# Cognitive Flexibility and Inhibition Deficits in HIV and Cocaine Dependence: Evidence from Stroop and Trail Making Tests

## TL;DR

This study finds that people with HIV or cocaine dependence show similar but distinct problems with cognitive control, even without severe cognitive impairment.

## Contribution

The study identifies unique and overlapping executive function deficits in HIV and cocaine dependence using standardized neuropsychological tests.

## Key findings

- HIV was linked to slower performance on the Stroop Interference task.
- Cocaine dependence was associated with more errors on Stroop tasks, indicating inhibitory control issues.
- There was no significant interaction between HIV and cocaine dependence on cognitive performance.

## Abstract

Objective: To better define potential executive function difficulties in individuals living with HIV but not clinically identified as having HAND, with and without mild to moderate cocaine dependence (CD), our cross-sectional study examined executive function performance on the Stroop Color-Word Test (Stroop) and the Trail Making Test (TMT) in four groups stratified by HIV and CD status. Method: We recruited 101 participants (26 HIV+/CD+; 18 HIV+/CD−; 30 HIV−/CD+; 27 HIV−/CD−). We utilized a 2 (HIV: yes/no) × 2 (Cocaine: yes/no) MANCOVA while controlling for age and premorbid intelligence on the Stroop trials (i.e., color-naming, word-reading, interference), and TMT-A and TMT-B z-scores, number of errors, and the B/A ratio. Results: HIV was associated with significantly slower performance on the Stroop Interference (p = 0.012, η2 = 0.064). CD showed a trend towards slower performance on interference trials (p = 0.061, η2 = 0.037) and was associated with significantly more errors on the Stroop Word-Reading (p = 0.028, η2 = 0.050) and Interference trials (p = 0.046, η2 = 0.041), suggestive of difficulties with inhibitory control and written language processing. There were no significant HIV × Cocaine interactions. Conclusions: Our results suggest HIV without clinically identified cognitive impairment and CD are associated with distinct and potentially overlapping executive functioning deficits, particularly for measures of inhibitory control. Notably, CD showed trend-level slowing on Stroop Interference performance, suggesting partial overlap with HIV effects. Clarifying the specific cognitive processes impacted by HIV and CD can help guide tailored interventions to improve functional outcomes in these populations.