title: Relationship of ethnicity, age, education, and reading level to speed and executive function among HIV+ and HIV- women: the Women's Interagency HIV Study (WIHS) Neurocognitive Substudy.
abstract: Use of neuropsychological tests to identify HIV-associated neurocognitive dysfunction must involve normative standards that are well suited to the population of interest. Norms should be based on a population of HIV-uninfected individuals as closely matched to the HIV-infected group as possible and must include examination of the potential effects of demographic factors on test performance. This is the first study to determine the normal range of scores on measures of psychomotor speed and executive function among a large group of ethnically and educationally diverse HIV-uninfected, high-risk women, as well as their HIV-infected counterparts. Participants (n = 1,653) were administered the Trail Making Test Parts A and B (Trails A and Trails B), the Symbol Digit Modalities Test (SDMT), and the Wide Range Achievement Test-3 (WRAT-3). Among HIV-uninfected women, race/ethnicity accounted for almost 5% of the variance in cognitive test performance. The proportions ofvariance in cognitive test performance accounted for by age (13.8%), years of school (4.1%), and WRAT-3 score (11.5%) were each significant, but did not completely account for the effect of race (3%). HIV-infected women obtained lower scores than HIV-uninfected women on time to complete Trails A and B, SDMT total correct, and SDMT incidental recall score, but after adjustment for age, years of education, racial/ethnic classification, and reading level, only the difference on SDMT total correct remained significant. Results highlight the need to adjust for demographic variables when diagnosing cognitive impairment in HIV-infected women. Advantages of demographically adjusted regression equations developed using data from HIV-uninfected women are discussed.
authors.affiliation: Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Department of Neurology, and the Gertrude H. Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York, USA. jjm71@columbia.edu
authors.forename: Jennifer J
authors.initials: JJ
authors.lastname: Manly
authors.forename: Clifford
authors.initials: C
authors.lastname: Smith
authors.forename: Howard A
authors.initials: HA
authors.lastname: Crystal
authors.forename: Jean
authors.initials: J
authors.lastname: Richardson
authors.forename: Elizabeth T
authors.initials: ET
authors.lastname: Golub
authors.forename: Ruth
authors.initials: R
authors.lastname: Greenblatt
authors.forename: Esther
authors.initials: E
authors.lastname: Robison
authors.forename: Eileen M
authors.initials: EM
authors.lastname: Martin
authors.forename: Mary
authors.initials: M
authors.lastname: Young
mesh_terms: D000328:Adult; D000375:Aging; D000704:Analysis of Variance; D003072:Cognition Disorders / Q000150:complications*; D004522:Educational Status; D005006:Ethnicity; D056344:Executive Function / Q000502:physiology*; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000208:ethnology / Q000523:psychology; D006306:Health Surveys; D006801:Humans; D008875:Middle Aged; D009483:Neuropsychological Tests; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011932:Reading; D012189:Retrospective Studies; D055815:Young Adult