static-content.springer.com10.1007... · Web viewSakamoto, Thomas, Marcotte, Umlauf, Franlkin, Heaton, ... CVLT = California Verbal Learning Test. CWT = Stroop Colour Word Test

Overview of Studies Assessing the Utility of Screening Batteries in Detecting HIV-Associated Neurocognitive Disorder

Reference Screening Measure

NP Gold Standard

Exclusion Criteria

Sample size, Population,

Country Location

Sample Demographics

Mean years (SD)

HIV+ Sample Characteristics

Mean (SD)

Impairment Classification Criteria and

Rate

Design, Analysis, Main Findings

Strengths and

Limitations

Chalermchai, Valcour, Sithinamsuwan, Pinyakorn, Clifford, Paul, et al. (2013). Trail making test A improves performance characteristics of the International HIV Dementia Scale to identify symptomatic HAND.

Paper & Pen: IHDS

IHDS + TMTA

Valcour et al. (2007): Grooved Pegboard, Finger Tapping, Timed gait, TMTA, Colour Trails 1, Colour Trails 2, Adult Verbal Learning Test, BVMT, Escala de Inteligencia Wechsler para Adulto (EIWA) Coding & Block Design, Animal Fluency, First Names Verbal Fluency

History of head injury, neurological or psychiatric conditions, current illicit drug use, acute illness, learning disability

Thailand 75 HIV+ Hospital outpatients

44% male Age = 34.75 (7.15) years Education = 11.15 (4.85) years

100% cART naïve

CD4 cell count < 350

CD4 cell count = 213 (140.6) cells/mm3

Plasma VL = 4.85 (.62)

2007 AAN criteria: overall z score + self-reported or informant functional status via semi-structured interview

Gold Standard impairment rate: 51% overall27% MND/HAD

Screen impairment rate NR

Cross-sectional

Criterion validity as determined by ROC curves based on 3 criteria:

ANI + MND + HAD vs unimpaired IHDS AUC = .612 34.2% sensitivity 86.5% specificity

MND + HAD vs ANI + unimpaired:cutoff ≤ 10 IHDS AUC = .774 53.3% sensitivity 89.8% specificity TMTA AUC = .773 (cutoff -1SD) IHDS+TMTA = 86% sensitivity 62% PPP

HAD vs MND + ANI + unimpaired: IHDS AUC = .944

Application of AAN criteria

No HIV- control group

Limited sample demographics reported

Comorbid conditions NR

HIV duration, AIDS status NR

Incomplete criterion validity indexes

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NP Gold Standard

Exclusion Criteria


Country Location

Sample Demographics

Mean years (SD)


Mean (SD)


Rate


Strengths and

Limitations

Sakamoto, Thomas, Marcotte, Umlauf, Franlkin, Heaton, et al. (2013) Concurrent classification accuracy of the HIV Dementia Scale for HIV-associated neurocognitive disorders in the CHARTER cohort.

Paper & Pen: HDS

COWATAnimal FluencyCodingf

Symbol Searchf

TMTATMTBWCST-64LNSf

PASATGrooved Pegboard, FMLTSMLT

NR CHARTER Study

1580 HIV+

America

Age = 43.1 years (±8.5)Educ = 12.5 years (±2.6)77% male40% Caucasian48% African American12% Other30% HCV positive 51% lifetime depression38% substance use disorder within last 12 months74% lifetime substance use disorder

62% AIDS diagnosis70% currently on cART60% detectable HIV RNA plasma VLYears HIV duration = 9.88 years (±6.4) Years cART duration = 0.92 (IQR: 0.33, 2.25)Median Nadir CD4 = 179 (IQR: 50, 307)Median Current CD4 = 423 (IQR: 263, 607)

NP Impairment: 2007 AAN criteria.

Overall Impairment rate = 51%

HDS Impairment Rate: using raw cutoff score ≤10 = 17%, using T-score <40 = 56%

Cross-sectional ROC curve analyses, criterion validity indexes,

HDS raw score cutoff ≤ 10: AUC = 0.68 24% sensitivity, 92% specificity, 75% PPP, 54% NPP, 57% Overall accuracy, Odd's Ratio = 3.4

HDS raw score cutoff ≤ 14 (optimal): AUC = 0.68 66% sensitivity, 61% specificty, 64% PPP, 63% NPP, 63% Overall Accuracy, Odd's Ratio = 3.0

HDS T<40: 69% sensivity, 56% specificity, 62% PPP, 64% NPP, 63% Overall accuracy, Odd's Ratio = 2.9

Did not exclude individuals with comorbid conditions

Used AAN criteria for NP impairment

Comprehensive NP battery

Large HIV+ sample size


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NP Gold Standard

Exclusion Criteria


Country Location

Sample Demographics

Mean years (SD)


Mean (SD)


Rate


Strengths and

Limitations

Moore, Roediger, Eberly, Blackstone, Hale, Weintrob, et al. (2012). Identification of an abbreviated test battery for detection of HIV-associated neurocognitive impairment in an early-managed HIV-infected cohort.

