Anjali Sharma1, David E Vance2, Donald R Hoover3, Qiuhu Shi4, Michael T Yin5, Susan Holman6, Michael W Plankey7, Phyllis C Tien8,9, Kathleen M Weber10, Michelle Floris-Moore11, Hector H Bolivar12, Elizabeth T Golub13, Marcia McDonnell Holstad14, Leah H Rubin13,15. 1. Department of Medicine, Albert Einstein College of Medicine, Bronx, NY. 2. School of Nursing, The University of Alabama at Birmingham, Birmingham, AL. 3. Department of Statistics, Rutgers University, Piscataway, NJ. 4. Department of Public Health, New York Medical College, Valhalla, NY. 5. Department of Medicine, Columbia University Medical Center, NY, NY. 6. Department of Medicine, State University of New York Downstate Medical Center, Brooklyn, NY. 7. Department of Medicine, Georgetown University Medical Center, Washington, DC. 8. Department of Medicine, VA Medical Center, University of California San Francisco, San Francisco, CA. 9. University of California San Francisco, San Francisco, CA. 10. Cook County Health and Hospitals System, Chicago, IL. 11. Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC. 12. Department of Medicine, University of Miami Health System, Miami, FL. 13. Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. 14. Emory School of Nursing, Atlanta GA; and. 15. Departments of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD.
Abstract
OBJECTIVE: To determine whether domain-specific neurocognitive (NC) impairments predict falls in HIV+ compared with HIV- women. DESIGN: Cross-sectional data analysis from 825 HIV+ and 392 HIV- women in the Women's Interagency HIV Study with NC testing within 2 years before falls surveys. METHODS: NC impairment (T score <40) was assessed in 7 domains: executive function, psychomotor speed, attention, learning, memory, fluency, and fine motor function. For domains associated with any fall within 6 months in simple logistic regression (P < 0.05), hierarchical regression models evaluated associations between NC impairment and odds of falling, adjusting for: (1) study site and HIV, (2) demographics, (3) comorbid conditions, (4) substance use/central nervous system active medications, and HIV-specific factors. RESULTS: Median age was higher in HIV+ than HIV- women (51 vs. 48 yrs); prevalence of falls was similar (19% HIV+, 16% HIV-). Overall, executive function [OR (odds ratio) = 1.82, 95% CI (confidence interval): 1.21 to 2.74; P = 0.004], psychomotor speed (OR = 1.59, 95% CI: 1.05 to 2.42, P = 0.03), and fine motor (OR 1.70, 95% CI: 1.11 to 2.61, P = 0.02) impairments were associated with greater odds of falls in fully adjusted models. In fully adjusted models, associations of executive function, psychomotor speed, and fine motor were nonsignificant among HIV+ women; conversely, among HIV- women, associations with impaired executive and fine motor functions were strengthened and remained significant. CONCLUSIONS: Cognitive impairment was associated with falls among middle-aged HIV- but not HIV+ women. Additional studies should elucidate mechanisms by which domain-specific NC impairment impacts fall risk among older HIV+ and HIV- women and how different factors modify relationships between cognition and falls.
OBJECTIVE: To determine whether domain-specific neurocognitive (NC) impairments predict falls in HIV+ compared with HIV- women. DESIGN: Cross-sectional data analysis from 825 HIV+ and 392 HIV- women in the Women's Interagency HIV Study with NC testing within 2 years before falls surveys. METHODS: NC impairment (T score <40) was assessed in 7 domains: executive function, psychomotor speed, attention, learning, memory, fluency, and fine motor function. For domains associated with any fall within 6 months in simple logistic regression (P < 0.05), hierarchical regression models evaluated associations between NC impairment and odds of falling, adjusting for: (1) study site and HIV, (2) demographics, (3) comorbid conditions, (4) substance use/central nervous system active medications, and HIV-specific factors. RESULTS: Median age was higher in HIV+ than HIV- women (51 vs. 48 yrs); prevalence of falls was similar (19% HIV+, 16% HIV-). Overall, executive function [OR (odds ratio) = 1.82, 95% CI (confidence interval): 1.21 to 2.74; P = 0.004], psychomotor speed (OR = 1.59, 95% CI: 1.05 to 2.42, P = 0.03), and fine motor (OR 1.70, 95% CI: 1.11 to 2.61, P = 0.02) impairments were associated with greater odds of falls in fully adjusted models. In fully adjusted models, associations of executive function, psychomotor speed, and fine motor were nonsignificant among HIV+ women; conversely, among HIV- women, associations with impaired executive and fine motor functions were strengthened and remained significant. CONCLUSIONS: Cognitive impairment was associated with falls among middle-aged HIV- but not HIV+ women. Additional studies should elucidate mechanisms by which domain-specific NC impairment impacts fall risk among older HIV+ and HIV- women and how different factors modify relationships between cognition and falls.
Authors: Melanie C Bacon; Viktor von Wyl; Christine Alden; Gerald Sharp; Esther Robison; Nancy Hessol; Stephen Gange; Yvonne Barranday; Susan Holman; Kathleen Weber; Mary A Young Journal: Clin Diagn Lab Immunol Date: 2005-09
Authors: Meredith Greene; Kenneth E Covinsky; Victor Valcour; Yinghui Miao; Joy Madamba; Harry Lampiris; Irena Stijacic Cenzer; Jeffrey Martin; Steven G Deeks Journal: J Acquir Immune Defic Syndr Date: 2015-06-01 Impact factor: 3.731
Authors: Ned Sacktor; Richard L Skolasky; Eric Seaberg; Cynthia Munro; James T Becker; Eileen Martin; Ann Ragin; Andrew Levine; Eric Miller Journal: Neurology Date: 2015-12-30 Impact factor: 9.910
Authors: Anjali Sharma; Donald R Hoover; Qiuhu Shi; Susan Holman; Michael W Plankey; Amber L Wheeler; Kathleen Weber; Michelle Floris-Moore; Hector H Bolivar; David E Vance; Wendy J Mack; Elizabeth T Golub; Marcia McDonnell Holstad; Michael T Yin Journal: Antivir Ther Date: 2016-07-18
Authors: Julie A Womack; Terrence E Murphy; Linda Leo-Summers; Jonathan Bates; Samah Jarad; Alexandria C Smith; Thomas M Gill; Evelyn Hsieh; Maria C Rodriguez-Barradas; Phyllis C Tien; Michael T Yin; Cynthia A Brandt; Amy C Justice Journal: J Acquir Immune Defic Syndr Date: 2022-10-01 Impact factor: 3.771
Authors: Anna A Rubtsova; Gina Wingood; Ighovwerha Ofotokun; C Christina Mehta; Deborah Gustafson; David E Vance; Anjali Sharma; Adaora A Adimora; Marcia Holstad Journal: AIDS Behav Date: 2021-06-11
Authors: Christina K Psomas; Donald R Hoover; Qiuhu Shi; Todd T Brown; David E Vance; Susan Holman; Michael W Plankey; Phyllis C Tien; Kathleen M Weber; Michelle Floris-Moore; Hector H Bolivar; Elizabeth T Golub; Marcia McDonnell Holstad; Kendra K Radtke; Bani Tamraz; Kristine M Erlandson; Leah H Rubin; Anjali Sharma Journal: J Acquir Immune Defic Syndr Date: 2022-07-01 Impact factor: 3.771