{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T17:59:49Z","timestamp":1792000789284,"version":"4.4.0"},"reference-count":53,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2023,12,23]],"date-time":"2023-12-23T00:00:00Z","timestamp":1703289600000},"content-version":"vor","delay-in-days":22,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000774","name":"Newcastle University","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000774","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Int J Geriat Psychiatry"],"published-print":{"date-parts":[[2023,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>HIV\u2010associated neurocognitive disorders (HAND) are a spectrum of cognitive impairments in chronic HIV infection. HAND is common in sub\u2010Saharan Africa (SSA), despite combination antiretroviral therapy (cART). Older people appear to be at increased risk. It is unknown if cognitive reserve (CR), which is protective in neurodegenerative dementias, protects against HAND.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objective<\/jats:title><jats:p>To evaluate the association of CR and risk of HAND in an older cART\u2010treated population in SSA.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Cross\u2010sectional observational study completed in hospital outpatient clinics in Southwest Tanzania. We assessed HIV\u2010positive participants aged \u226550\u00a0years established on cART using a neuropsychological test battery, functional assessment, informant history and depression screen. Control participants were HIV\u2010negative individuals attending chronic disease clinics. We used operationalised Frascati criteria for HAND diagnosis. CR was measured using the Cognitive Reserve Index (CRI) and other proxy measures.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The prevalence of HAND was 64.4% (<jats:italic>n<\/jats:italic>\u00a0=\u00a0219\/343). Lower CRI score [odds ratio (OR)\u00a0=\u00a00.971, <jats:italic>p<\/jats:italic>\u00a0=\u00a00.009] and less formal education (OR\u00a0=\u00a04.364, <jats:italic>p<\/jats:italic>\u00a0=\u00a00.026) were independent risk factors for HAND but HIV\u2010severity measures were not. Unemployment and low\u2010skilled manual work were associated with increased risk of HAND in bivariate analysis but not in multivariable analysis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Higher total CRI score and more formal education appeared to be protective against HAND, in this cohort. Potentially, cognitively and socially stimulating activities and exercise could increase cognitive reserve in later life. Cognitive reserve could possibly be more important than HIV\u2010disease severity in risk of HAND in older people with treated HIV.<\/jats:p><\/jats:sec>","DOI":"10.1002\/gps.6042","type":"journal-article","created":{"date-parts":[[2023,12,23]],"date-time":"2023-12-23T15:17:40Z","timestamp":1703344660000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["The role of cognitive reserve in mediating HIV\u2010associated neurocognitive disorders in older adults living with\u2010treated HIV in Mbeya, Tanzania: A cross\u2010sectional observational study"],"prefix":"10.1002","volume":"38","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1688-9521","authenticated-orcid":false,"given":"Sadler","family":"M","sequence":"first","affiliation":[{"name":"Newcastle University  Newcastle Upon Tyne UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kuhoga","family":"E","sequence":"additional","affiliation":[{"name":"Department of Epidemiology Bio\u2010Statistics and Clinical Research University of Dar es Salaam\u2010Mbeya College of Health and Allied Sciences UDSM\u2010MCHAS  Mbeya Tanzania"},{"name":"Vijiji Tanzania Rural Health Promotion  Mbeya Tanzania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thumma\u2010Reddy","family":"N","sequence":"additional","affiliation":[{"name":"Newcastle University  Newcastle Upon Tyne UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chuma","family":"E","sequence":"additional","affiliation":[{"name":"Department of Epidemiology Bio\u2010Statistics and Clinical Research University of Dar es Salaam\u2010Mbeya College of Health and Allied Sciences UDSM\u2010MCHAS  Mbeya Tanzania"},{"name":"Vijiji Tanzania Rural Health Promotion  Mbeya Tanzania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Said","family":"K","sequence":"additional","affiliation":[{"name":"Mbeya Zonal Referral Hospital (MZRH)  Mbeya Tanzania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mpoki Simioni","family":"Kaminyoge","sequence":"additional","affiliation":[{"name":"Vijiji Tanzania Rural Health Promotion  Mbeya Tanzania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mussa","family":"B","sequence":"additional","affiliation":[{"name":"Vijiji Tanzania Rural Health Promotion  Mbeya Tanzania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Walker","family":"R","sequence":"additional","affiliation":[{"name":"Newcastle University  Newcastle Upon Tyne UK"},{"name":"Northumbria Healthcare NHS Foundation Trust North Tyneside General Hospital  North Shields UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Livingston","family":"G","sequence":"additional","affiliation":[{"name":"Division of Psychiatry University College London  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gray","family":"W. 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