Comparison of scales to evaluate the progression of HIV-associated neurocognitive disorder.
AIM: First, to compare the characterization of neurocognitive deficits in milder stages of HIV-associated neurocognitive disorder (HAND) derived from existing dementia rating scales of the American Academy of Neurology (AAN) and Memorial Sloan Kettering (MSK) with the 2007 consensus ('Frascati') classification. Second, to identify potential sociodemographic and clinical predictors of HAND progression during 1-year follow-up. METHODS: 104 HIV-infected subjects in an existing cohort system were evaluated with a medical history, exam, neuropsychological test battery and functional assessments. The degree of HAND was rated using the AAN, MSK and Frascati scales. The degree of concordance among these scales was determined. In addition, 45 subjects were reassessed for changes in their neurocognitive status at 1-year follow-up. Associations between age, education, sex, depression ratings, substance abuse, race, hepatitis C serostatus, CD4 count and progression of HAND were examined. RESULTS: There was excellent concordance (gamma > 0.8) among the Frascati, MSK and AAN ratings. Subjects rated as having minor cognitive motor disorder on the AAN scale (n = 45) were evenly split between Frascati rating of asymptomatic neurocognitive impairment (n = 24) and mild neurocognitive disorder (n = 21). At 1-year follow-up of 45 subjects, 31% had worsened, 13% had improved and 56% were stable. Predictors of progression included age older than 50 years (odds ratio: 5.57; p = 0.013) and female gender (odds ratio: 3.13; p = 0.036). CONCLUSION: The Frascati HAND rating scale has excellent concordance with previous neurocognitive rating scales and can be used to better characterize milder stages of cognitive impairment. Older individuals and women appeared to be more likely to show neurocognitive progression.
Gandhi
Nishiena S
NS
Department of Neurologyy, Johns Hopkins University, School of Medicine, Baltimore, MD 21287, USA.
Moxley
Richard T
RT
Creighton
Jason
J
Roosa
Heidi Vornbrock
HV
Skolasky
Richard L
RL
Selnes
Ola A
OA
McArthur
Justin
J
Sacktor
Ned
N
J Clin Exp Neuropsychol. 1990 Dec;12(6):963-78
2286659
AIDS. 2004 Jan 1;18 Suppl 1:S79-86
15075502
Neurology. 1993 Nov;43(11):2245-52
8232937
Neurology. 1998 Jun;50(6):1814-20
9633733
Ann Neurol. 1997 Nov;42(5):679-88
9392566
Biomed Pharmacother. 2009 Sep;63(8):561-5
19026516
Arch Neurol. 2002 Jun;59(6):923-8
12056927
AIDS. 1998 Mar 5;12(4):389-94
9520168
Neurology. 1999 Feb;52(3):607-13
10025796
J Acquir Immune Defic Syndr Hum Retrovirol. 1996 Jan 1;11(1):39-44
8528731
J Infect Dis. 1997 Apr;175(4):963-6
9086160
J Acquir Immune Defic Syndr. 2007 Jun 1;45(2):174-82
17356465
Neurology. 2007 Oct 30;69(18):1789-99
17914061
J Neurovirol. 2009 Jul;15(4):324-33
19499454
J Neurovirol. 2002 Dec;8 Suppl 2:115-21
12491162
Neurology. 2002 Aug 13;59(3):342-7
12177366
J NeuroAIDS. 1996;1(4):17-30
16873176
Ann Neurol. 1997 Nov;42(5):689-98
9392567
J Int Neuropsychol Soc. 2002 Mar;8(3):448-60
11939702
J Neurovirol. 2008 Oct;14(5):362-7
18989814
J Neuroimmunol. 2004 Dec;157(1-2):3-10
15579274
J Infect Dis. 1988 Nov;158(5):1079-83
3053922
Trends Neurosci. 2001 Jul;24(7):411-6
11410272
Neurology. 1991 Jun;41(6):778-85
2046917
Arch Neurol. 2001 Mar;58(3):473-9
11255452
Arch Neurol. 2004 Nov;61(11):1687-96
15534180
J Neuroimmunol. 2009 Jan 3;206(1-2):106-11
19101040
J Neurovirol. 2009 Apr;15(2):187-95
19306228