Paper & pen:

2, 3, and 4 test combinations of comprehensive NP battery

Grooved Pegboard, Symbol Searchf, Codingf, TMTA, PASAT, Digit Spanf, BVMT-R, HVLT-R, WCST, TMTB, Stroop CWT, Letter Fluency, Animal Fluency, Action Fluency

NR 200 HIV+

US military beneficiaries

America

95.5% male48.5% White29% Black14% Hispanic 8.5% Other 34% with post-secondary degree Median age = 36.4 years (IQR 28.1-43.6)

3.5% current illicit drug use1.5% Hepatitis C

Median CD4 count = 546 cells/mm3 (IQR: 417-706)

64% ART treated

Median HIV disease duration = 5 years (IQR: 2-11 years)

Gold standard:T scores converted to global deficit score (≥ 0.5 = impaired) Overall impairment rate = 19%

Screen Impairment: 2-test combination - 2 tests T < 40 or 1 test T ≤ 35 3-test combination - 3 tests T < 40 or 1 test T < 40 + 1 test T < 35, or 1 test T < 30 4-test combination: 4 tests T < 40, or 2 tests T < 40 + 1 test T < 35, or 2 tests T < 35, or 1 test T < 40 + 1 test T< 30, or 1 test T < 25Screen impairment NR

Cross-sectional

2 test combination (Stroop Color Word Test & HVLT-R learning): 73% sensitivity 83.1% specificity 50% PPP 93% NPP 13.3 Odds ratio

3 test combination (Stroop Color Word Test & HVLT-R learning & PASAT): 86.5% sensitivity 75.5% specificity 45.7% PPP 95.9% NPP 19.7% Odds ratio

4 test combination (Stroop Color Word Test & HVLT-R learning & PASAT & Action Fluency): 86.5% sensitivity 87.1% specificity 61.5% PPP 96.4% NPP43.2% Odds ratio

Comprehensive gold standard

Detailed sample characteristics


AIDS, VL, nadir CD4 NR

No measure of IADL, did not use AAN criteria

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(Continued)


NP Gold Standard

Exclusion Criteria


Country Location

Sample Demographics

Mean years (SD)


Mean (SD)


Rate


Strengths and

Limitations

Becker, Dew, Aizenstein, Lopez, Morrow, & Saxton (2011).

Concurrent validity of a computer-based screening tool for use in adults with HIV disease

Computerised

CAMCI: accuracy & RT on Star TaskForward Digit SpanWord RecognitionWord RecallPicture RecognitionGo/No-Go testDigit Reverse SpanShopping Trip

Specific NP tests NR

Domains: Memory Language VisuoconstructionPsychomotor speedMotor skillsExecutive function

Neurological disease, CNS OI, tumours, or stroke, learning disability, ADHD, active substance abuse or dependence, current major depression

Sample type NR

Americana

29 HIV+30 HIV-

HIV+95% male69.9% CaucasianAge =51.1 (6.2)Education =15.1 (1.9)Wide Range Test of Achievement =11.7 (1.9)4.3% Diabetes43.5%Hypertension 21.7% History of Drug Abuse / Dependence47.8% History of Depression

HIV-77.8% male61.1% CaucasianAge=50.7 (6.3)Educ =14.6 (2.5)Wide Range Test of Achievement =11.1 (3.0)5.6% Diabetes22.2%Hypertension 44.4% History Drug Abuse / Dependence61.6% History Depression

NR NP impairment:

Based on Global Impairment Rating (0-9), where 5-9 = impaired:

30.51% impaired69.49% normal/ borderline

NOTE: analysis based on assumed Impairment prevalence rate = 30%


Longitudinal (12 and 24 weeks follow-up)

Step-wise discriminant function analysis discriminating NP impaired from NP normal/borderline

Criterion validity indexes

Raw scores: 6/14 tasks (Wilks’λ= 0.42, df = 6, p < 0.001)72% sensitivity98% specificity89% NPP93% PPP89% classification accuracyRepeated with T scores: 3/12 tasks (Wilks’λ= 0.62, df = 3, p < 0.001) 56% sensitivity100% specificity 84% NPP100% PPP86% classification accuracy

Specific NP tests, HIV sample characteristics, Screen impairment rate NR

Small sample sizes

Screen criterion validity based on assumed prevalence rate, not actual sample prevalence rate

Criterion validity generated without the inclusion of ‘borderline’ group as impaired

Construct validity of screen NR

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NP Gold Standard

Exclusion Criteria


Country Location

Sample Demographics

Mean years (SD)


Mean (SD)


Rate


Strengths and

Limitations

Joska, Westgarth-Taylor, Hoare, Thomas, Paul, Myer, et al. (2011).

Validity of the International HIV Dementia Scale in South Africa

Paper & pen:

IHDS

Grooved PegboardFinger TappingTMTACT1Codingg

HVLT-RBVMT-RMATMCTCT2CWTWCSTAnimal FluencyFruit and Vegetable Fluency

Severe psychiatric disorder, recent history of substance abuse, significant neurological disorder, head injury, loss of consciousness >30 min

Primary health care centres

South Africa

96 HIV+94 HIV-

Ethnicity NR

HIV+20.8% maleAge = 29.75 (3.67)Education =10.05 (1.77)

HIV-37.6% maleAge = 25.16 (5.15)Education =10.88 (1.28)

AIDS, disease stage, NR

ART naïve CD4 count =218.09b (150.5)Years since diagnosis = 3.35 (2.04)

NP impairment rate:

American Academy of Neurology criteria (2007): NP battery + PAOFI + QLESQ

18.75% Normal13.54% ANI31.25% MND36.46% HAD


Cross-sectionalHIV+ normed against HIV-

Criterion validity indexes, ROC analyses

Cutoff ≤10ANI+MND+HAD vs normal:44.83% sensitivity 78.57% specificity 79% PPP, 100% NPP, 55.81% correct classification

MND+HAD vs ANI+normal:AUC = 0.6481% sensitivity54% specificity

Cutoff ≤11ANI+MND+HAD vs normal:72.41% sensitivity 46.43% specificity 65% PPP, 100% NPP, 63.95% correct classification

HAD vs normal:AUC =0.6074% sensitivity33% specificity

Ethnicity, AIDS, disease stage, NR

HIV+ & HIV- were sig different in age & education


5

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NP Gold Standard

Exclusion Criteria


Country Location

Sample Demographics

Mean years (SD)


Mean (SD)


Rate


Strengths and

Limitations

Levine, Palomo, Hinkin, Valdes-Sueiras, Lopez, et al. (2011).

