Education correction using years in school or reading grade-level equivalent? Comparing the accuracy of two methods in diagnosing HIV-associated neurocognitive impairment

Abstract

Neuropsychological tests generally require adjustments for years of education when determining the presence of neurocognitive impairment. However, evidence indicates that educational quality, as assessed with reading tests, may be a better reflection of educational attainment among African Americans. Thus, African Americans with poor educational quality may be incorrectly classified with neurocognitive impairment based on neuropsychological tests. We compared the accuracy of neuropsychological test scores standardized using reading grade-equivalent versus years of education in predicting neurocognitive impairment among a sample of Whites and African-American adults who were HIV+. Participants were examined by a neurologist and classified with or without HIV-associated neurocognitive disorders according to accepted criteria. Participants were also classified as impaired versus not impaired based on their neuropsychological test scores standardized by 1) self-reported education or 2) WRAT-3 reading grade-level. Cross tabulation tables were used to determine agreement of the two methods in detecting impairment. Among African-Americans, standardized scores derived from reading scores had greater specificity than those derived from years of education (84.1% vs. 77.3). Among the Whites, correction based on years of education had both greater specificity and sensitivity. The results suggest that reading tests may be a useful alternative for determining NCI among African Americans.

Cognitive function in women with HIV

“…By comparison, although significant, the effect size for years of education ranged from 0.08 to 0.18 SD units. That finding is consistent with findings from studies in predominantly male cohorts 36,37 and extends previous demonstrations that reading level is a stronger predictor of cognitive function than years of school in cohorts with large African American representation, 22 such as the WIHS.…”

The relationship of demographic and psychosocial variables to pain-related outcomes in a rural chronic pain population

“…[1,4,23,77,107] In the current study, low reading levels were associated with elevated pain intensity and catastrophizing scores. This is consistent with past research that has linked low educational attainment to maladaptive pain-coping strategies (including high pain catastrophizing).…”

Relationship of ethnicity, age, education, and reading level to speed and executive function among HIV+ and HIV– women: The Women's Interagency HIV Study (WIHS) Neurocognitive Substudy

“…This work joins the growing number of studies that have found influences of ethnic group (Bohnstedt, Fox, & Kohatsu, 1994; Unverzagt, Hall, Torke, & Rediger, 1996; Mast, Fitzgerald, Steinberg, MacNeill, & Lichtenberg, 2001; Teresi, Albert, Holmes, & Mayeux, 1999; Fillenbaum, Hughes, Heyman, George, & Blazer, 1988; Escobar et al, 1986; Welsh et al, 1995; Kuller et al, 1998; Salmon et al, 1989; Overall & Levin, 1978; Adams, Boake, & Crain, 1982; Roberts & Hamsher, 1984; Welsh et al, 1995; Ross, Lichtenberg, & Christensen, 1995; Carlson, Brandt, Carson, & Kawas, 1998; Fillenbaum, Heyman, Huber, Ganguli, & Unverzagt, 2001; Manly et al, 1998a; Jacobs et al, 1997) and quality of education (Weiss et al, 1995; Manly et al, 1999; 1981; Lecours et al, 1987 Lecours et al, 1994; Ardila, Rosselli, & Rosas, 1989; Rosselli, Ardila, & Rosas, 1990; 1997) on cognitive test performance among ethnic minorities. The impact of cultural and educational background on neuropsychological test performance is an important consideration in the diagnosis of disease-related cognitive impairment, where it has been shown that ethnic minorities are more likely to be misdiagnosed as impaired in studies of HIV-related cognitive impairment (Rohit et al, 2007; Miller, Heaton, Kirson, & Grant, 1997; Manly et al, 1998c) and dementia (Manly et al, 1998a). …”

“…Research conducted among 200 participants in the Manhattan HIV Brain Bank (Ryan et al, 2005) found that African Americans and Hispanics had lower overall reading levels as compared to non-Hispanic Whites, African Americans were more likely to have reading levels significantly discrepant from their reported years of school, and that discrepancies between years of school and education had a stronger relationship to neuropsychological test performance than racial/ethnic classification. A study of 113 HIV-infected participants of the National Neurological AIDS Bank (Rohit et al, 2007) found that when cognitive test scores adjusted for reading level were used, they had increased specificity for detection of physician-diagnosed possible or probable minor cognitive and motor disorder (MCMD) or HIV-Associated Dementia by over 20% above that of scores corrected for years of education among African Americans. This increase in specificity of reading-level adjusted scores was accompanied by a decrease in sensitivity as compared to education-adjusted scores (48.4% vs. 61.3%).…”