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Impaired Cognition Predicts Falls Among Women with and Without HIV Infection.

OBJECTIVE
To determine if domain-specific neurocognitive (NC) impairments predict falls in HIV+ compared to HIV- women.


DESIGN
Cross-sectional data analysis from 825 HIV+ and 392 HIV- women in the Women's Interagency HIV Study (WIHS) with NC testing within two years prior to falls surveys.


METHODS
NC impairment (T score <40) was assessed in seven 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<.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/CNS active medications, and HIV-specific factors.


RESULTS
Median age was higher in HIV+ than HIV- women (51yrs vs. 48yrs); prevalence of falls was similar (19% HIV+, 16% HIV-). Overall, executive function (OR [odds ratio]=1.82, 95%CI [confidence interval] 1.21-2.74; P=0.004), psychomotor speed (OR=1.59, 95%CI 1.05-2.42, P=0.03), and fine motor (OR 1.70, 95%CI 1.11-2.61, 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 non-significant 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.