title: Exploring the utility of the Montreal Cognitive Assessment to detect HIV-associated neurocognitive disorder: the challenge and need for culturally valid screening tests in South Africa.
abstract: There is a strong need in South Africa for neuropsychological tests that can help detect HIV-associated neurocognitive disorder (HAND) in the country's 5.6 million people living with HIV. Yet South African neuropsychologists are challenged to do so, as few neuropsychological tests or batteries have been developed or adapted for, and normed on, South Africa's linguistically, culturally, educationally, and economically diverse population. The purpose of this study was to explore the utility of the Montreal Cognitive Assessment to detect HIV-associated neurocognitive impairment among a sample of HIV+ and HIV- Black, Xhosa-speaking South Africans. HIV+ participants performed significantly worse overall and specifically in the domains of visuospatial, executive, attention, and language (confrontation naming). Regression analysis indicated that HIV status and education were the strongest predictors of total scores. Floor effects were observed on cube drawing, rhinoceros naming, serial 7s, and one abstraction item, suggesting those items might not be useful in this population. While the Montreal Cognitive Assessment holds promise to help detect HAND in South Africa, it will likely need modification before it can be normed and validated for this population. Findings from this study may help neuropsychologists working with similar populations.
authors: HIV Center for Clinical and Behavioral Studies, Columbia University and New York State Psychiatric Institute, New York, NY 10032, USA. rnr2110@columbia.edu
authors: Reuben N
authors: RN
authors: Robbins
authors: John A
authors: JA
authors: Joska
authors: Kevin G F
authors: KG
authors: Thomas
authors: Dan J
authors: DJ
authors: Stein
authors: Teboho
authors: T
authors: Linda
authors: Claude A
authors: CA
authors: Mellins
authors: Robert H
authors: RH
authors: Remien
mesh_terms: D000328:Adult; D044383:Black People; D003072:Cognition Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology; D003469:Culture; D004522:Educational Status; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000453:epidemiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D012016:Reference Values; D012044:Regression Analysis; D012189:Retrospective Studies; D013019:South Africa / Q000453:epidemiology; D044465:White People; D055815:Young Adult