title: A Comparison of Five Brief Screening Tools for HIV-Associated Neurocognitive Disorders in the USA and South Africa.
abstract: Screening for HIV-associated neurocognitive disorders (HAND) is important to improve clinical outcomes. We compared the diagnostic sensitivity and specificity of the mini-mental state examination, International HIV dementia scale (IHDS), Montreal cognitive assessment, Simioni symptom questionnaire and cognitive assessment tool-rapid version (CAT-rapid) to a gold standard neuropsychological battery. Antiretroviral-experienced participants from Cape Town, South Africa, and Baltimore, USA, were recruited. The sensitivity and specificity of the five tools, as well as those of the combined IHDS and CAT-rapid, were established using 2 × 2 contingency tables and ROC analysis. More than a third (65165) had symptomatic HAND. In detecting HIV-D, the CAT-Rapid had good sensitivity (94 %) and weak specificity (52 %) (cut-point ≤10), while the IHDS showed fair sensitivity (68 %) and good specificity (86 %) (cut-point ≤10). The combined IHDS and CAT-rapid showed excellent sensitivity and specificity for HIV-D at a cut-off score of ≤16 (out of 20; 89 and 82 %). No tool was adequate in screening for any HAND. The combination IHDS and CAT-rapid tool appears to be a good screener for HIV-D but is only fairly sensitive and poorly specific in screening for any HAND. Screening for milder forms of HAND continues to be a clinical challenge.
authors: HIV Mental Health Research Unit, Department of Psychiatry and Mental Health, Groote Schuur Hospital, Anzio Road, Observatory, 7925, Cape Town, South Africa. John.Joska@uct.ac.za.
authors: J A
authors: JA
authors: Joska
authors: ACSENT Laboratory, Department of Psychology, University of Cape Town, Cape Town, South Africa.
authors: J
authors: J
authors: Witten
authors: ACSENT Laboratory, Department of Psychology, University of Cape Town, Cape Town, South Africa.
authors: K G
authors: KG
authors: Thomas
authors: HIV Mental Health Research Unit, Department of Psychiatry and Mental Health, Groote Schuur Hospital, Anzio Road, Observatory, 7925, Cape Town, South Africa.
authors: C
authors: C
authors: Robertson
authors: HIV Mental Health Research Unit, Department of Psychiatry and Mental Health, Groote Schuur Hospital, Anzio Road, Observatory, 7925, Cape Town, South Africa.
authors: M
authors: M
authors: Casson-Crook
authors: Johns Hopkins University School of Medicine, Baltimore, USA.
authors: H
authors: H
authors: Roosa
authors: Johns Hopkins University School of Medicine, Baltimore, USA.
authors: J
authors: J
authors: Creighton
authors: Brigham and Women's Hospital, Boston, USA.
authors: J
authors: J
authors: Lyons
authors: Johns Hopkins University School of Medicine, Baltimore, USA.
authors: J
authors: J
authors: McArthur
authors: Johns Hopkins University School of Medicine, Baltimore, USA.
authors: N C
authors: NC
authors: Sacktor
mesh_terms: D015526:AIDS Dementia Complex / Q000175:diagnosis* / Q000523:psychology; D015142:Baltimore; D003072:Cognition Disorders / Q000175:diagnosis; D003431:Cross-Cultural Comparison; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000523:psychology; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000295:instrumentation* / Q000379:methods; D009483:Neuropsychological Tests; D011237:Predictive Value of Tests; D012372:ROC Curve; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D013019:South Africa; D011795:Surveys and Questionnaires / Q000592:standards*
keywords: HIV-associated neurocognitive disorders; HIV-dementia; Screening