A comparison of screening batteries in the detection of neurocognitive impairment in HIV-infected Spanish speakers

Paper & pen:HDSMMSENEUROPSI (Reported in Otrosky et al., 1999, Spanish adaptations of English standardised neuropsychological tests: Orientation, Digits backwards, Visual detection, Serial 3 subtraction, Verbal Memory, Figure Copy, Confrontation naming, Repetition, Comperehension, Verbal and Semantic Fluency, Reading, WritingSimilaritiesCalculation Alternating hand movements)

NP battery translated in Spanish:

Grooved PegboardLNSf

PASATCodingf

Symbol Searchf

HVLT-RBVMT-RWCSTVerbal FluencyTMTB

< 18 years oldNot raised in Mexico or Central AmericaUnable to complete NP battery

National Neurology AIDS bank

American (Spanish speakers that migrated from Mexico or Central America)

21 HIV+

85.7% male100% HispanicAge = 47.3 (8.2)Education = 8.7 (4.5)

Comorbidities NR

AIDS, disease stage, years since diagnosis, VL, NR

100% on cARTMedian CD4 count =254b(152)

American Academy of Neurology (1996) criteria

NP Impairment rate:38.09% normal9.52% ANI4.76% MND19.05% HAD28.57 other(overall impairment rate = 52.38%)

MMSE impairment:14.3%

HDS impairment:61.9%

NEUROPSI impairment:71.4%

Note: 100% ANI cases misclassified as normal for MMSE, vs 50% for HDS & NEUROPSI

Cross-sectional

Raw scores converted to T-scores, then to Global T-score

ANI+MND+HAD vs normal:MMSE (cutoff ≤24): AUC = 0.408% sensitivity88% specificityHDS (cutoff ≤10):AUC = 0.6367% sensitivity50% specificityNEUROPSIAUC = 0.5975% sensitivity38% specificity

MND+HAD vs ANI+normal:MMSE (cutoff ≤24): AUC = 0.5710% sensitivity88% specificityHDS (cutoff ≤10):AUC = 0.6570% sensitivity50% specificityNEUROPSI AUC = 0.6580% sensitivity38% specificity


Comorbidities, AIDS, disease stage, years since diagnosis, VL, NR

Criterion validity indexes based on whole HAND spectrum


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NP Gold Standard

Exclusion Criteria


Country Location

Sample Demographics

Mean years (SD)


Mean (SD)


Rate


Strengths and

Limitations

Simioni, Cavassini, Annoni, Abraham, Bourquin, Schiffer, et al. (2010).

Cognitive dysfunction in HIV patients despite long-standing suppression of viremia

Paper & pen:

HDS

NARTTMTA TMTB Digit Spanf

Alzheimer’s Disease Assessment Scale-cognitive subscale

CANTAB:Reaction TimeRapid Visual Information ProcessingSpatial Working Memory

Major CNS OI within past 3 yearsOther OI not affecting brain in past 2 monthsActive drug useDSM-IV major depressionPregnant

Hospital outpatients

Swiss

100 HIV+(50 HIV+ with cognitive complaints, 50 HIV+ no complaints)

Overall sample:73% ≥ high school 73% Caucasian72% men

HAND:65% maleNART = 102 (10.7)Age = 47.1 (9.6)14% antidepressant9% methadone31% HAD-A ≥ 1016% HAD-D ≥ 10NPI = 14.3 (17.7)

No HAND:92% maleNART = 108.8 (7.6)Age = 48.5 (9.6)4% antidepressant4% methadone15% HAD-A ≥ 104% HAD-D ≥ 10NPI = 3 (2.1)

100% on HAART 100% undetectable VL ≥ 3 months

HAND:Years since diagnosis = 12.4 (6.6)undetectable VL (years) = 4.2 (2.6)CD4 count = 586.9b (245.5)Nadir CD4 = 166.5b (138.8)8% Toxoplasmosis

No HAND:Years since diagnosis = 11.2 (5.8)undetectable VL (years) = 5.1 (3.4)CD4 count = 627b (307.9)Nadir CD4 = 182.2b (115)0% Toxoplasmosis

American Academy of Neurology criteria (Antinori et al., 2007):

NP Impairment rate:74% overall42% ANI28% MND4% HAD26% normal

Self-reported cognitive complaints questionnaire: n = 5027% general18% memory related16% mental slowing9% attention deficits

n = 50 no self reported cognitive complaints

Cross-sectional

ROC curve analysis, criterion validity indexes

Cutoff ≤ 10

Overall sample (n = 100)54.1% sensitivity 96.2% specificity

Optimal cutoff ≤14 (p<0.001)AUC = 0.83

Self-reported cognitive complaints:83% sensitivity 63% specificity 92% PPP

No complaints:88% sensitivity 67% specificity 82% PPP


Limited NP battery

Unusually high HAND rate in sample

Did not compute separate criterion validity indexes for computerised and paper and pen NP tests

Included ANI in HAND impairment rate


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NP Gold Standard

Exclusion Criteria


Country Location

Sample Demographics

Mean years (SD)


Mean (SD)


Rate


Strengths and

Limitations

Skinner, Adewale, Gill, & Power. (2009).

