Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Stanford.
Center for Health Sciences, SRI International, Menlo Park, Califormia, USA.
AIDS. 2023 Jun 1;37(7):1085-1096. doi: 10.1097/QAD.0000000000003531. Epub 2023 Mar 3.
Determine the independent contributions of central nervous system (CNS) and peripheral nervous system (PNS) metrics to balance instability in people with HIV (PWH) compared with people without HIV (PWoH).
Volumetric MRI (CNS) and two-point pedal discrimination (PNS) were tested as substrates of stance instability measured with balance platform posturography.
125 PWH and 88 PWoH underwent balance testing and brain MRI.
The PWH exhibited stability deficits that were disproportionately greater with eyes closed than eyes open compared with PWoH. Further analyses revealed that greater postural imbalance measured as longer sway paths correlated with smaller cortical and cerebellar lobular brain volumes known to serve sensory integration; identified brain/sway path relations endured after accounting for contributions from physiological and disease factors as potential moderators; and multiple regression identified PNS and CNS metrics as independent predictors of postural instability in PWH that differed with the use of visual information to stabilize balance. With eyes closed, temporal volumes and two-point pedal discrimination were significant independent predictors of sway; with eyes open, occipital volume was an additional predictor of sway. These relations were selective to PWH and were not detected in PWoH.
CNS and PNS factors were independent contributors to postural instability in PWH. Recognizing that myriad inputs must be detected by peripheral systems and brain networks to integrate sensory and musculoskeletal information for maintenance of postural stability, age- or disease-related degradation of either or both nervous systems may contribute to imbalance and liability for falls.
确定中枢神经系统（CNS）和周围神经系统（PNS）指标对 HIV 感染者（PWH）与非 HIV 感染者（PWoH）平衡不稳定的独立贡献。
使用平衡平台姿势描记术测试体积 MRI（CNS）和两点足趾分辨（PNS），作为姿势不稳定的基础。
125 名 PWH 和 88 名 PWoH 接受了平衡测试和脑部 MRI。
PWH 表现出稳定性缺陷，闭眼时比睁眼时更为明显，与 PWoH 相比。进一步的分析表明，较大的姿势失衡，表现为更长的摆动路径，与已知负责感觉整合的皮质和小脑小叶脑体积较小相关；在考虑生理和疾病因素作为潜在调节因素的贡献后，识别到的大脑/摆动路径关系仍然存在；多元回归确定了 CNS 和 PNS 指标是 PWH 姿势不稳定的独立预测因素，这与使用视觉信息来稳定平衡有关。闭眼时，颞叶体积和两点足趾分辨是摆动的重要独立预测因素；睁眼时，枕叶体积是摆动的另一个预测因素。这些关系是 PWH 特有的，在 PWoH 中没有发现。
CNS 和 PNS 因素是 PWH 姿势不稳定的独立贡献者。认识到为了维持姿势稳定，周围系统和大脑网络必须检测到多种输入，以整合感觉和肌肉骨骼信息，年龄或疾病相关的神经系统的退化可能会导致平衡失调和跌倒的倾向。
