Memory Strategy Use, Cognition, and Metacognition Among People Aging with HIV

Living with the HIV virus is a chronic health condition with life expectancies among treated people similar to seronegative individuals. However, older people living with HIV (PLWH) are at higher risk for comorbidities, including cognitive impairment, than their seronegative counterparts. Use of memory strategies has been shown to enhance memory performance among older PLWH, yet few studies have examined factors that drive memory strategy use as well as how impairments in metacognition may hinder the initiation of memory strategies. To address this gap, associations between cognitive function, locus of control and memory strategy use among PLWH with and without memory impairment were examined, followed by the association between metacognition and memory strategy use among PLWH. A secondary analysis was performed using cross-sectional data of 174 PLWH aged 40+ years. Spearman’s correlation was used to determine associations between memory strategy use (total, internal, and external), objective cognitive performance (seven domains and global), and locus of control (internal and external), and informed follow-up linear regression models. ANOVA was used to assess differences in memory strategy use between PLWH across metacognition groups (i.e., concordance between subjective and objective memory functioning yielding four groups: agree both normal, agree both impaired, over-estimators, under-estimators). Among PLWH with memory impairment, higher use of total memory strategies was associated with higher SES, White race, and higher external locus of control (powerful others subscale). Higher use of internal memory strategies was associated with higher SES, White race, older age, and higher external locus of control (powerful others and chance subscales). Higher external strategy use was associated with better executive function. Among PLWH without impairment, higher use of total memory strategies was associated with younger age. Higher use of internal memory strategies was associated with poorer global cognition, executive, and learning function. Higher external strategy use was associated with female sex, younger age, and higher SES. Higher internal locus of control was correlated with better function in all cognitive domains among PLWH without memory impairment. Among all PLWH, those who underestimated their cognitive ability used the most memory strategies, while those who overestimated their abilities used the least memory strategies. Those who correctly estimated their cognitive abilities as being normal or impaired fell in the middle with correct estimators of impaired cognition using the second most memory strategies. As PLWH get older, education around the use of effective memory strategies as well as social support to reinforce memory strategy use may be key to promoting improved confidence in cognitive abilities and quality-of-life as cognition declines. PLWH who overestimate their cognitive abilities and people from low socioeconomic status backgrounds may be less likely to use memory strategies and may benefit from being targeted for memory strategy education.