Improving Detection of HIV-Associated Cognitive Impairment: Comparison of the International HIV Dementia Scale and a Brief Screening Battery.
The International HIV Dementia Scale (IHDS) was developed to screen for HIV-associated dementia, but it has been used more generally for HIV-associated neurocognitive disorder (HAND). This study sought to examine the accuracy of the IHDS in a cohort of Brazilian HIV-infected individuals and compare its performance to an alternative screening battery for detecting HAND.



A total of 108 participants (including 60 HIV-infected persons) completed the IHDS and a gold standard neuropsychological (NP) battery of 17 tests. As alternative screening method, all possible 3-test combinations from the NP battery were examined and a superiority index (a marker of specificity and sensitivity) was calculated.



Sensitivity and specificity to HAND using the standard IHDS cutpoint of 10 were 36% and 75%, respectively. The best balance between sensitivity and specificity was accomplished with a modified cutpoint of 11.5, which yielded sensitivity of 72% and specificity of 58%. The top two most sensitive test combinations, compared with the gold standard NP battery, were Trail Making Test A, Wechsler Adult Intelligence Scale III Digit Symbol and Hopkins Verbal Learning Test-Revised Total Recall (sensitivity 91%, specificity 96%), and Digit Symbol, Brief Visuospatial Memory Test-Revised Total Recall and Grooved Pegboard Test-dominant hand (sensitivity 94%, specificity 91%).



Both test combinations can be administered in less than 10 minutes and were more accurate than the IHDS in classifying HIV+ participants as NP impaired or unimpaired. These data suggest that demographically corrected T-scores from commonly used NP measures with modest time and material demands can improve identification of patients with HAND who may benefit from a more extensive NP examination.
*Department of Virology Laboratory, Hospital de Clinicas, at Institution, Universidade Federal do Paraná, Curitiba; †Instituto de Pesquisa Pelé Pequeno Príncipe; Hospital Pequeno Príncipe; Department of Psychology, Department of Infectious Diseases; and ‡Department of Psychiatry and Department of Neurosciences, HIV Neurobehavioral Research Program and University of California San Diego.
Sérgio Monteiro
SM
de Almeida
Rujvi
R
Kamat
Mariana
M
Cherner
Anya
A
Umlauf
Clea E
CE
Ribeiro
Ana Paula
AP
de Pereira
Donald
D
Franklin
Robert K
RK
Heaton
Ronald J
RJ
Ellis
D015526:AIDS Dementia Complex / Q000175:diagnosis*; D000328:Adult; D001938:Brazil; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D009483:Neuropsychological Tests; D012680:Sensitivity and Specificity; D013997:Time Factors; D014894:Weights and Measures