Abstract
Background:
Due to widespread availability of effective antiretroviral regimens, the HIV population over 60 years old is growing, but this population suffers from more morbidity. This morbidity includes HIV Associated Neurocognitive Disorders (HAND) and it affects > 50% of HIV patients of all ages. The high frequency and effects of cognitive impairment may be more burdensome in HIV patients over 60 years old. Motor findings are a common consequence of neuroAIDS and can even be the presenting symptom of HIV infection. There have been few studies investigating HIV motor dysfunction in the aging HIV population.
Methods:
HIV-infected subjects were enrolled into the UCSF HIV over 60 cohort and subjects with normal cognition and Alzheimer's disease (AD) were evaluated from matching studies at the UCSF Memory and Aging Center. Trained physicians completed the Unified Parkinson's Disease Rating Scale motor exam (UPDRS). Nonparametric ANOVA was used to compare UPDRS scores across groups. All UPDRS comparisons were adjusted for age and Clinical Dementia Rating score. Spearman linear regressions were used to investigate correlation between UPDRS scores and brain volumes measured by FreeSurfer® from 3T Siemens images.
Results:
The UPDRS scores were significantly higher in HIV compared to controls (median [IQR]: 4 [1–5] and 2 [0–2], respectively, P = .003). HIV infected subjects with cognitive impairment had higher UPDRS scores than those without (P = .018). Although both were higher than controls, HIV and AD groups did not differ from each other on UPDRS scores (P = .48). The amygdala and thalamus volumes both correlated with UPDRS score in the HIV group in models adjusted for intracranial volume (amygdala r2 = 0.131, P = .006, thalamus r2 = 0.053, P = .085); but significance was lost in thalamus volume when adjusted for age.
Conclusions:
These findings provide evidence that motor findings are more frequent in HIV and AD compared to controls; but we did not find evidence that they were higher in HIV compared to AD. The volumes of the thalamus and the amygdala showed a weak but significant correlation with UPDRS scores supporting their involvement in motor dysfunction.
Conflict of Interest
The authors report no conflict of interest. Funding: This work was supported by NIH [K23-AG032872 (VV), P50- AG023501 (BM), UL1 RR024131 (UCSF GCRC), the Larry L. Hillblom Foundation, P30-AI027763 (UCSF CFAR), the UCSF AIDS Research Institute, and the Medical Student Training in Aging Research (MSTAR) program.