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

Paper & pen:

HDSIHDSMMSE

Grooved PegboardTMTASDMTTMTB

NR HIV clinic

Canadian

33 HIV+(13 HIV+ with HAND, 20 HIV+ with other neurological diseases including seizure, stroke, myopathy, neuropathy)

13 HIV-

HIV+ HAND 92.3% maleAge =52.7 (8.9)Education = 13.4 (2.3)

HIV+ Other neurological disease85% maleAge =47.1 (7.2)Education = 13.7 (3.4)

13 HIV-53.9% maleAge = 49.5 (5.6)Education =15.1 (SD NR)

Ethnicity, Comorbidities NR

All HIV+ currently receiving or had prior exposure to HAART

HIV+ HAND CD4 count =348b

(253) VL= 1.9c (2.1)

HIV+ ONDCD4 count =468b

(268) VL = 1.8c (2.3)

NP impairment rate:

American Academy of Neurology criteria (1996)

HAND (n = 13):n = 7 (21%) MNDn = 6 (18%) HADAll MSK scores ≤ 2

Cross-sectional

ROC analyses, criterion validity indexes:

HDS: Cutoff ≤10AUC = 0.8266.7% classification accuracy46.2% sensitivity 80.0% specificity 60.0% PPP

Cutoff ≤11 61.5% sensitivity 80.0% specificity

IHDS: cutoff ≤10AUC = 0.7469.7% classification accuracy76.9% sensitivity 65.0% specificity 58.8% PPP

MMSE: Cutoff ≤27AUC = 0.4851.5% classification accuracy 46.2% sensitivity 55.0% specificity 40% PPP

Very limited NP battery

Small sample size

Sample did not include mild cognitive impairment, criterion validity indexes not computed for ANI

Ethnicity, comorbidities, AIDS, disease stage, years since diagnosis, NR

Impairment rates for screens NR


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NP Gold Standard

Exclusion Criteria


Country Location

Sample Demographics

Mean years (SD)


Mean (SD)


Rate


Strengths and

Limitations

Morgan, Woods, Scott, Childers, Beck, Ellis, et al. (2008).

Predictive validity of demographically adjusted normative standards for the HIV Dementia Scale

Paper & pen:

HDS

Outlined in Woods et al. 2004:


PASATTMTACodingf

Symbol Searchf

HVLT_RBVMT-RWCSTVerbal FluencyTMTB

History of neurological or psychiatric illness, current illicit drug use

Sample obtained from various neuroAIDS studies at the University of California, San Diego

American

135 HIV+182 HIV-

Normal:77% male60% CaucasianAge=39 (8)Education =12.8 years (2.6)

ANI86% male64% CaucasianAge= 38.5 years (11)Education =12.2. (3)

MCMD96% male50% CaucasianAge= 44.3 (7)Education =14.3 (3)

HAD93% male93% CaucasianAge =40.2 (4)Education =12.5 (2)

HIV-68% male73% CaucasianAge=36.6 (12)Education =13.8 (2.5)

HIV+ Normal:52% AIDS29% immunosuppressed 59% on cART

HIV+ ANI46% AIDS9% immunosuppressed77% on cART

HIV+ MCMD77% AIDS50% immunosuppressed 59% on cART

HIV+ HAD93% AIDS43% immunosuppressed 71% on cART

HIV disease stage, VL, CD4 count, nadir CD4 count NR

NP Impairment rate:

Modified American Academy of Neurology criteria (1991):

57% normal16% ANI16% MCMD10% HAD

HDS impairment rate: 42.96%

Cross-sectional

HIV+ scores normed against HIV- controls

Criterion validity indexesCutoff ≤10

Overall:17.2% sensitivity 93.5% specificity66.7% PPP60.0 NPP3.0 OR

ANI0% sensitivity 93.5% specificity 72.7% PPP 76.7% NPP3.0 OR

MCMD22.7% sensitivity 93.5% specificity 50% PPP80.9% NPP4.2 OR

HAD35.7% sensitivity 93.7% specificity 50% PPP88.9% NPP, 8.0 OR

HIV disease stage, VL, CD4 count, NR

Large sample sizes

Comprehensive reporting of criterion validity indexes that included degrees of HAND severity (ANI, MCMD, HAD), and also for demographically adjusted T-scores in addition to standard raw cut off


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NP Gold Standard

Exclusion Criteria


Country Location

Sample Demographics

Mean years (SD)


Mean (SD)


Rate


Strengths and

Limitations

Singh, Sunpath, John, Eastham & Gouden (2008). The utility of a rapid screening tool for depression and HIV dementia amongst patients with low CD4 counts - a preliminary report

Paper & Pen: IHDS

Translated to Zulu RCFT Digit Span Forward Digit Span Backwards TMTATMTB

CD4 >200 cells/mm3 Younger than 18 years Delirious

20 HIV+ Hospital Inpatients Ugandan

95% African 40% male Median age = 34 (IQR: 30-39)

Comorbidities:40% Major depression 10% Substance induced mood disorder 10% dysthymia

All ART naïve

Median CD4 count = 35 (IQR: 22-91)

Moderate Impairment: "beyond the norms on at least 2 tests"

Severe Impairment: "abnormal performance on 3 or more tests"

Impairment rate:80% "any neurocognitive impairment"


Cross-sectional


cut-off < 10: 88% sensitivity 50% specificity

cut-off 10.5: 94% sensitivity 25% specificty

cut-off 9.5: 38% sensitivity 75% specificity

Non-Western sample Education NR

Limited criterion validity indexes Small sample size Limited Disease characteristics reported

Poorly defined Impairment criteria

10

(Continued)


NP Gold Standard

Exclusion Criteria


Country Location

Sample Demographics

Mean years (SD)


Mean (SD)


Rate


Strengths and

Limitations

Bottiggi, Chang, Schmitt, Avison, Mootoor, Nath, et al. (2007).

