Neurocognitive screening tools in HIV/AIDS: comparative performance among patients exposed to antiretroviral therapy

Skinner, Stuart; Adewale, AJ; DeBlock, Leah; Gill, M. John; Power, Christopher

doi:10.1111/j.1468-1293.2008.00679.x

Cited by 84 publications

(82 citation statements)

References 32 publications

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“…Tools such as the HIV Dementia Scale (HDS), the International HDS, and the Folstein Mini-Mental Status Examination (MMSE) are relatively insensitive to the milder cognitive signs that predominate in the HAART era [14,16]. Furthermore, such scales were designed to detect, but not to measure, cognitive impairment.…”

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confidence: 99%

Computerized testing augments pencil-and-paper tasks in measuring HIV-associated mild cognitive impairment*

et al. 2011

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Existing tools for rapid cognitive assessment in HIV-positive individuals with mild cognitive deficits lack sensitivity or do not meet psychometric requirements for tracking changes in cognitive ability over time. MethodsSeventy-five nondemented HIV-positive patients were evaluated with the Montreal Cognitive Assessment (MoCA), a brief battery of standardized neuropsychological tests, and computerized tasks evaluating frontal-executive function and processing speed. Rasch analyses were applied to the MoCA data set and subsequently to the full set of data from all tests. ResultsThe MoCA was found to adequately measure cognitive ability as a single, global construct in this HIV-positive cohort, although it showed poorer precision for measuring patients of higher ability. Combining the additional tests with the MoCA resulted in a battery with better psychometric properties that also better targeted the range of abilities in this cohort. ConclusionThis application of modern test development techniques shows a path towards a quick, quantitative, global approach to cognitive assessment with promise both for initial detection and for longitudinal follow-up of cognitive impairment in patients with HIV infection. IntroductionMild cognitive impairment has been increasingly recognized as a common feature of chronic HIV infection, even in patients with good viral control on highly active antiretroviral therapy (HAART) [1]. It occurs in 30-50% of patients, depending on both the cohort under study and how the impairment is identified [1][2][3][4][5][6][7][8]. The current diagnostic approach is descriptive: HIV-associated neurocognitive disorder (HAND) is termed 'asymptomatic neurocognitive impairment' when found on testing in the absence of symptoms, and 'mild neurocognitive disorder' when both signs and symptoms are present, but are not severe enough to constitute frank dementia [9]. The underlying pathophysiology remains poorly understood [10], posing challenges in the everyday management of these mildly affected patients.How should cognitive impairment be detected in routine practice? Should those found to be affected have their HAART regimen changed, to emphasize antiretrovirals with better central nervous system penetration? Should additional therapies, such as anti-excitotoxic agents or drugs targeting neurodegenerative changes, be added to their treatment? If such changes are made, how should the effects be monitored? The answers to such questions require better tools to assess cognition in HIV-infected individuals. The ideal measure should not only establish the diagnosis, but also quantify the severity of impairment. DOI: 10.1111/j.1468-1293.2010.00910.x HIV Medicine (2011 r 2011 British HIV Association 472It should also be free, brief, easy to administer with minimal training by any health professional, and available to clinics where HIV-infected patients receive their care. The present study describes the initial steps in the development of such a method to measure cognition across the intact to mildly impaired ...

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confidence: 99%

Computerized testing augments pencil-and-paper tasks in measuring HIV-associated mild cognitive impairment*

et al. 2011

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“…Specific bedside tools such as the HIV dementia scale and the International HIV Dementia Scale have been shown to lack diagnostic effectiveness owing to inconsistencies in language comprehension and confounding clinical parameters. 6 Furthermore, potential plasma biomarkers have shown little specificity in detecting HIV-associated cognitive disorders. 7 Although cerebrospinal fluid (CSF) markers are considered a more valuable clinical tool, 8 the requirement for CSF examination is challenging, and less invasive methods are preferable.…”

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confidence: 99%

A comparison of two post-processing analysis methods to quantify cerebral metabolites measuredviaproton magnetic resonance spectroscopy in HIV disease

