Neurological soft signs and brain morphology in people living with HIV

Abstract

Neurological soft signs (NSS) are a common feature of severe psychiatric disorders such as schizophrenia but are also prevalent in organic brain diseases like HIV-associated neurocognitive disorder (HAND) or Alzheimer’s disease. While distinct associations between NSS, neurocognition, and cerebral regions were demonstrated in schizophrenia, these associations still have to be elucidated in HIV. Therefore, we investigated 36 persons with HIV of whom 16 were neurocognitively healthy and 20 were diagnosed with HAND. NSS were assessed using the Heidelberg scale. NSS scores were correlated with gray matter (GM) using whole brain voxel-based morphometry. Results showed significantly elevated NSS in the HAND group when compared to the neurocognitively healthy with respect to NSS total score and the subscores “orientation” and “complex motor tasks”. While the two groups showed only minor, non-significant GM differences, higher NSS scores (subscales “motor coordination”, “orientation”) were significantly correlated with GM reduction in the right insula and cerebellum (FWE-corrected). Our results corroborate elevated NSS in HIV+ patients with HAND in contrast to cognitively unimpaired patients. In addition, cerebral correlates of NSS with GM reductions in insula and cerebellum were revealed. Taken together, NSS in this patient group could be considered a marker of cerebral damage and neurocognitive deficits.

Tryptophan–Kynurenine Pathway Activation and Cognition in Virally Suppressed Women With HIV

“…More sensitive and specific tests are needed to evaluate the functional impact of motor decline in PWH. 39,40 Dysfunction in other components of motor function such as muscle strength, coordination, and gait (which were not evaluated in this analysis) have also been observed in the context of HIV [41][42][43] ; future studies are required to identify whether IDO activation is associated with deficits across the spectrum of motor functioning in HIV. IDO activation is strongly associated to aging and chronic inflammatory conditions such as osteoporosis, and independently predicts mortality in PWH on ART.…”

A new perspective on HIV: effects of HIV on brain-heart axis

“…Blahak et al suggested that white matter injury can disrupt the prefrontal subcortical motor circuit, resulting in impaired balance and an increased risk of falls (123). In addition to white matter injury, advanced HAND patients may exhibit decreased subcortical volume, caudate nucleus volume, cerebral malacia foci, and brain atrophy (66,124,125). HIV can also contribute to other acute central nervous system diseases, such as stroke.…”

“…After receiving visceral sensory signals from the posterior insular lobe, the anterior insular lobe sends out visceral movement signals, regulating visceral movement, including the CS (170). In HIV-infected individuals, damage to the gray matter of the right insular lobe can result in parasympathetic inhibition and sympathetic excitation, leading to increased heart rate and blood pressure (125,171,172). Overstimulation of the posterior insula can contribute to the development of conditions such as atrioventricular block, premature ventricular contractions, prolonged QT interval, and even asystole (173).…”