Motor Function and Human Immunodeficiency Virus-Associated Cognitive Impairment in a Highly Active Antiretroviral Therapy-Era Cohort
08/2008
Journal Article
Authors:
Robinson-Papp, J.;
Byrd, D.;
Mindt, M.;
Oden, N.;
Simpson, D.;
Morgello, S.;
Bank, M.H.I.V.Brain
Secondary:
Arch Neurol
Volume:
65
Pagination:
1096-1101
URL:
http://www.ncbi.nlm.nih.gov/pubmed/18695060
Keywords:
Adult; AIDS Dementia Complex; Antiretroviral Therapy- Highly Active; Cognition Disorders; Cohort Studies; Female; HIV; HIV Infections; Longitudinal Studies; Male; Middle Aged; Motor Skills; Motor Skills Disorders; Neuropsychological Tests
Abstract:
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.