The HIV dementia scale: Predictive power in mild dementia and HAART

Paper & pen:

HDS

Paper & pen:

NARTWAIS-III Short FormGrooved PegboardFinger OscillationTimed GaitRuff 2 & 7TMTASDMTFigure Memory Learning Test CWTVerbal FluencyTMTB

Computerised:CalCAPBasic Choice Reaction Time,Sequential Reaction Time,Pursuit-Rotor Learning

CNS OI Space occupying lesionsneurological disorder diabetes, hepatic and renal dysfunction substance abuse ≤ 6 months

HIV clinics

American

46 HIV+

88% Caucasian87% male

NART=105 (11) Age =38.5 (7.4) Education = 13.5 (2.6)

Comorbidities NR

46% currently on cART, mean duration =14 months (20.8)

AIDS, disease duration, CD4 cell count, VL, NR

Impairment rate based on MSK classification:

47.8% Normal (MSK=0)52.2% Subclinical or abnormal (MSK = 0.5-2)

Severe impairment:Overall z-score ≤-2SD

Moderate impairment:z-score of ≤-2SD on ≥2 NP tests

Mild impairment:z-score of ≤-1SD on 1 NP tests, no self-reported functional/emotional decline

NP impairment rate NR

Cross-sectional


Only NP tests: GP, CODf, TMTA, RAVLT, TMTB, Verbal Fluency were used in analysis

Cutoff ≤ 10

Severe impairment:36% sensitivity 94% specificity 71% PPP 77% NPPR = 0.38 kappa =0.34

Moderate impairment:57% sensitivity 84% specificity 62% PPP 82% NPP R = 0.42 kappa =0.42

Mild impairment:93% sensitivity38% specificity39% PPP92% NPPR = 0.31kappa=0.22

Small sample size


Comorbiditie, AIDS, disease duration, CD4 cell count, VL, NR

NP impairment rate NR

Criterion validity indexes reported for only a subset of NP tests (n =8)

Reported criterion validity for varying degrees of impairment


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NP Gold Standard

Exclusion Criteria


Country Location

Sample Demographics

Mean years (SD)


Mean (SD)


Rate


Strengths and

Limitations

Wonja, Skolasky, McArthur, Maldonado, Hechavarria, Mayo, et al. (2007).

Spanish validation of the HIV dementia scale in woman

Paper & pen:

HDS-S (Spanish translation)

Spanish-adapted:

Grooved PegboardTMTASDMTVisual Choice Reaction TimeRAVLT CWTTMTB

NR HIV clinics

Puerto Rican

60 HIV+

36 HIV-

100% female

Ethnicity, comorbidities NR

HIV+Age =36.4 (7.0)Education =12.2 (2.0)WAIS-R vocabulary index score= 49.4 (14.4)BDI = 12.6 (10.6)

HIV-Age =34.2 (6.9)Education =12.6 (2.0)WAIS-R vocabulary index score= 50.9 (16.0)BDI = 4.0 (5.8)

93% on cART7% ART naïve

nadir CD4 cell count =222.82b (176)

plasma VL = 3.07c (1.25)

CSF VLc =2.09 (0.62)

HIV and cART duration, AIDS NR

American Academy of Neurology criteria (Antinori et al., 2007)

31.7% normal

68.3% impaired:30.0% ANI11.6% MCMD26.7% HAD

Cross-sectional

Analysis of variance and receiver operating characteristic (ROC) curves, criterion validity indexes

HDS:Optimal cutoff ≤12 for detecting HAND (ANI, MCMD, HAD)AUC = .80 63.4% sensitivity 84.2% specificity 89.7% PPP51.6% NPP

Optimal cutoff for detecting symptomatic HAND (MCMD & HAD): HDS-S:cutoff ≤1387% sensitivity46% specificity86.96% PPP45.95 NPP

Exclusion criteria, comorbidities NR

Ethnicity, years since diagnosis, AIDS, NR

Sample comprised of women only

Limited NP battery

Included the whole spectrum of HAND including ANI in impairment rate and criterion validity indexes


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NP Gold Standard

Exclusion Criteria


Country Location

Sample Demographics

Mean years (SD)


Mean (SD)


Rate


Strengths and

Limitations

Cysique, Maruff, Darby & Brew. (2006).

The assessment of cognitive function in advanced HIV-1 infection and AIDS dementia complex using a new computerised cognitive test battery

Computerised:

CogStateLog mean Reaction Time & accuracy:

DetectionIdentificationSelectionMonitoringOne BackMatchingIncidental Learning Associate Learning

Grooved PegboardDigit Spanf

TMTASDMTCVLTRCFT 3 MinuteVerbal FluencySimilaritiesf

TMTBSemantic FluencyBoston Naming TestRCFT Copy

Neurological disorderCurrent or past major depression or psychosisHead injuryCurrent alcohol abuse or drug dependenceCurrent active CNS OI

Hospital outpatients

Australian

11 HIV+ Aids Dementia Complex (ADC)

49 HIV+ advanced (non-demented)

21 HIV-

100% AIDS (CDC stage 3 )


HIV+ ADC: 100% maleAge= 48.18 (8.48)Education =13.82 (318)NART Full-Scale IQ=108.8 (12.41)

