Defining Neurocognitive Impairment in HIV: Deficit Scores Versus Clinical Ratings

Abstract

Background Because HIV-related neurocognitive impairment is usually mild and variable, clinical ratings (CR) and global deficit scores (GDS) are recommended for detecting HIV-associated neurocognitive disorders (HAND). The CR-approach requires impairment in at least two ability domains; GDS considers number and severity of impairments across all measures. We examined classification agreement and clinical correlates of the two methods. Method Neurocognitive functioning of 1574 HIV-infected participants was assessed via a comprehensive, seven-domain neuropsychological battery. Global neurocognitive impairment was defined for each participant independently by CR and GDS. Participants were classified into four categories (Dually-normal, impaired by CR-only, impaired by GDS-only, or Dually-impaired). Results There was 83% concordance between CR and GDS classifications; in total, 56% of participants were deemed impaired by CR and 41% were classified as impaired by GDS. Impairment by GDS virtually guaranteed CR impairment, but 16% of participants were additionally classified as impaired only by CR. As compared to Dually-normal participants, those classified as Dually and CR-only impaired were more likely to have AIDS, have more severe co-occurring conditions, have more severe depressive symptoms, be unemployed, and have more everyday functioning complaints (ps < 0.05). Conclusion Impairment classifications of the two methods were in high agreement; however, more people were classified as impaired using the CR-approach compared to the GDS approach, and those impaired according to CR-only showed fewer neurocognitive and functional deficits than the Dually-impaired participants. The CR approach may be most appropriate for detecting more subtle forms of neurocognitive impairment. Clinicians and researchers should recognize the strengths and weaknesses of each method when evaluating neurocognitive complications in HIV.

The Role of Employment on Neurocognitive Reserve in Adults With HIV: A Review of the Literature

“…Furthermore, many adults with HIV may lack the neurocognitive stimulation provided by such employment. In a sample of 1,574 adults with HIV, Blackstone and colleagues (2012a) assessed these adults on a seven-domain neurocognitive battery. Compared to those without neurocognitive deficits, those who were classified as having neurocognitive deficits were more likely to have AIDS, have more severe co-morbid conditions, have more depressive symptoms, have more complaints in everyday functioning, and – be unemployed.…”

Prevalence and Correlates of Persistent HIV-1 RNA in Cerebrospinal Fluid During Antiretroviral Therapy

“…To classify the presence and severity of neurocognitive impairment, a published objective algorithm was used that requires presence of at least mild impairment in at least 2 cognitive domains, conforms to the Frascati criteria for diagnosing HAND [1], and yielded excellent interrater reliability in prior studies [22]. Neurocognitive performance was then summarized by the global clinical rating, a validated method that integrates relevant information about the 7 neurocognitive domains and yields a value between 1 (for normal performance) and 9 (for severely impaired performance), with a value of 5 indicating definite, mild impairment [23]. Frascati guidelines were also used to classify comorbid neuropsychiatric conditions, the most common of which are summarized in the Supplementary Materials.…”

Similar changes in neuropsychological functioning in english and spanish speaking HIV patients

“…Individual Deficit Scores (DS) were derived from the standardized z ‐scores as follows: DS = 0 (normal) if z ‐score >−1.0, DS = 1 (mild to normal) if z ‐score is [>−1.5, ≤−1.0], DS = 2 (mild) if z ‐score is [>−2.0, ≤−1.5), DS = 3 (moderate) if z ‐score is [>−2.5, ≤−2.0), DS = 4 (moderate to severe) if z ‐score is [>−3.0, ≤−2.5), and DS = 5 (severe) if z ‐score ≤−3.0. The domain DS was calculated as the average of the test DS comprising the domain, while the Global Deficit Score (GDS) was computed as the average of the 15 individual DSs (Blackstone et al., 2012; Carey et al., 2004). The 48‐week changes in NP z ‐scores were compared between the 188 English and the 21 Spanish speakers regardless of treatment arms since there were no differences in NP z ‐scores between the A5303 treatment arms.…”