HIV and Cognitive Impairment in Clinical Practice: The Evaluation of a Stepwise Screening Protocol in Relation to Clinical Outcomes and Management

Hakkers, Charlotte S; Kraaijenhof, Jordan M; Oers-Hazelzet, Esther B van; Visser‐Meily, Anne; Hoepelman, Andy I. M.; Arends, Joop E.; Barth, Roos E.

doi:10.1089/apc.2017.0022

Cited by 10 publications

(8 citation statements)

References 27 publications

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“…Before referring patients for a complete neuropsychological evaluation, these possible comorbidities should be identified. 86 Therefore, a step-wise protocol that includes cognitive screening would be easy to implement in daily clinical practice, guiding physicians on how to manage this complex problem. 86 …”

Section: Future Researchmentioning

confidence: 99%

HIV-Associated Neurocognitive Disorder (HAND): Obstacles to Early Neuropsychological Diagnosis

Vastag¹,

Fira-Mlădinescu²,

Roşca³

2022

IJGM

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Despite the recent advances in HIV treatment, HIV-associated neurocognitive disorder (HAND) prevalence remains high, especially in the mild forms. Current recommendations endorse routine screening for HAND and early identification, but there are several obstacles in diagnosing and managing cognitive impairment in people living with HIV. The purpose of this review is to provide an overview of the concepts and diagnostic tools in the field of HAND and report on the strengths and limitations of currently available approaches.

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Section: Future Researchmentioning

confidence: 99%

HIV-Associated Neurocognitive Disorder (HAND): Obstacles to Early Neuropsychological Diagnosis

Vastag¹,

Fira-Mlădinescu²,

Roşca³

2022

IJGM

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“…Individuals with abnormal screening results should be investigated further for the underlying causes of cognitive dysfunction, including mood disorders, cognition-impairing effects of ART, thyroid disease, syphilis, and B12 deficiency [ 44 ]. These abnormalities should be identified before referring patients for a further full neuropsychological assessment [ 75 ]. A stepwise protocol including cognitive screening would be easy to implement in routine clinical practice, guiding clinicians in dealing with this complex problem [ 75 ].…”

Section: Discussionmentioning

confidence: 99%

“…These abnormalities should be identified before referring patients for a further full neuropsychological assessment [ 75 ]. A stepwise protocol including cognitive screening would be easy to implement in routine clinical practice, guiding clinicians in dealing with this complex problem [ 75 ].…”

Section: Discussionmentioning

confidence: 99%

International HIV Dementia Scale for HIV-Associated Neurocognitive Disorders: A Systematic Review and Meta-Analysis

Roşca

Tadger²,

Cornea

et al. 2021

Diagnostics

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The present study aims to systematically review the evidence on the accuracy of the International HIV Dementia Scale (IHDS) test for diagnosing human immunodeficiency virus (HIV)-associated neurocognitive disorders (HAND) and outline the quality and quantity of research evidence available on the accuracy of IHDS in people living with HIV. We conducted a systematic literature review, searching five databases from inception until July 2020. We extracted dichotomized positive and negative test results at various thresholds and calculated the sensitivity and specificity of IHDS. Quality assessment was performed according to the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) criteria. Fifteen cross-sectional studies, published between 2011 and 2018, met the inclusion criteria for meta-analysis. Overall, 3760 patients were included, but most studies recruited small samples. We assessed most studies as being applicable to the review question, though we had concerns about the selection of participants in three studies. The accuracy of IHDS was investigated at thirteen cut-off points (scores 6–12). The threshold of 10 is the most useful for optimal HAND screening (including asymptomatic neurocognitive disorder, symptomatic HAND, and HIV-associated dementia) with fair diagnostic accuracy.

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“…Patients with abnormal screening results should be further assessed for the underlying causes of cognitive impairments such as mood disorders, cognition-impairing effects of ART, thyroid disease, syphilis and B12 deficiency. These abnormalities should be correctly identified before referring patients for a full neuropsychological assessment (Hakkers et al 2017). A stepwise protocol including cognitive screening would be easy to implement in routine clinical practice showing physicians how to deal with this complex problem (Hakkers et al 2017).…”

Section: Discussionmentioning

confidence: 99%

“…These abnormalities should be correctly identified before referring patients for a full neuropsychological assessment (Hakkers et al 2017). A stepwise protocol including cognitive screening would be easy to implement in routine clinical practice showing physicians how to deal with this complex problem (Hakkers et al 2017).…”

Section: Discussionmentioning

confidence: 99%

Montreal Cognitive Assessment (MoCA) for HIV-Associated Neurocognitive Disorders

2019

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This study aims to systematically review the evidence on the accuracy of the Montreal Cognitive Assessment (MoCA) test for diagnosing HIV-associated neurocognitive disorders (HAND) and to outline the quality and quantity of research evidence available about the accuracy of MoCA in populations infected with HIV. We conducted a systematic literature review, searching five databases from inception until January 2019. We extracted dichotomized positive and negative test results at various thresholds and calculated the sensitivity and specificity of MoCA. Quality assessment was performed according to the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) criteria. Eight cross-sectional studies met the inclusion criteria for meta-analysis. Overall, 1014 patients were included but most studies recruited small samples. Recruitment period ranged from 2009 to 2015. We assessed most studies as being applicable to the review question though we had concerns about the selection of participants in three studies. The accuracy of MoCA for diagnosing HAND was reported at six cutoff points (scores 22-27). The MoCA test provides information about general cognitive functioning disturbances that contribute to a diagnosis of HAND. A lower threshold than the original cutoff of 26 is probably more useful for optimal screening of HAND, as it lowers false positive rates and improves diagnostic accuracy. Nonetheless, the choice of cutoff always comes with a sensitivity-specificity trade-off, the preferred cut point depending on whether sensitivity or specificity is more valuable in a given context. This is a post-peer-review, pre-copyedit version of an article published in Neuropsychology Review.

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HIV and Cognitive Impairment in Clinical Practice: The Evaluation of a Stepwise Screening Protocol in Relation to Clinical Outcomes and Management

Cited by 10 publications

References 27 publications

HIV-Associated Neurocognitive Disorder (HAND): Obstacles to Early Neuropsychological Diagnosis

HIV-Associated Neurocognitive Disorder (HAND): Obstacles to Early Neuropsychological Diagnosis

International HIV Dementia Scale for HIV-Associated Neurocognitive Disorders: A Systematic Review and Meta-Analysis

Montreal Cognitive Assessment (MoCA) for HIV-Associated Neurocognitive Disorders

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