title: A brief and feasible paper-based method to screen for neurocognitive impairment in HIV-infected patients: the NEU screen.
abstract: OBJECTIVE
  Practical screening methods are necessary to detect neurocognitive impairment (NCI) in HIV-infected patients. We aimed to find a brief and feasible paper-based tool to facilitate the diagnosis of an HIV-associated neurocognitive disorder.
  
  
  METHODS
  A total of 106 HIV-infected outpatients with variable clinical characteristics were recruited in a multicenter investigation. NCI was diagnosed using a standardized neuropsychological tests battery (7 areas, 21 measures, ∼2 hours). Multiple score combinations were compared to find a paper-based method that took ≤10 minutes to apply. The presence of NCI was considered the gold standard for comparisons, and the sensitivity and specificity were calculated.
  
  
  RESULTS
  Subjects were mostly middle-aged (median, 44 years) men (87%) on antiretroviral treatment. NCI was detected in 51 individuals (48%) and was associated with lower nadir CD4 count (P < 0.001), receiving antiretroviral therapy (P = 0.004), fewer years of education (P = 0.009), and presence of comorbidities (P < 0.001). The score combination that showed the highest sensitivity (74.5%) and specificity (81.8%) detecting NCI included 3 measures of attention/working memory, executive functioning, and verbal fluency (part A of Trail Making Test, part B of Trail Making Test, and Controlled Oral Word Association Test scores). A broader paper-based selection of measures covering 7 areas indicated a sensitivity of 100% and a specificity of 96.3% (7 measures, ∼35 minutes).
  
  
  CONCLUSIONS
  The combination of the 3 measures presented in this study seems to be a rapid and feasible screening mean for NCI in HIV-infected patients. This approach, combined with screening for potential comorbidities and daily functioning interference, could help in the initial stages of a HIV-associated neurocognitive disorder diagnosis and in settings with limited access to neuropsychological resources.
authors.affiliation: *Fundació Lluita contra la SIDA, Hospital Universitari Germans Trias i Pujol, Badalona, Spain; †Universitat Autònoma de Barcelona, Bellaterra, Spain; ‡Universitat Politècnica de Catalunya, Barcelona, Spain; §Consorci Sanitari Hospital de Terrassa, Terrassa, Spain; ‖Universitat de Barcelona, Grup de Recerca Consolidat en Neuropsicologia, Barcelona, Spain; and ¶Institut per la Recerca de la SIDA, Fundació IrsiCaixa, Badalona, Spain.
authors.forename: Jose A
authors.initials: JA
authors.lastname: Muñoz-Moreno
authors.forename: Anna
authors.initials: A
authors.lastname: Prats
authors.forename: Núria
authors.initials: N
authors.lastname: Pérez-Álvarez
authors.forename: Carmina R
authors.initials: CR
authors.lastname: Fumaz
authors.forename: Maite
authors.initials: M
authors.lastname: Garolera
authors.forename: Eduardo
authors.initials: E
authors.lastname: Doval
authors.forename: Eugènia
authors.initials: E
authors.lastname: Negredo
authors.forename: Maria J
authors.initials: MJ
authors.lastname: Ferrer
authors.forename: Bonaventura
authors.initials: B
authors.lastname: Clotet
mesh_terms: D015526:AIDS Dementia Complex / Q000175:diagnosis*; D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D009483:Neuropsychological Tests; D012680:Sensitivity and Specificity; D013997:Time Factors
chemical_list: D044966:Anti-Retroviral Agents