title: Evaluation of brief screening tools for neurocognitive impairment in HIV/AIDS: a systematic review of the literature.
abstract: OBJECTIVE
  To systematically review literature on brief screening tools used to detect and differentiate between normal cognition and neurocognitive impairment and HIV-associated neurocognitive disorders (HANDs) in adult populations of persons with HIV.
  
  
  METHODS
  A formal systematic review.
  
  
  METHODS
  We searched six electronic databases in 2011 and contacted experts to identify relevant studies published through May 2012. We selected empirical studies that focused on evaluating brief screening tools (<20 min) for neurocognitive impairment in persons with HIV. Two reviewers independently reviewed retrieved literature for potential relevance and methodological quality. Meta-analyses were completed on screening tools that had sufficient data.
  
  
  RESULTS
  Fifty-one studies met inclusion criteria; we focused on 31 studies that compared brief screening tools with reference tests. Within these 31 studies, 39 tools were evaluated and 67% used a comprehensive neuropsychological battery as a reference. The majority of these studies evaluated HIV-associated dementia (HAD). Meta-analyses demonstrated that the HIV Dementia Scale (HDS) has poor pooled sensitivity (0.48) and the International HIV Dementia Scale (IHDS) has moderate pooled sensitivity (0.62) in detecting a range of cognitive impairment. Five newer screening tools had relatively good sensitivities (>0.70); however, none of the tools differentiated HAND conditions well enough to suggest broader use. There were significant methodological shortcomings noted in most studies.
  
  
  CONCLUSIONS
  HDS and IHDS perform well to screen for HAD but poorly for milder HAND conditions. Further investigation, with improved methodology, is required to understand the utility of newer screening tools for HAND; further tools may need to be developed for milder HAND conditions.
authors.affiliation: aOntario HIV Treatment Network bUniversity of Toronto cMaple Leaf Clinic, Toronto, Ontario dSt. Michael's Hospital, Toronto, Ontario eSouthern Alberta HIV Clinic and University of Alberta, Edmonton, Alberta fSunnybrook Hospital, Toronto, Ontario, Canada gUniversity of California, San Diego, La Jolla, California, USA.
authors.forename: Amy R
authors.initials: AR
authors.lastname: Zipursky
authors.forename: David
authors.initials: D
authors.lastname: Gogolishvili
authors.forename: Sergio
authors.initials: S
authors.lastname: Rueda
authors.forename: Jason
authors.initials: J
authors.lastname: Brunetta
authors.forename: Adriana
authors.initials: A
authors.lastname: Carvalhal
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: McCombe
authors.forename: M John
authors.initials: MJ
authors.lastname: Gill
authors.forename: Anita
authors.initials: A
authors.lastname: Rachlis
authors.forename: Ron
authors.initials: R
authors.lastname: Rosenes
authors.forename: Gordon
authors.initials: G
authors.lastname: Arbess
authors.forename: Thomas
authors.initials: T
authors.lastname: Marcotte
authors.forename: Sean B
authors.initials: SB
authors.lastname: Rourke
mesh_terms: D015526:AIDS Dementia Complex / Q000175:diagnosis; D000328:Adult; D003072:Cognition Disorders / Q000150:complications / Q000175:diagnosis*; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000523:psychology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests / Q000592:standards*; D012680:Sensitivity and Specificity; D055815:Young Adult