: Aging; Cognition; HIV; HIV-associated neurocognitive disorder; Mindfulness Based Stress Reduction.

Abstract

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