Cognitive and Motor Impairment Patterns among HIV+ Adults with and without Stroke in Botswana: Implications for Neurorehabilitation
- 1Department of Physical Medicine and Rehabilitation, University of Pennsylvania
Abstract
BackgroundHIV and stroke are major contributors to disability in sub-Saharan Africa, yet their combined impact on cognitive and motor functioning remains poorly understood. Botswana has a high prevalence of HIV and rising stroke incidence, underscoring the need to characterize impairment to inform neurorehabilitation.
ObjectiveTo examine differences in cognitive performance, motor function, and activities of daily living between adults living with HIV only and those living with both HIV and stroke in Botswana.
MethodsThirty-three adults (19 HIV only; 14 HIV/ stroke) completed standardized cognitive (e.g. MoCA and Digit Symbol Coding [DSC]), and motor assessments (such as Box and Block Test [BBT], Grooved Pegboard [GPB], Grip Strength [GS], 10-Meter Walk Test [10MWT], Timed Up and Go [TUG]), and ADL measures (such as Barthel Index, Lawton IADL). Group comparisons used Wilcoxon rank-sum tests. Impairment was determined using both international z-score norms and Botswana-specific cutoffs from a prior cohort study.
ResultsCognitive impairment was evident in both groups, but DSC z-scores were worse in the HIV/stroke vs HIV only group (median= -2.71 vs -1.34, p=0.015). Gross motor function showed deficits in the HIV/stroke group, including lower dominant-hand BBT performance (median z-score -2.79 vs. -1.75; p=0.008). Fine motor dexterity was markedly reduced in the HIV/stroke group, with GPB dominant-hand median z-scores of -4.26 vs. -1.40 (p=0.038) and non-dominant-hand impairment rates of 100% vs. 63.2% (p=0.043). Non-dominant GS was weaker in the HIV/stroke group (100% impaired vs. 47.4%; p=0.0014). Lower-limb performance was substantially worse, including TUG (median z-score -3.63 vs. 0.10; p=0.0001) and 10MWT (median z-score -5.36 vs. -2.47; p=0.0025). ADL scores were also lower in the HIV/stroke group compared to both Barthel and Lawton (p=0.002).
ConclusionsHIV alone is associated with cognitive and motor impairment, with the addition of stroke producing significantly greater deficits across all motor domains. These findings demonstrate the need to integrate structured neurorehabilitation into HIV clinical care in Botswana.
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BibTeX
@misc{johnson2026cognitive,
title = {{Cognitive and Motor Impairment Patterns among HIV+ Adults with and without Stroke in Botswana: Implications for Neurorehabilitation}},
author = {M. J. Johnson and R. J. Mendonca and F. S. Shofer and N. Mogorosi and N. Goitsemang and L. Bothomilwe and C. C. Ocampo-Ilagan and B. Tsima and J. M. Nthitu and L. Mbakile-Mahlanza and M. B. Kebaetse},
howpublished = {medRxiv},
year = {2026},
month = oct,
doi = {10.64898/2026.10.07.26364959},
url = {https://www.medrxiv.org/content/10.64898/2026.10.07.26364959v1},
note = {CC BY-NC-ND},
}
RIS
TY - UNPB
TI - Cognitive and Motor Impairment Patterns among HIV+ Adults with and without Stroke in Botswana: Implications for Neurorehabilitation
AU - M. J. Johnson
AU - R. J. Mendonca
AU - F. S. Shofer
AU - N. Mogorosi
AU - N. Goitsemang
AU - L. Bothomilwe
AU - C. C. Ocampo-Ilagan
AU - B. Tsima
AU - J. M. Nthitu
AU - L. Mbakile-Mahlanza
AU - M. B. Kebaetse
PY - 2026
DA - 2026/10/07
PB - medRxiv
DO - 10.64898/2026.10.07.26364959
UR - https://www.medrxiv.org/content/10.64898/2026.10.07.26364959v1
AB - BackgroundHIV and stroke are major contributors to disability in sub-Saharan Africa, yet their combined impact on cognitive and motor functioning remains poorly understood. Botswana has a high prevalence of HIV and rising stroke incidence, underscoring the need to characterize impairment to inform neurorehabilitation. ObjectiveTo examine differences in cognitive performance, motor function, and activities of daily living between adults living with HIV only and those living with both HIV and stroke in Botswana. MethodsThirty-three adults (19 HIV only; 14 HIV/ stroke) completed standardized cognitive (e.g. MoCA and Digit Symbol Coding [DSC]), and motor assessments (such as Box and Block Test [BBT], Grooved Pegboard [GPB], Grip Strength [GS], 10-Meter Walk Test [10MWT], Timed Up and Go [TUG]), and ADL measures (such as Barthel Index, Lawton IADL). Group comparisons used Wilcoxon rank-sum tests. Impairment was determined using both international z-score norms and Botswana-specific cutoffs from a prior cohort study. ResultsCognitive impairment was evident in both groups, but DSC z-scores were worse in the HIV/stroke vs HIV only group (median= -2.71 vs -1.34, p=0.015). Gross motor function showed deficits in the HIV/stroke group, including lower dominant-hand BBT performance (median z-score -2.79 vs. -1.75; p=0.008). Fine motor dexterity was markedly reduced in the HIV/stroke group, with GPB dominant-hand median z-scores of -4.26 vs. -1.40 (p=0.038) and non-dominant-hand impairment rates of 100% vs. 63.2% (p=0.043). Non-dominant GS was weaker in the HIV/stroke group (100% impaired vs. 47.4%; p=0.0014). Lower-limb performance was substantially worse, including TUG (median z-score -3.63 vs. 0.10; p=0.0001) and 10MWT (median z-score -5.36 vs. -2.47; p=0.0025). ADL scores were also lower in the HIV/stroke group compared to both Barthel and Lawton (p=0.002). ConclusionsHIV alone is associated with cognitive and motor impairment, with the addition of stroke producing significantly greater deficits across all motor domains. These findings demonstrate the need to integrate structured neurorehabilitation into HIV clinical care in Botswana.
ER -