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Motor Function and Human Immunodeficiency Virus–Associated Cognitive Impairment in a Highly Active Antiretroviral Therapy–Era Cohort
Jessica Robinson-Papp, MD;
Desiree Byrd, PhD;
Monica Rivera Mindt, PhD;
Neal Leonard Oden, PhD;
David M. Simpson, MD;
Susan Morgello, MD; for the Manhattan HIV Brain Bank
Arch Neurol. 2008;65(8):1096-1101.
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.
Author Affiliations: Departments of Pathology (Drs Robinson-Papp, Byrd, Rivera Mindt, and Morgello), Neurology (Drs Robinson-Papp and Simpson), Psychiatry (Drs Byrd and Rivera Mindt), and Neuroscience (Dr Morgello), Mount Sinai Medical Center, New York, New York; and The EMMES Corporation, Rockville, Maryland (Dr Oden).
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