HIV+ Advanced: 98% maleAge= 46.61 (9.44) Education = 13.82 (2.89), NART Full-Scale IQ = 114.6 (10.36)

21 HIV-: 100% maleAge= 49.33 (8.18) Education = 15.43 (3.2) NART Full-Scale IQ = 118.9 (5.78)

HIV+ ADC:

Mean year of HIV diagnosis = 1992 (6.18)

nadir CD4 count= 136.54b (128.44)

CD4 count= 406.45b (258.56)

VL =3.82c (1.44)

27.3% undetectable VL

HIV+ Advanced:

Mean year of diagnosis =1990 (5.01)

Nadir cell count= 76.4b (58.89)

CD4 count = 338.73b (211.37)

VL =2.72c (1.36)55% undetectable VL

NP impairment rate:

< 2 SD in 2/14 NP measures100% of ADC NP impaired 53.1% HIV+ Advanced (non-demented)

Overall NP impairment rate:61.67%

Cross-sectional

Binary logistic regression, criterion validity indexes

HIV+ Advanced NP Impaired vs non-impaired: 81.1% sensitivity 69.9% specificity 80% PPP70% NPP77% classification accuracy

ADC vs HIV+ advanced: 18% sensitivity 98% specificity 67% PPP84% NPP83% classification accuracy

Moderate to small sample sizes


Did not include mild impairment

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NP Gold Standard

Exclusion Criteria


Country Location

Sample Demographics

Mean years (SD)


Mean (SD)


Rate


Strengths and

Limitations

Ellis, Evans, Clifford, Moo, McArthur, Collier, et al. (2005).

Clinical validation of the NeuroScreen.

Paper & pen:

Brief NeuroCognitive Screen (BNCS):TMTATMTBCodingf

Grooved PegboardTimed GaitPASATSymbol Searchf

HVLT-RVocabularyf

NR Sample source NR

American†

301 HIV+

86% male 60% Caucasian26% African American 14% otherAge= 44 (9)Education =14 (3)

15% past history of intravenous drug use

Median nadir CD4 count =105b

(IQR: 28, 273)Current median CD4 count =417b

(IQR: 280, 631)

AIDS, years since diagnosis, cART, VL, NR

NP Impairment:

≤1SD on 2 tests, or ≤2SD on 1 test = 56%

American Academy of Neurology criteria (1991):48.2% asymptomatic15.9% MCMD2.4% HAD8.2% other causes25% unreliable

Screen (BNCS) impairment:

≤1SD below mean on 2 tests, or ≤2SD below mean on 1 test =14.9%

≤1SD on 1 test,overall impairment rate = 31.8%

Cross-sectional


≤1SD on 2 tests, or ≤2SD on 1 test:23.6% sensitivity98.3% specificity 95.1% PPP 47.9% NPP

≤1SD on 1 test:60%correct classification rate44% sensitivity 84% specificity

BNCS Average z-score:Optimal cutoff =-0.558% sensitivity 82% specificity 68% classification accuracy

Clinical rating ≥5:1.8% sensitivity100% specificity42.3% classification accuracy

Limited NP battery

No HIV- control sample

Exclusion criteria, sample type and location NR

Limited comorbidites reported

AIDS, years since diagnosis, cART, NR


14

(Continued)


NP Gold Standard

Exclusion Criteria


Country Location

Sample Demographics

Mean years (SD)


Mean (SD)


Rate


Strengths and

Limitations

Richardson, Morgan, Vielhauer, Cuevas, Buondonno, & Keane. (2005).

Utility of the HIV dementia scale in assessing risk for significant HIV-related cognitive-motor deficits in a high-risk urban adult sample

Paper & pen:

HDS

Paper & pen:

Grooved PegboardDigit Spanf

TMTARAVLTCWTVerbal FluencyTMTBRCFT Copy

CalCAP

NR Medical Centres

American

40 HIV+

65% male55% African American30% Caucasian15% LatinoAge= 40.95 (5.85)Education = 12.15 (1.72)

Comorbidities: BDI-II total = 20.19 (11.06)

DSM-IV criteria (SCID-I): 67.5% mood disorders45% anxiety disorders17.5% psychotic disorders67.5% Antisocial or Borderline Personality Disorder65% Alcohol dependence 7.5% Alcohol abuse 5% Cannabis dependence 2.5% Cannabis Abuse67.5% Cocaine dependence

CD4 count =502.39b (372.43) 33% VL <400d 60% AIDS diagnosis

Years since diagnosis, nadir CD4 count, cART NR

NP impaired: ≤ 2SD below normative data on ≥ 1 NP task in ≥ 2 domains

NP impairment rate: 50% impaired

HDS impairment rate:40%

Cross-sectional


Cutoff ≤10AUC =.5855% sensitivity 75% specificity 63% classification accuracy


Small sample size

Years since diagnosis, AIDS, cART, NR

Did not compare utility of computerised screen (CalCAP) to NP paper & pen tests


15

(Continued)


NP Gold Standard

Exclusion Criteria


Country Location

Sample Demographics

Mean years (SD)


Mean (SD)


Rate


Strengths and

Limitations

Sacktor, Wong, Nakasujja, Skolasky, Selnes, Musisi, et al. (2005).

