title: Concurrent classification accuracy of the HIV dementia scale for HIV-associated neurocognitive disorders in the CHARTER Cohort.
abstract: BACKGROUND
  The HIV Dementia Scale (HDS) was developed to screen for HIV-associated neurocognitive disorders (HAND), but concerns have persisted regarding its substandard sensitivity. This study aimed to examine the classification accuracy of the HDS using raw and norm-based cut points and to evaluate the contribution of the HDS subtests to predicting HAND.
  
  
  METHODS
  A total of 1580 HIV-infected participants from 6 US sites completed the HDS, and a gold standard neuropsychological battery, on which 51% of participants were impaired.
  
  
  RESULTS
  Sensitivity and specificity to HAND using the standard raw HDS cut point were 24% and 92%, respectively. The raw HDS subtests of attention, recall, and psychomotor speed significantly contributed to classification of HAND, whereas visuomotor construction contributed the least. A modified raw cut point of 14 yielded sensitivity of 66% and specificity of 61%, with cross-validation. Using norms also significantly improved sensitivity to 69% with a concomitant reduction of specificity to 56%, whereas the positive predictive value declined from 75% to 62% and negative predictive value improved from 54% to 64%. The HDS showed similarly modest rates of sensitivity and specificity among subpopulations of individuals with minimal comorbidity and successful viral suppression.
  
  
  CONCLUSIONS
  Findings indicate that while the HDS is a statistically significant predictor of HAND, particularly when adjusted for demographic factors, its relatively low diagnostic classification accuracy continues to hinder its clinical utility. A raw cut point of 14 greatly improved the sensitivity of the previously established raw cut score, but may be subject to ceiling effects, particularly on repeat assessments.
authors.affiliation: Department of Psychiatry, University of California, San Diego, San Diego, CA 92103, USA.
authors.forename: Maiko
authors.initials: M
authors.lastname: Sakamoto
authors.forename: Thomas D
authors.initials: TD
authors.lastname: Marcotte
authors.forename: Anya
authors.initials: A
authors.lastname: Umlauf
authors.forename: Donald
authors.initials: D
authors.lastname: Franklin
authors.forename: Robert K
authors.initials: RK
authors.lastname: Heaton
authors.forename: Ronald J
authors.initials: RJ
authors.lastname: Ellis
authors.forename: Scott
authors.initials: S
authors.lastname: Letendre
authors.forename: Terry
authors.initials: T
authors.lastname: Alexander
authors.forename: J A
authors.initials: JA
authors.lastname: McCutchan
authors.forename: Erin E
authors.initials: EE
authors.lastname: Morgan
authors.forename: Steven P
authors.initials: SP
authors.lastname: Woods
authors.forename: Ann C
authors.initials: AC
authors.lastname: Collier
authors.forename: Christina M
authors.initials: CM
authors.lastname: Marra
authors.forename: David B
authors.initials: DB
authors.lastname: Clifford
authors.forename: Benjamin B
authors.initials: BB
authors.lastname: Gelman
authors.forename: Justin C
authors.initials: JC
authors.lastname: McArthur
authors.forename: Susan
authors.initials: S
authors.lastname: Morgello
authors.forename: David
authors.initials: D
authors.lastname: Simpson
authors.forename: Igor
authors.initials: I
authors.lastname: Grant
mesh_terms: D015526:AIDS Dementia Complex / Q000175:diagnosis* / Q000473:pathology*; D000328:Adult; D015510:Clinical Medicine / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D014481:United States