Impairments of Motor Function While Multitasking in HIV

Abstract

Human immunodeficiency virus (HIV) became a treatable illness with the introduction of combination antiretroviral therapy (CART). As a result, patients with regular access to CART are expected to live decades with HIV. Long-term HIV infection presents unique challenges, including neurocognitive impairments defined by three major stages of HIV-associated neurocognitive disorders (HAND). The current investigation aimed to study cognitive and motor impairments in HIV using a novel multitasking paradigm. Unlike current standard measures of cognitive and motor performance in HIV, multitasking increases real-world validity by mimicking the dual motor and cognitive demands that are part of daily professional and personal settings (e.g., driving, typing and writing). Moreover, multitask assessments can unmask compensatory mechanisms, normally used under single task conditions, to maintain performance. This investigation revealed that HIV+ participants were impaired on the motor component of the multitask, while cognitive performance was spared. A patient-specific positive interaction between motor performance and working memory recall was driven by poor HIV+ multitaskers. Surprisingly, HAND stage did not correspond with multitask performance and a variety of commonly used assessments indicated normal motor function among HIV+ participants with poor motor performance during the experimental task. These results support the use of multitasks to reveal otherwise hidden impairment in chronic HIV by expanding the sensitivity of clinical assessments used to determine HAND stage. Future studies should examine the capability of multitasks to predict performance in personal, professional and health-related behaviors and prognosis of patients living with chronic HIV.

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“…Fifth, our HIV-positive group consisted of mostly non-Hispanic white males with some college education, which is not fully representative of HIV-positive persons in the United States. Sixth, prior research indicates multitasks may better detect motor impairment compared to a single motor task (i.e., finger tapping) 56 ; the Grooved Pegboard Test, however, involves the use of many complex operations and is correlated with a range of cognitive functions. 19…”

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“…HIV+ subjects present a diminished motor performance at multitasking and a decreased velocity compared to the control group. This may affect the daily life and require more attention to [96]. A psychomotor slowing of HIV patients was already described in early neuropsychological studies [97], which was presumed to be from the frontostriatal origin.…”

Drug Use and Abuse in HIV

“…Neuropsychological testing has shown that approximately fifty percent of patients presenting HIV, in antiretroviral therapy, are afflicted by mild cognitive impairment (MCI)/HIV dementia, or other types of cognitive impairment as well as in the integrity of motor functioning, which implies that the prevalence was unaltered from the pre-to the potent antiretroviral period, although incidence of MCI had increased and HIV dementia decreased [1][2][3]. The presence -of neuropsychiatry co-morbidity in the pathophysiology of HIV compounds the suffering and detrimental prognosis of those afflicted with a complex relationship between HIV infection and psychiatric co-morbidity [4,5].…”