Disparate trajectories of cognitive aging among American Indian and Alaskan Native people with and without HIV.

Objective: This study describes trajectories of cognitive aging among American Indian/Alaskan Native (AI/AN) adults with and without HIV and the role of immunosenescence longitudinally. Method: We characterized trajectories of cognitive aging in a sample of 333 AI/AN and 309 non-Hispanic White (NHW) adults who were followed longitudinally for up to 20 years by the HIV Neurobehavioral Research Program (HNRP) across six U.S. research sites. We used growth curve modeling with autoregressive Lag-1 structures and heterogeneous residual variances to assess the role of ethnoracial identity and HIV grouping upon decline in trajectories of cognitive aging. Results: HIV− AI/AN adults demonstrated earlier and steeper decline in normative trajectories of cognitive aging on tasks of processing speed, timed tasks of attention/working memory, executive function, and psychomotor speed in comparison to HIV− NHW adults. Accentuated trajectories of cognitive aging were evident in both HIV+ and HIV+ immunosuppressed groups in comparison to HIV− peers and were primarily driven by the role of immunosenescence. Conclusions: AI/AN disparities in trajectories of cognitive aging are evident and are likely explained by the interplay of biopsychosociocultural factors, including immunosenescence. Question: Do American Indian/Alaskan Native (AI/AN) adults differ in normative trajectories of cognitive aging and does immunosenescence play a role in these differences? Findings: AI/AN adults and those with weaker immune systems demonstrated earlier and steeper decline in trajectories of cognitive aging. Importance: AI/AN adults likely have unique biopsychosociocultural processes that contribute to accentuated cognitive aging. Next Steps: A comprehensive and highly dimensional approach is needed to parse out the diverse effects of biopsychosociocultural factors upon cognitive aging.