The international HIV dementia scale: A new rapid screening test for HIV dementia

Paper & pen:

IHDS

American:Grooved PegboardSDMTRAVLTVerbal FluencyOdd Man OutRCFT Copy

CalCAP

Ugandan:(all tasks translated into Ugandan)Grooved PegboardTimed GaitDigit Spanf

CT1SDMTWHO/UCLA VLT CT2

American:Current or past CNS OIHistory of severe medical, psychiatric, or neurological disorder

Ugandan:<18 yearsActive or known past CNS OIHisotry of chronic neurological disorder, active psychiatric disorder, alcoholism, physical deficit (e.g., amputation), severe functional impairment (Karnofsky <50), severe medical illness

Infectious diseases clinic

American & Ugandan cohorts

(13a) American: 66 HIV+

(13b) Ugandan: 81 HIV+100 HIV-

Sex, ethnicity, comorbidities NR

American:Normal: Age= 43.4 (7.5)Education = 13.8 (2.9) Subclinical: Age =43.7 (6.6) Education = 13.1 (2.6) Mild Dementia:Age =47.1 (5.8) Education =12.8 (1.7) Moderate Dementia:Age= 43.9 (8.2), Education = 11.8 (1.9) Severe Dementia: Age =48.9Education = 13

Ugandan:81 HIV+ Age= 37 (9.4) Education =8.7 (4.9)

HIV-Age =31.4 (7.3) Education = 9.7 (3.8)

American:VL, AIDS, years since diagnosis, cART NR

Normal: CD4 count =262b

(181)

Subclinical:CD4 count= 186b

(166)

Mild Dementia:CD4 count =146b

(120)

Moderate Dementia: CD4 count= 167b

(194)

Severe Dementia:CD4 count = 817b

Ugandan:CD4 count, VL, AIDS, disease stage, years since diagnosis, cART NR

American:MSK dementia stage rating, based on age & educ adjusted overall NP z-score (≤ 2 SD on 1 NP test, or ≤ 1 SD on 2 NP tests) + functional performance + depressive symptoms:

Normal: 7.58%Subclinical: 54.55%Overall impaired: 37.88%Mild: 22.73%Moderate: 13.64%Severe: 1.52%

Ugandan: HIV+ MSK rating based on NP performance + functional performance (0, 0.5, >1), compared to HIV- controls: 31% impaired

Cross-sectional

Receiver operating characteristic (ROC) curve, criterion validity indexes

American:Optimal cutoff ≤9.5 71% sensitivity 79% specificity

cutoff ≤1080% sensitivity 57% specificity

Ugandan:Optimal cutoff ≤1080% sensitivity 55% specificity

cutoff ≤10.588% sensitivity 48% specificity

Sex, Ethnicity, Comorbidities NR

VL, AIDS, disease stage, years since diagnosis, cART NR in either cohort, and CD4 count also NR in Ugandan

Limited criterion validity indexes reported, and not calculated for degrees of cognitive impairment

Criterion validity indexes did not include subclinical impairment in American or Ugandan studies


16

(Continued)


NP Gold Standard

Exclusion Criteria


Country Location

Sample Demographics

Mean years (SD)


Mean (SD)


Rate


Strengths and

Limitations

Carey, Woods, Rippeth, Gonzalez, Moore, Marcotte, et al. (2004).

Initial validation of a screening battery for the detection of HIV-associated cognitive impairment

Paper & pen:

HDS

Most sensitive paired combinations of NP tests in NP test battery

Grovved PegboardLNSf

PASATTMTACodingf

Symbol Searchf

HVLT-RBVMT-RCWTWCSTVerbal FluencyHCTTMTBSemantic Fluency

Other significant neurological, medical, or psychiatric disorders that may affect cognitive function, current substance-related disorders, lifetime IV drug use (≥10 occasions), recent substance use

Already enrolled in existing HIV research

American†

190 HIV+

84% male63% CaucasianAge= 41 (7)Education =13.7 (2)Wide-Range Test of Achievement-3= 88.8 (12)

58% AIDS47% CD4 <200b

median plasma VL=3.2c (IQR: 2.3, 4.7)

HIV duration, cART, Years since diagnosis NR

NP Impairment based on American Academy of Neurology criteria (1991) clinical rating:= ≥5 cutoff score on ≥2 domains= 28.95%

HDS impairment rate:3.16%

HVLT-R Total Recall & nghGP impairment rate based on Global Deficit Score (GDS; ≤ T = 40 on 2 tests or ≤ T = 35 on 1 test):= 33.16%

Cross-sectional

Criterion validity indexes, ROC curve analyses

HDS:Cutoff ≤ 109% sensitivity98% specificity 67% PPP73% NPPOR=0.2 AUC=0.6872% classification accuracy

HVLT-R Recall & ndhGP:78% sensitivity 85% specificity68% PPP91% NPP83% classification accuracyOR=20.6, AUC=0.89

HVLT-R Recall & CODf: 75% sensitivity92% specificity79% PPP90% NPP87% classification accuracy OR=33, AUC=0.90

Location of sample, comorbidities, ears since diagnosis NR


Multicolinearity issues as screen based on paired combinations of NP gold standard


17

(Continued)


NP Gold Standard

Exclusion Criteria


Country Location

Sample Demographics

Mean years (SD)


Mean (SD)


Rate


Strengths and

Limitations

Gonzalez, Heaton, Moore, Letendre, Ellis, Wolfson, et al. (2003).

