title: Comparison of scales to evaluate the progression of HIV-associated neurocognitive disorder.
abstract: 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.
authors.affiliation: Department of Neurologyy, Johns Hopkins University, School of Medicine, Baltimore, MD 21287, USA.
authors.forename: Nishiena S
authors.initials: NS
authors.lastname: Gandhi
authors.forename: Richard T
authors.initials: RT
authors.lastname: Moxley
authors.forename: Jason
authors.initials: J
authors.lastname: Creighton
authors.forename: Heidi Vornbrock
authors.initials: HV
authors.lastname: Roosa
authors.forename: Richard L
authors.initials: RL
authors.lastname: Skolasky
authors.forename: Ola A
authors.initials: OA
authors.lastname: Selnes
authors.forename: Justin
authors.initials: J
authors.lastname: McArthur
authors.forename: Ned
authors.initials: N
authors.lastname: Sacktor
references.citation: J Clin Exp Neuropsychol. 1990 Dec;12(6):963-78
references.pmid: 2286659
references.citation: AIDS. 2004 Jan 1;18 Suppl 1:S79-86
references.pmid: 15075502
references.citation: Neurology. 1993 Nov;43(11):2245-52
references.pmid: 8232937
references.citation: Neurology. 1998 Jun;50(6):1814-20
references.pmid: 9633733
references.citation: Ann Neurol. 1997 Nov;42(5):679-88
references.pmid: 9392566
references.citation: Biomed Pharmacother. 2009 Sep;63(8):561-5
references.pmid: 19026516
references.citation: Arch Neurol. 2002 Jun;59(6):923-8
references.pmid: 12056927
references.citation: AIDS. 1998 Mar 5;12(4):389-94
references.pmid: 9520168
references.citation: Neurology. 1999 Feb;52(3):607-13
references.pmid: 10025796
references.citation: J Acquir Immune Defic Syndr Hum Retrovirol. 1996 Jan 1;11(1):39-44
references.pmid: 8528731
references.citation: J Infect Dis. 1997 Apr;175(4):963-6
references.pmid: 9086160
references.citation: J Acquir Immune Defic Syndr. 2007 Jun 1;45(2):174-82
references.pmid: 17356465
references.citation: Neurology. 2007 Oct 30;69(18):1789-99
references.pmid: 17914061
references.citation: J Neurovirol. 2009 Jul;15(4):324-33
references.pmid: 19499454
references.citation: J Neurovirol. 2002 Dec;8 Suppl 2:115-21
references.pmid: 12491162
references.citation: Neurology. 2002 Aug 13;59(3):342-7
references.pmid: 12177366
references.citation: J NeuroAIDS. 1996;1(4):17-30
references.pmid: 16873176
references.citation: Ann Neurol. 1997 Nov;42(5):689-98
references.pmid: 9392567
references.citation: J Int Neuropsychol Soc. 2002 Mar;8(3):448-60
references.pmid: 11939702
references.citation: J Neurovirol. 2008 Oct;14(5):362-7
references.pmid: 18989814
references.citation: J Neuroimmunol. 2004 Dec;157(1-2):3-10
references.pmid: 15579274
references.citation: J Infect Dis. 1988 Nov;158(5):1079-83
references.pmid: 3053922
references.citation: Trends Neurosci. 2001 Jul;24(7):411-6
references.pmid: 11410272
references.citation: Neurology. 1991 Jun;41(6):778-85
references.pmid: 2046917
references.citation: Arch Neurol. 2001 Mar;58(3):473-9
references.pmid: 11255452
references.citation: Arch Neurol. 2004 Nov;61(11):1687-96
references.pmid: 15534180
references.citation: J Neuroimmunol. 2009 Jan 3;206(1-2):106-11
references.pmid: 19101040
references.citation: J Neurovirol. 2009 Apr;15(2):187-95
references.pmid: 19306228