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

Arch Neurol. 2008 Aug;65(8):1096-101. doi: 10.1001/archneur.65.8.1096.


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.

Publication types

  • Comparative Study
  • Research Support, N.I.H., Extramural
  • Validation Study

MeSH terms

  • AIDS Dementia Complex / complications
  • AIDS Dementia Complex / drug therapy*
  • AIDS Dementia Complex / psychology*
  • Adult
  • Antiretroviral Therapy, Highly Active* / trends
  • Cognition Disorders / complications
  • Cognition Disorders / drug therapy
  • Cognition Disorders / psychology
  • Cohort Studies
  • Female
  • HIV / drug effects*
  • HIV / physiology
  • HIV Infections / complications
  • HIV Infections / drug therapy
  • HIV Infections / psychology
  • Humans
  • Longitudinal Studies
  • Male
  • Middle Aged
  • Motor Skills / drug effects
  • Motor Skills / physiology
  • Motor Skills Disorders / complications
  • Motor Skills Disorders / drug therapy*
  • Motor Skills Disorders / psychology
  • Neuropsychological Tests