Computerized reaction time battery versus a traditional neuropsychological battery: Detecting HIV-related impairments

Computerised:

CalCAP Mini:Choice RT-Digits Sequential RT

Grooved PegboardPASATVisual SpanDigitse

TMTACT1RAVLTCT2HCT CWTVerbal FluencyTMTBBlock Designe

Head injury, psychiatric, substance use, and developmental disorders

Clinical trials

American†

82 HIV+

100% male58% Caucasian23% African American14% Hispanic4% otherAge = 40.4 (7.6) Education = 13.8 (2.9)

Comorbidities NR

CDC disease stages11% stage A37% stage B52% stage C

70% AIDS

For subset (n = 53):CD4 count =269b

(191; n=53)Plasma VL =3.62c (1.75; n= 70)CSF VL= 1.85c (1.80; n=60)

55% VL undetectable (n = 60)

All “strongly” suspected of neurobehavioural impairment via self report or physician referral

Raw scores converted to T-scores then deficit scores for each test, domain, and overall NP, and CalCAP screen.

Impairment = deficit score ≥ 0.5

NP battery impairment rate = 57%

CalCAP screen impairment rate = 49%

Cross-sectional

Receiver operating characteristic curve, criterion validity indexes

68% sensitivity 77% specificity72% classification accuracykappa = 0.44

Limited computerised screening - based on reaction time only


Location of sample, length of HIV disease, NR

HIV disease characteristics reported only for a subset of sample

Limited criterion validity indexes reported

18

(Continued)


NP Gold Standard

Exclusion Criteria


Country Location

Sample Demographics

Mean years (SD)


Mean (SD)


Rate


Strengths and

Limitations

Smith, van Gorp, Ryan, Ferrando, & Rabkin (2003).

Screening subtle HIV-related cognitive dysfunction: The clinical utility of the HIV Dementia Scale

Paper & pen:

HDS


CT1CVLTFacesf

CT2CWT

CalCAP

Substance use disorder within past 12 months, positive toxicology screen for substances

Source NR

American†

90 HIV+

Sex, Ethnicity, Comorbidities NR

Impaired:Age= 40.8 (7)Education =13.1 (2)

Normal:Age= 40.9 (5.4)Education =13.8 (3)

NR

Groups did not differ in: age, educ, sex, depressive symptoms, most recent CD4 cell count, VL, HIV disease duration

Those diagnosed with moderate to severe HIV-associated dementia (American Academy of Neurology & DSM-IV criteria) excluded

NP impairment (≤2SD on ≥2 NP tests) =48.89% impaired

HDS impairment rate NR

Cross-sectional


Cutoff ≤10

39% sensitivity85% specificity

Limited NP battery


Sex, ethnicity, sample type, comorbidities, AIDS, years since diangondis, CD4 count, severity of HIV disease, cART, NR

Excluded moderate-severe dementia

HDS impairment rate NR

Limited criterion validity, not computed separately for CalCAP & paper & pen


19

Notes: ANI = Asymptomatic Neurocognitive Impairment. ART = Antiretroviral Therapy. AUC = Area Under the Curve. BDI-II = Beck Depression Inventory, Second Edition. BVMT-R = Brief Visuospatial Memory Test-Revised. CalCAP = California Computerized Assessment Package. CAMCI = Computer Assessment of Mild Cognitive Impairment. CDC = Centre for Disease Control and Prevention. CT1 = Colour Trails 1. CT2 = Colour Trails 2. CVLT = California Verbal Learning Test. CWT = Stroop Colour Word Test. D-score = Deficit Score. DASS-21 = Depression, Anxiety, Stress Scale, 21 Item. DSM-IV = Diagnostic and Statistical Manual of Mental Disorders, 4th Edition. HAD = HIV-Associated Dementia. HAD-A = Hospital Anxiety and Depression Scale, Anxiety subtest. HAD-D = Hospital Anxiety and Depression Scale, Depression subtest. HAND = HIV-Associated Neurocognitive Disorder. HCT = Halstead Category Test. HDS = HIV Dementia Scale. HVLT-R = Hopkins Verbal Learning Test-Revised. IHDS = International HIV Dementia Scale. LNS = Letter Number Sequencing. MAT = Mental Alternation Test. MCT = Mental Control Test. MMSE = Mini Mental Status Exam. MND = Minor Neurocognitive Disorder. MSK = Memorial Sloan Kettering Dementia Rating Scale. NART = National Adult Reading Test. NEUROPSI = Spanish-adapted neuropsychological screen. NP = Neuropsychology. NPI = Neuropsychiatric Inventory. NPP = Negative Predictive Power. NR = Not Reported. OR = Odds Ratio. PAOFI = Patient’s Assessment of Own Function Inventory. PPP = Positive Predictive Power. QLESQ = Quality of Life and Enjoyment Satisfaction Questionnaire. RAVLT = Rey Auditory Verbal Learning Test. RCFT = Rey Complex Figure Test. ROC Curve = Receiver Operating Characteristic Curve. RT = Reaction Time. SCID-I = Structured Clinical Interview for DSM-IV Axis I Disorders. SDMT = Symbol Digit Modalities Test. TMTA = Trail Making Test part A. TMTB = Trail Making Test part B. VL = Viral Load. WAIS = Wechsler Adult Intelligence Scale. WCST = Wisconsin Card Sort Test. WMS = Wechsler Memory Scale. a Sample location assumed based on location of first authorb cells/mm3

c log10 copies/mld copies/mle Wechsler Adult Intelligence Scale-Revised/Wechsler Memory Scale, Revisedf Wechsler Adult Intelligence Scale-Revised/Wechsler Memory Scale, Third Editiong Wechsler Adult Intelligence Scale-Revised/Wechsler Memory Scale, Fourth Edition

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Documents

static-content.springer.com10.1007... · Web viewSakamoto, Thomas, Marcotte, Umlauf, Franlkin, Heaton, ... CVLT = California Verbal Learning Test. CWT = Stroop Colour Word Test