Impaired Cognition Predicts Falls Among Women With and Without HIV Infection
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.
Sharma, A., Vance, D. E., Hoover, D. R., Shi, Q., Yin, M. T., Holman, S., Plankey, M. W., Tien, P. C., Weber, K. M., Floris-Moore, M., Bolivar, H. H., Golub, E. T., McDonnell Holstad, M., & Rubin, L. H. (2020). Impaired Cognition Predicts Falls Among Women With and Without HIV Infection. Journal of Acquired Immune Deficiency Syndromes, 83 (3), 301-309. https://doi.org/10.1097/QAI.0000000000002262