Abstract
BackgroundPractical screening strategies are necessary to detect neurocognitive impairment of all severities in HIV populations, which remains prevalent despite highly active antiretroviral therapy and requires full neuropsychological testing for diagnosis. We aimed to develop a brief and clinically feasible battery to screen for HIV-associated neurocognitive disorders (HAND) in resource-limited settings even where English is not the native language.MethodsA total of 53 outpatients were recruited from a multi-ethnic Southeast Asian HIV-positive cohort. Performance on a neuropsychological protocol was used to define cognitive impairment, of which 28 patients (52.8%) were identified with HAND. Receiver operating characteristic analysis was used to determine the best combinations of cognitive tests for the screening battery.Results3 different combinations of cognitive tests that required minimal literacy, time to administer, and administrator training were found to classify HAND with fair accuracy. Montreal Cognitive Assessment (MoCA), in combination with tests of psychomotor coordination, verbal learning and speed processing, yielded area under curve scores of above 0.75, the primary outcome of receiver operating characteristic analysis.ConclusionThe 3-test combinations presented in this study appear to be promising screening options for HAND in HIV-infected patients. The addition of 2 tests to MoCA improves the overall accuracy while retaining its convenience, giving more potential for the inclusion of cognitive screening in routine clinical care. Further validation of the batteries in specific settings is warranted to determine specific screening cut-offs to a global cognitive score.
Highlights
Despite the introduction of highly active antiretroviral therapy (HAART), the prevalence of HIV-associated neurocognitive disorders (HAND) remains high; up to 50% of HIV-positive individuals are estimated to experience some level of neurocognitive impairment [1]
The current nosology for HAND covers three disorders ranging in severity from asymptomatic neurocognitive impairment (ANI) to mild neurocognitive disorder (MND) to HIVassociated dementia (HAD)
Of the 28 patients who were classified with cognitive impairment, 21 (75%) scored above the cut-off values for Montreal Cognitive Assessment (MoCA) (≥ 26) and International HIV Dementia Scale (IHDS) (> 10)
Summary
Despite the introduction of highly active antiretroviral therapy (HAART), the prevalence of HIV-associated neurocognitive disorders (HAND) remains high; up to 50% of HIV-positive individuals are estimated to experience some level of neurocognitive impairment [1]. Cognitive performance and report of functional impairment form the basis for the diagnostic criteria of HAND, with functional decline in MND and HAD patients and ANI patients lacking functional complaints. No validated screening tool is yet capable of discriminating between levels of cognitive impairment associated with varying HAND severities. Practical screening strategies are necessary to detect neurocognitive impairment of all severities in HIV populations, which remains prevalent despite highly active antiretroviral therapy and requires full neuropsychological testing for diagnosis. We aimed to develop a brief and clinically feasible battery to screen for HIV-associated neurocognitive disorders (HAND) in resource-limited settings even where English is not the native language
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