Concurrent Validity of a Computer-Based Cognitive Screening Tool for Use in Adults with HIV Disease

Abstract

As the incidence of HIV-associated dementia has decreased, the survival of HIV-infected individuals with milder forms of cognitive impairment has increased. Detecting this milder impairment in its earliest stages has great clinical and research importance. We report here the results of an initial evaluation of the Computer Assessment of Mild Cognitive Impairment (CAMCI Ò ), a computerized screening tool designed to assess abnormal cognitive decline with reduced respondent and test administrator burden. Fifty-nine volunteers (29 HIV infected; age = 50.9 years; education = 14.9 years; 36/59 males) completed the CAMCI Ò and a battery of neuropsychological tests. The CAMCI was repeated 12 and 24 weeks later. The results from the CAMCI were compared to Global and Domain Impairment scores derived from the full neuropsychological test battery. The CAMCI detected mild impairment (compared with normal and borderline test performance) with a sensitivity of 0.72, specificity of 0.97, positive predictive rate of 0.93, and a negative predictive rate of 0.89. Median stability over 12 and 24 weeks of follow-up was 0.32 and 0.46, respectively. These rates did not differ as a function of serostatus. A discriminant function analysis correctly classified 90% of the subjects with respect to their overall Global Impairment Rating from six of the CAMCI scores. This preliminary study demonstrates that the CAMCI is sensitive to mild forms of cognitive impairment, and is stable over 24 weeks of follow-up. A larger trial to obtain risk-group appropriate normative data will be necessary to make the instrument useful in both clinical practice and research (e.g., clinical trials).

Association of Fatigue Intensification with Cognitive Impairment during Radiation Therapy for Prostate Cancer

“…It is also well tolerated by elderly patients with limited computer knowledge and can be completed in 20 min [26]. Furthermore, CAMCI® is a sensitive tool for detecting mild cognitive problems in nondemented patients [26, 49]. To demonstrate the sensitivity of CAMCI® in discerning cognitive difficulties in the cancer population, we incorporated the Stroop test in our study, as it is a widely used test across multiple disciplines including cancer-related fatigue [51].…”

“…CAMCI® has good test-retest reliability and has demonstrated good sensitivity (86%) as well as specificity (94%) for the identification of mild forms of cognitive impairment [26, 48]. The sensitivity of CAMCI® was 0.72 relative to the Global Impairment Rating, with good positive and negative predictive values of 0.93 and 0.89, respectively [49]. CAMCI® was administered in English on a touch screen tablet PC at baseline, at midpoint, and at completion of EBRT.…”

“…The CAMCI® scores for each task are presented in percentile format [26, 50]. The following tasks are included in CAMCI® [49]. …”

Identifying Risk Factors for HIV-Associated Neurocognitive Disorders Using the International HIV Dementia Scale

“…Notably, research studies in the United States that have used formal neuropsychometric endpoints have observed a stable overall prevalence of HAND with greater preponderance of milder forms (Heaton et al 2010; Lescure et al 2011). However, these studies often do not represent the general HIV+ population in terms of sociodemographics and lifestyle behaviors (Sacktor et al 2005; Becker et al 2011; Overton et al 2011; Richardson et al 2005). Our study population was unique in that it was composed of all potential HIV+ individuals who attended a general infectious disease clinic.…”

Cross-Sectional Study of Unexplained White Matter Lesions in HIV Positive Individuals Undergoing Brain Magnetic Resonance Imaging

“…21 Their significance in HIV clinical practice, particularly as an incidental finding, remains unclear. There have been recent advances in non-imaging tools used to diagnose and monitor NCI in HIV, [22][23][24][25] using techniques that are reproducible and require less expertise than neuropsychological assessment. However, given some of the uncertainty over the longer term clinical importance of mild-to-moderate cognitive difficulties, improved understanding of biomarkers such as structural and functional imaging is vital.…”