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Motor function and human immunodeficiency virus-associated cognitive impairment in a highly active antiretroviral therapy-era cohort.

2008 Aug

Journal Article

Robinson-Papp, J.; Byrd, D.; Mindt, M.Rivera; Oden, N.Leonard; Simpson, D.M.; Morgello, S.

Arch Neurol






Adult; AIDS Dementia Complex; Antiretroviral Therapy, Highly Active; Cognition Disorders; Cohort Studies; Female; HIV; HIV Infections; Humans; Longitudinal Studies; Male; Middle Aged; Motor Skills; Motor Skills Disorders; Neuropsychological Tests

BACKGROUND: Cognitive impairment has long been recognized as a manifestation of human immunodeficiency virus (HIV) infection. However, highly active antiretroviral therapy (HAART) has altered the neurologic manifestations of HIV.OBJECTIVES: To develop a measure to quantify the motor abnormalities included in the original descriptions of HIV-associated dementia (HAD); to determine whether motor, affective, and behavioral dysfunction predict cognitive impairment; and to determine whether quantitative motor testing is a helpful adjunct in the diagnosis of HAD in a complex population from the HAART era.DESIGN: Neurologic and neuropsychological data were collected from the Manhattan HIV Brain Bank, a longitudinal cohort study of patients with advanced HIV. The HIV-Dementia Motor Scale (HDMS) was developed and validated and cognitive and affective or behavioral function was quantified using global neuropsychological T scores, the Beck Depression Inventory (BDI), and an independent assessment of apathy. Relationships among cognitive, motor, affective, and behavioral performance were examined using correlation, linear regression, and analyses of variance.SETTING: An urban AIDS research center.PARTICIPANTS: A total of 260 HIV-positive, predominantly minority patients.MAIN OUTCOME MEASURES: The HDMS scores and global neuropsychological T scores.RESULTS: The HDMS and BDI scores were independent predictors of cognitive impairment. Significant cognitive impairment was found in patients with motor dysfunction. Patients diagnosed as having HAD had a greater degree of motor impairment than those with other neurocognitive diagnoses.CONCLUSIONS: Motor, affective, and behavioral abnormalities predict cognitive impairment in HIV-positive patients in this HAART-era cohort. The HDMS may be useful in the assignment of HIV-associated neurocognitive impairment in HIV populations in which normative data or neuropsychological test design is not optimal.

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