title: Defining cognitive impairment in people-living-with-HIV: the POPPY study.
abstract: The reported prevalence of cognitive impairment (CI) varies widely in cohorts of people living with HIV (PLWH); this may partly be due to the use of different diagnostic criteria. Agreement between diagnostic criteria of CI, the optimal definition to use, and associations with patient-reported cognitive symptoms have not been fully investigated.
  
  
  
  Two hundred ninety PLWH aged >50 years and 97 matched negative controls completed a detailed assessment of cognitive function and three questions regarding cognitive symptoms. Age- and education-adjusted test scores (T-scores) determined if subjects met the following definitions of CI: Frascati, global deficit score (GDS) and the multivariate normative comparison (MNC) method.
  
  
  
  PLWH were more likely than controls to meet each definition of CI (ORs were 2.17, 3.12 and 3.64 for Frascati, GDS and MNC, respectively). Agreement of MNC with Frascati and GDS was moderate (Cohen's k = 0.42 and 0.48, respectively), whereas that between Frascati and GDS was good (k = 0.74). A significant association was found between all the three criteria and reporting of memory loss but not with attention and reasoning problems. The 41 (14 %) PLWH meeting all the three criteria had the lowest median global T-score (36.9) and highest rate of symptom reporting (42 %).
  
  
  
  Different CI criteria show fair diagnostic agreement, likely reflecting their ability to exclude CI in the same group of individuals. Given the lower overall cognitive performance and higher rates of symptom reporting in those meeting all three criteria of CI, further work assessing this as a definition of CI in PLWH is justified.
authors: Research Department of Infection & Population Health, UCL - Royal Free Campus, London, UK. d.defrancesco@ucl.ac.uk.
authors: Davide
authors: 0000-0002-6185-0514
authors: D
authors: De Francesco
authors: Division of Infectious Diseases, Imperial College London, London, UK.
authors: Jonathan
authors: J
authors: Underwood
authors: King's College London, London, UK.
authors: Frank A
authors: FA
authors: Post
authors: Brighton and Sussex Medical School, Brighton, UK.
authors: Jaime H
authors: JH
authors: Vera
authors: Mortimer Market Centre, UCL, London, UK.
authors: Ian
authors: I
authors: Williams
authors: Chelsea and Westminster Healthcare NHS Foundation Trust, London, UK.
authors: Marta
authors: M
authors: Boffito
authors: UK Community Advisory Board, London, UK.
authors: Memory
authors: M
authors: Sachikonye
authors: Homerton University Hospital, London, UK.
authors: Jane
authors: J
authors: Anderson
authors: UCD School Of Medicine, Dublin, Ireland.
authors: Patrick W G
authors: PW
authors: Mallon
authors: Division of Infectious Diseases, Imperial College London, London, UK.
authors: Alan
authors: A
authors: Winston
authors: Research Department of Infection & Population Health, UCL - Royal Free Campus, London, UK.
authors: Caroline A
authors: CA
authors: Sabin
mesh_terms: D016022:Case-Control Studies; D060825:Cognitive Dysfunction / Q000175:diagnosis / Q000209:etiology* / Q000523:psychology; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000523:psychology; D006679:HIV Seropositivity; D006801:Humans; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D010207:Papaver; D057566:Self Report
keywords: Cognitive impairment; HIV; HIV-associated neurocognitive disorder; Neurology; Patient-reported cognitive symptoms