title: Neuropsychological screening tools in Italian HIV+ patients: a comparison of Montreal Cognitive Assessment (MoCA) and Mini Mental State Examination (MMSE).
abstract: OBJECTIVE
  Despite the progress in HIV treatments, mild forms of cognitive impairment still persist. Brief and sensitive screening tools are needed. We evaluated the accuracy of the Montreal Cognitive Assessment (MoCA) compared to the Mini Mental State Examination (MMSE) to detect cognitive impairment in HIV-infected participants.
  
  
  METHODS
  HIV-infected patients were consecutively enrolled during routine outpatient visits at a single institution. The MoCA, the MMSE, and a comprehensive neuropsychological battery were administered. Patients were considered as affected by cognitive impairment if they showed decreased cognitive function in at least two ability domains based on age and education adjusted Italian normative cut-offs.
  
  
  RESULTS
  Ninety-three HIV-infected participants (75% males, median age 47, all on antiretroviral therapy; 90% HIV-RNA <50copies/mL, median CD4 644 cells/μL) were enrolled. Thirteen participants (14%) were diagnosed as cognitively compromised via a comprehensive neuropsychological examination. The area under the curve of the adjusted MMSE and MoCA scores to detect cognitive impairment were .51 (95% CI = .31-.72, p = .877) and .70 (95% CI = .53-.86, p = .025), respectively. A MoCA score <22 was able to predict the cognitive impairment with 62% of sensitivity and 76% of specificity.
  
  
  CONCLUSIONS
  Our findings suggested that the prognostic performance of the MoCA to detect cognitive impairment among mildly impaired HIV-infected participants was only moderate. Further investigations are needed to identify optimal cognitive tests to screen HIV-infected individuals or to explore whether a combination of cognitive tests might represent a viable alternative to a single screening tool.
authors.affiliation: a Institute of Clinical Infectious Diseases , Catholic University of Sacred Heart , Rome , Italy.
authors.forename: Benedetta
authors.initials: B
authors.lastname: Milanini
authors.affiliation: a Institute of Clinical Infectious Diseases , Catholic University of Sacred Heart , Rome , Italy.
authors.forename: Nicoletta
authors.initials: N
authors.lastname: Ciccarelli
authors.affiliation: a Institute of Clinical Infectious Diseases , Catholic University of Sacred Heart , Rome , Italy.
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Fabbiani
authors.affiliation: a Institute of Clinical Infectious Diseases , Catholic University of Sacred Heart , Rome , Italy.
authors.forename: Eleonora
authors.initials: E
authors.lastname: Baldonero
authors.affiliation: a Institute of Clinical Infectious Diseases , Catholic University of Sacred Heart , Rome , Italy.
authors.forename: Silio
authors.initials: S
authors.lastname: Limiti
authors.affiliation: a Institute of Clinical Infectious Diseases , Catholic University of Sacred Heart , Rome , Italy.
authors.forename: Roberta
authors.initials: R
authors.lastname: Gagliardini
authors.affiliation: a Institute of Clinical Infectious Diseases , Catholic University of Sacred Heart , Rome , Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Borghetti
authors.affiliation: a Institute of Clinical Infectious Diseases , Catholic University of Sacred Heart , Rome , Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: D'Avino
authors.affiliation: a Institute of Clinical Infectious Diseases , Catholic University of Sacred Heart , Rome , Italy.
authors.forename: Annalisa
authors.initials: A
authors.lastname: Mondi
authors.affiliation: a Institute of Clinical Infectious Diseases , Catholic University of Sacred Heart , Rome , Italy.
authors.forename: Manuela
authors.initials: M
authors.lastname: Colafigli
authors.affiliation: a Institute of Clinical Infectious Diseases , Catholic University of Sacred Heart , Rome , Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Cauda
authors.affiliation: a Institute of Clinical Infectious Diseases , Catholic University of Sacred Heart , Rome , Italy.
authors.forename: Simona
authors.initials: S
authors.lastname: Di Giambenedetto
mesh_terms: D000328:Adult; D000368:Aged; D010054:Brief Psychiatric Rating Scale; D003071:Cognition; D003072:Cognition Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology*; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology*; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D008609:Mental Status Schedule; D008875:Middle Aged; D009483:Neuropsychological Tests
keywords: AIDS; HIV; HIV dementia; Neuropsychological test; cognitive disorders