Scott¹,

Underwood²,

Garvey³

et al. 2016

BJR

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Objective: Non-invasive biomarkers to monitor cerebral function in treated human immunodeficiency virus (HIV) disease are required. Cerebral metabolite ratios (CMRs) measured by proton-MR spectroscopy ( 1 H-MRS) are a potential biomarker. Here, we compare two postprocessing software packages to quantify CMRs. Methods: Cerebral 1 H-MRS data from 11 HIV-positive subjects before and after antiretroviral therapy intensification with maraviroc were quantified using a java-based version of the MR user interface package (jMRUI) and the totally automatic robust quantitation in nuclear MR (TARQUIN). 1 H-MRS data included N-acetylaspartate (NAA), creatine (Cr), choline (Cho) and myo-inositol (mI) from three cerebral locations. Differences in quantification and clinical associations of CMRs measured by the two packages were evaluated. Results: Mean CMRs were generally lower when measured by TARQUIN than by jMRUI (NAA/Cr, Cho/Cr, mI/ Cr ratios of 1.78, 0.83, 0.81 for jMRUI, and 1.27, 0.25, 0.81 for TARQUIN). Longitudinal changes were observed in CMRs in the basal ganglia voxel although these changes were not statistically significant [17.1% (p 5 0.18), 10.0% (p 5 0.91) and 26.6% (p 5 0.61) and 114.8% (p 5 0.18), 1 17.9% (p 5 0.07) and 134.8% (p 5 0.17) for NAA/Cr, Cho/Cr and mI/Cr ratios measured by TARQUIN and jMRUI, respectively]. Plasma maraviroc concentration was associated with a decrease in mI/Cr ratio measured via TARQUIN (p 5 0.049). Conclusion: Although CMRs differed when quantified by jMRUI vs TARQUIN, these differences were consistently observed across three cerebral locations, and clinical associations were evident by both methods. Advances in knowledge: TARQUIN and jMRUI are viable options to use in the post-processing of cerebral MRS data acquired in HIV disease.

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“…Skinner et al tested the relative performance of the MMSE, HDS and IHDS. 26 At the recommended cut-off the positive predictive value of the IHDS, HDS and MMSE were 58.8 , 60.0 and 40 %. 26 None of these tests are ideal; however, the IHDS shows most promise for wide scale implementation in our setting.…”

Section: Hiv-associated Dementia (Had)mentioning

confidence: 99%

What’s in a Name? AIDS Dementia Complex, HIV-associated Dementia, HIV-associated neurocognitive disorder or HIV Encephalopathy

Singh¹

2012

Afr. J. Psych

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The current paper reviews currently used and proposed nomenclature for neurocognitive disorders associated with HIV, and proposes a unitary system as well as recommends an operational approach to screening/diagnosing severe forms of HIV associated neurocognitive disorder (HAND) in order to identify individuals who might benefit from antiretrovirals (ARVs). The terms HIV dementia complex, HIV-associated dementia (HAD) and HIV encephalopathy (HIE) are being replaced by more refined definitions for the spectrum HIV associated neurocognitive disorder (HANDs). The Diagnostic and Statistical Manual (DSM) will introduce a further term-major neurocognitive disorder. The nosology can become very confusing as the terms are not exactly equivalent. Clinicians need guidance on how to interpret new terms to implement current legislation and treatment guidelines that use the old term HIE. As a WHO stage 4 disease, patients with HIE are eligible for ARVs irrespective of their CD4 count. However, there are no locally available operational criteria how to diagnose HIV encephalopathy (HIE). The updated terminology is preferred because it requires assessing cognition objectively with neuropsychological tests. It is recommended that the International HIV Dementia Scale be used to screen patients and to thereafter confirm diagnosis with further neuropsychological tests e.g. the trail making and digit span tests.

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Neurocognitive screening tools in HIV/AIDS: comparative performance among patients exposed to antiretroviral therapy

Abstract: The present findings indicate that the MMSE is a weak tool for diagnosing HAND in this group of patients but the HDS and IHDS demonstrate better efficiencies, although cut-off values for the HDS require reassessment in the era of effective antiretroviral therapy.

Cited by 84 publications

References 32 publications

Computerized testing augments pencil-and-paper tasks in measuring HIV-associated mild cognitive impairment*

Computerized testing augments pencil-and-paper tasks in measuring HIV-associated mild cognitive impairment*

A comparison of two post-processing analysis methods to quantify cerebral metabolites measuredviaproton magnetic resonance spectroscopy in HIV disease

What’s in a Name? AIDS Dementia Complex, HIV-associated Dementia, HIV-associated neurocognitive disorder or HIV Encephalopathy

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