Abstract
BackgroundHIV-associated neurocognitive disorders (HAND) remain prevalent despite improved antiretroviral treatment (ART), and it is essential to have a sensitive and specific HAND screening tool.MethodsParticipants were 200 HIV-infected US military beneficiaries, managed early in the course of HIV infection, had few comorbidities, and had open access to ART. Participants completed a comprehensive, seven-domain (16-test), neuropsychological battery (∼120 min); neurocognitive impairment (NCI) was determined using a standardized score derived from demographically adjusted T-scores (global deficit score ≥0.5). Restricting the estimated administration time of the screening battery to < = 20 minutes, we examined the sensitivity and specificity of detecting NCI for all possible combinations of 2-, 3-, and 4- tests from the comprehensive battery.ResultsParticipants were relatively healthy (median CD4 count: 546 cells/mm3) with 64% receiving ART. Prevalence of NCI was low (19%). The best 2-test screener included the Stroop Color Test and the Hopkins Verbal Learning Test-Revised (11 min; sensitivity = 73%; specificity = 83%); the best 3-test screener included the above measures plus the Paced Auditory Serial Addition Test (PASAT; 16 min; sensitivity = 86%; specificity = 75%). The addition of Action Fluency to the above three tests improved specificity (18 min; sensitivity = 86%; specificity = 87%).ConclusionsCombinations of widely accepted neuropsychological tests with brief implementation time demonstrated good sensitivity and specificity compared to a time intensive neuropsychological test battery. Tests of verbal learning, attention/working memory, and processing speed are particularly useful in detecting NCI. Utilizing validated, easy to administer, traditional neuropsychological tests with established normative data may represent an excellent approach to screening for NCI in HIV.
Highlights
HIV-associated neurocognitive disorders (HAND) remain prevalent despite improved antiretroviral treatment; up to 50% of HIV infected (HIV+) individuals are estimated to experience some level of neurocognitive impairment (NCI) [1]
Rather than decide the optimal combination of tests to define one specific screening battery, we have chosen to present an enumeration of the top-ranked combinations; this provides users with the information needed to select the highest-ranked combination from among those that satisfy site constraints in time, training, cost, or equipment (Table 1)
Our study reveals that several combinations of traditional neuropsychological tests that require relatively little administration time (i.e.,20 minutes, and in some cases,10 minutes) can yield good sensitivity and specificity in identifying neurocognitive impairment as assessed by a larger test battery in a relatively high functioning sample of HIV-infected military beneficiaries
Summary
HIV-associated neurocognitive disorders (HAND) remain prevalent despite improved antiretroviral treatment; up to 50% of HIV infected (HIV+) individuals are estimated to experience some level of neurocognitive impairment (NCI) [1]. There is a growing demand for even briefer neurocognitive assessments, such as neurocognitive screening instruments, which can aid in the preliminary identification of individuals who may be appropriate to undergo further testing. These screening batteries or instruments would ensure an efficient use of time and resources in both clinical and research protocols [3]. HIV-associated neurocognitive disorders (HAND) remain prevalent despite improved antiretroviral treatment (ART), and it is essential to have a sensitive and specific HAND screening tool
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